POLICY NOTE Efficiency of Planning, Programming and Delivery of Social Protection Programs on Early Years BACKGROUND To maximize the impact of social protection programs, it is critical to: (1) align the allocation of resources with national policies and strategies; (2) design programs that are able to reach their intended beneficiaries with adequate coverage and benefits; (3) ensure efficiency in programming and financing; and (4) ensure efficiency in actual program delivery at the local level. This policy note analyses all four points based on the findings of the recent Social Protection Public Expenditure Review1, but with a particular focus on mother and child programs. It highlights areas where challenges remain and proposes policy recommendations to address those. Investing in children’s human capital is one of the most critical investments a country can make to break the cycle of poverty and reap the demographic dividend. It can support the productivity and competitiveness of the future workforce and thus affect the growth trajectory of the country. Adequate stimulation and nutrition, especially during the first years of life, is critical for children’s physical, cognitive, and socioemotional growth and development. And children who are left behind in their formative years are often unable to reach strong learning outcomes.2 1 Efficiency of Planning, Programming and Delivery of Social Protection Programs on Early Years POLICY NOTE Global evidence also shows that interventions promoting nutrition and cognitive development in early years significantly increased the earning capacity of children when they grew up.3 Despite important improvements, child malnutrition remains a challenge in Bangladesh. While stunting among children under 5 has declined from 51 percent in 2004 to 28 percent in 2019, Bangladesh still accounts for 4 percent of the global burden with nearly 5.5 million stunted children.4 There are also large disparities according to maternal education and wealth levels—18 percent of children whose mothers have secondary education are stunted, while the rate rises to 47 percent for mothers with no formal education.5 Similarly, though infant mortality is below the South Asian average, children in the poorest households are nearly twice as likely to die before the age of 5 as those from the richest in Bangladesh. In Bangladesh, households with children are poorer than those without children, across multiple dimensions.6 This also has an important urban dimension since vulnerability to poverty, defined as the population living close to the poverty line, is high in urban Bangladesh with 1 in 2 households at the risk of falling into poverty. Urban areas are deprived in other dimensions as well— a third of the household heads have no education, low school attainment rate among children and high prevalence of malnutrition among others. Furthermore, climate shocks have a disproportionate impact on the poor, because they generally live in higher-risk areas and have limited coping mechanisms. They revert to depletive coping strategies – selling assets, migrating, reducing food intake, pulling children from school, foregoing health care, early marriage, etc. – which put in peril their human and productive capital, thereby having long terms impacts. POLICY ALIGNMENT AND ALLOCATIVE EFFICIENCY Scope for better alignment of allocation Scheme (DSF-MHVS), the Ministry of Women and Children with life-cycle risks in early years Affair’s (MoWCA) Maternity Allowance Program for the Poor (MAPP) and Allowances for Urban Lactating Mother (AULM); The National Social Security Strategy identifies a series of the Local Government Division’s (LGD) Income Support life-cycle risks, as well as other a range of risks which affect Program for the Poorest (ISPP – Jawtno), and Ministry of Social households more generally. Different life-cycle groups face Welfare’s (MoSW) Child Protection and Child Welfare program. different risks. For instance, while health shocks exist across the DSF-MHVS began in FY2006-07 and is being implemented in life-cycle, there are particular risks associated with pregnancy 55 upazilas. The MAPP began in FY2007-08 and has expanded and early childhood, for instance birth, malnutrition, or rapidly to become a large national program, focused on cognitive development. poor women in rural areas. The AULM began in FY2010-11 The Government of Bangladesh implements a number of and focuses on working women in urban areas. ISPP-Jawtno programs dedicated to improved infant and maternal well- began in FY2014-15 and is implemented across 43 upazilas in being. However, while children under 5 years of age account Rangpur and Mymensingh Divisions. While these programs for almost one in every eight poor persons in Bangladesh, are relatively large, their coverage remains insufficient (total these programs account for only 4 percent of the total social number of beneficiaries around 1.6 million in FY2019-20). On a protection budget (excluding pensions) in FY2019-20. Major positive note, allocations to the MAPP and the AULM increased programs include the Ministry of Health and Family Welfare’s three-fold between FY2016-17 and FY2019-20. (MoHFW) Demand Side Financing-Maternal Health Voucher 2 POLICY NOTE The importance of investments in this age group is underlined seeks to consolidate MAPP and AULM while strengthening in the National Social Security Strategy and the object of administrative and delivery systems. This Government’s concerted efforts to adopt uniform principles of design for a objective is further reflected in the 8th Five Year Plan which comprehensive program, building on existing mother and proposes a significant increase in allocation for the MCBP (up child benefit programs. MoWCA launched the Mother and Child to 0.3 percent of GDP from the current 0.03 percent allocated Benefit Program (MCBP) in FY2018-19 (originally the Improved to MAPP and AULM). Greater allocations will be required to Maternity and Lactating Mothers Allowance - IMLMA) which take the program to its full scale in the coming years. ADEQUACY OF TARGETING AND BENEFITS Mother and child benefit programs are errors of 62 percent and 48 percent for maternity allowances, generally progressive, but exclusion and in rural areas (66 and 62 percent in urban areas) (Figure 1).7 inclusion errors persist A cumulative 40 percent (in rural areas) to 45 percent (in urban Lack of regular review of benefit levels may areas) of maternity allowances’ benefits accrue to the poorest limit the intended impacts of programs 30 percent. However, both inclusion and exclusion errors need Beyond issues of inclusion and exclusion, the level of benefits to be addressed. Data for 2019 suggest inclusion and exclusion is critical to ensure the program’s impact. The current monthly benefits (BDT 800) provided by the MCBP are higher than many other social protection programs. However, the size of benefits should be determined based on the intended objectives (within the budgetary constraints). Determination of transfer size Rural Rural suffers from lack of regular reviews to ensure they are in line 80 with economic and market conditions. For instance, while the nominal average monthly benefit of MAPP and AULM almost 70 61.7 65.5 61.9 doubled between FY2009-10 (BDT 435) and FY2019-20 (BDT 60 829), their real (inflation adjusted) value stood at the same 47.7 level (BDT 436 in FY2019-20) as FY2009-10 (Figure 2). Shocks or 50 inflationary pressure can further reduce the real value of these 40 benefits and thus their impact. 30 Scope to further promote behavioral 20 changes through programs 10 In combination with cash transfers, behavior change 0 components (BCC) have demonstrated their impact on early Inclusion error Exclusion error childhood outcomes. Evidence from Bangladesh showed that, when added to cash or food transfers, behavioral change communication led to significant improvements in child nutrition, beyond those reached by transfers alone.8 Figure 1: Inclusion and exclusion errors for maternity Adequate support from children’s environment is also crucial allowance programs, rural vs. urban for developing their full potential (including verbal interaction Sources: Authors’ estimates based on MICS 2019. and cognitive and socio-emotional stimulation early in 3 Efficiency of Planning, Programming and Delivery of Social Protection Programs on Early Years POLICY NOTE Average benefit (nominal) Average benefit (real) 900 800 700 600 500 400 300 200 100 0 FY2009-10 FY2010-11 FY2011-12 FY2012-13 FY2013-14 FY2014-15 FY2015-16 FY2016-17 FY2017-18 FY2018-19 FY2019-20 Figure 2: Average benefit of MAPP and AULM, nominal vs. real (FY2009-10 to FY2019-20) Sources: Authors’ estimates based on revised budget data, Finance Division, and CPI (2010 = 100) data from World Development Indicators. life), in addition to adequate nutrition and healthcare.9 By Limiting the combination of programs design, social protection programs provide an opportunity for might be reasonable for some programs, interactions with households, either at the time of payment of but counterproductive in other cases through dedicated activities to promote behavioral changes: information sessions, counseling sessions, and training on Many programs in Bangladesh explicitly rule out those who pregnancy, safe delivery, dietary diversity, early stimulation, already benefit from other programs. For 5 of the 11 largest etc. Some programs encourage or require participation in these programs, the rules explicitly state that those who received activities (such as ISPP-Jawtno) or require that households benefits (or regular benefits) from other governmental adopt certain behaviors or take particular actions (e.g. child programs (and NGOs for some) are ineligible. Even where health visit). BCC is particularly relevant as Bangladesh programs do not explicitly prohibit cumulation, reports from expands the MCBP, i.e. ensuring beneficiaries receive services the field suggest this is often used as a criterion (e.g., only 3 and counseling under the program in addition to the transfers; percent of beneficiaries from the DSF-MHVS also received having a comprehensive curriculum with customized support from NGOs). If programs play similar functions (and messaging; regular interaction with program participants, etc. have similar duration or benefits), preventing their combination rightly limits duplication (ideally, such programs might be consolidated). However, it is less opportune when programs are complementary. For instance, the DSF-MHVS covers time- bound costs incurred for pre- and post-natal visits and does not aim at providing sustained income support. Therefore, it does not substitute long-term support programs (e.g. Widow Allowance or Disability Allowance) and households should be able to benefit from both. THE WORLD BANK 4 POLICY NOTE EFFICIENCY IN PROGRAMMING Scope for improved institutional mobilization of local governments and programs. However, coordination local government institutions at the District, Upazila, and Union levels are generally under-resourced – at the human, Creating and protecting human capital of poor and vulnerable financial and logistical resource levels – and under-capacitated children in their early years can only be done through a to perform their functions. Ensuring the Government allocates combination of demand and supply-side interventions. resources towards programs’ operational costs, in addition to The needs fall across a range of sectors and services which the benefits themselves, is critical in this regard. call for cross-sectoral coordination and policy ownership across ministries, program administrators, and community members. There is an existing high-level inter-ministerial Scope for improvements in financial coordination mechanism – the National Council for Women reporting and Children Development, chaired by the Prime Minister with While central units of MoWCA and other agencies implementing representatives from 17 ministries as well as other national mother and child benefit programs use iBAS++ for budgeting organizations and professional bodies (MoWCA serves as the and reporting, some local-level officials are yet to start using Member-Secretary). Although the Council is responsible for the system. For major programs, iBAS only records the first coordinating the various policies and programs, it is unclear steps in a longer chain of transfers. While the use of the how it links to the Early Childhood Care and Development operating budget by design requires claiming expenses as Strategic Operational and Implementation Plan to harmonize reimbursements, transfers are in practice recorded as expenses activities across ministries towards comprehensive and without waiting for reconciliation with actual expenditure data. converging services. The National Social Security Strategy For instance, for DSF-MHVS, iBAS only records the transaction also assigns the leading role in the implementation of the from treasury to the ministry. The lack of reconciliation also consolidated MCBP to MoWCA. means that agencies are not able to monitor and adjust their While coordination and integration of services require programs, undermining accountability. the support of the higher governance level, it also needs EFFICIENCY IN DELIVERY AT THE LOCAL LEVEL G2P show promises in provisioning Management Information System (MIS) of at least three payments, but a sustainable cash-out programs implemented by MoWCA have been linked to the mechanism and financial literacy among Social Protection Budget Management Unit (SPBMU) to roll out G2P payments.12 On average, more than 80 percent of beneficiaries are needed these budgets had actually transitioned through G2P by the Due to multiplicity of steps, it can take a substantial time to end of FY2018-19. The proposed expansion of MCBP is already transfer funds from the treasury to implementing ministry and considering building on this best practice. onward to beneficiaries. Delays can impact implementation and program effectiveness, and be relatively costly.10 Initiated With regard to ‘cash-out’ (withdrawal of transfers by in 2018 by the Finance Division, the G2P scheme is able to beneficiaries), there are often transaction costs. These cut processing time to 10 days by eliminating administrative can amount up to 2-5 percent of benefits and can reduce layers while facilitating authenticated and secure payments significantly the impact on beneficiaries.13 However, Finance directly from the treasury to beneficiaries.11 To date, the Division has issued a circular that in the future, these costs will Allowances for the Financially Insolvent Disabled 5 Efficiency of Planning, Programming and Delivery of Social Protection Programs on Early Years POLICY NOTE be borne directly by programs, rather than recipients (will have which citizens are informed and able to hold government to be budgeted out of the Government’s overall expenditure). accountable. While program guidelines emphasize the In 2016, MoSW began piloting digitized payments through importance of communication and information, there is still the Bangladesh Post Office and agent banking, and in 2020 room for improvement as announcements and promotional through mobile financial services.14 The objectives were both activities tend to be limited to payment schedules, with to reduce the incidence of fraud and ghost beneficiaries (by less focus on enrolment. Overall, knowledge about major adopting biometrically authenticated and secure payments) programs is low: Knowledge of benefits amounts is generally and to facilitate access for beneficiaries. MoWCA and others higher than that of eligibility criteria, which oscillates between implementing MCBPs can also enhance their efforts in using 40 and 60 percent. cash-out options that are convenient for beneficiaries. It is also critical to establish a functional grievance redress mechanism. Good practices from existing programs can serve Scope for greater citizen engagement to as a reference point in this regard. For instance, ISPP-Jawtno boost accountability and quality of service receives grievances through its union-based safety net cell, delivery staffed by a safety net program assistant, serving the role as a one-stop-shop service center for the program, troubleshooting A key element for improved service delivery, in addition beneficiary problems with targeting, enrolment, services, and to improved capacity and processes, is the extent to payments.15 RECOMMENDATIONS • Increase allocation for early years programs. Increase Household Database that capture the heterogeneity of the investments on pregnant mothers and early childhood to poor and vulnerable, as part of programs’ identification build human capital of children, making good use of the processes. Since urban poverty patterns, vulnerabilities, window of opportunity of early years to make a significant and constraints are likely different, there is also a need to difference in their adult lives. Allocate in line with the number adapt existing programs (or tailor urban modalities) to of young children living in poor households, regional support the growing poor urban population. dimensions, and vulnerability context, for a progressive • Review the level of benefits regularly and put special expansion toward universality. Greater fiscal space for early emphasis on Behavioral Change Components (BCC). It years can be achieved through a combination of increased is critical to revisit the amounts transferred to ensure they budget allocations and efficiency gains. can have a meaningful impact on human capital outcomes • Ensure full coverage of the poorest by core programs, and poverty and take inflation into account. For programs including for early years, through improved eligibility to yield lasting behavioral changes, they can use insights criteria and identification processes. Many programs from behavioral science to enrich their interventions with would benefit from revising their eligibility and exclusion accompanying measures with a view to promote good criteria, to increase their focus on the poor and vulnerable practices (nutrition, parenting, etc.) which are critical to and to reflect changes that have occurred in poverty early years development. It is also critical to ensure strong patterns and living costs since the criteria were established. linkages between programs which serve young children, Updated eligibility criteria can help increase coverage of including MCBP, primary health care services for pregnant the poor by minimizing both exclusion and inclusion errors. women, infants, and toddlers; child nutrition; family resource This could be done using indicators used in the National centres and parenting education; pre-primary education; 6 POLICY NOTE sanitation; etc. To this end, it is essential to ensure inter- program management at the local level. Financial audit of ministerial coordination and MIS interoperability. social protection programs can help increase transparency of expenditures and processes and contribute to efficiency. • Strengthen social protection coordination mechanisms The Directorate of Social Safety Net Audit’s practice of and the link between policy and resources allocation. conducting financial audit for MoSW should also be The ‘Cabinet Committee on the Overall Supervision of emulated for other ministries and agencies implementing Social Protection’ should play a more important role programs on early years. in linking allocations for mother and children to policy priorities. To broaden its coverage, the Committee should • Transition to an efficient payment system and sustainable review all core programs (financed from both operating cash-out mechanism. With regard to cash-in of transfers and development budgets) and analyze their alignment from treasury to beneficiary accounts, it is imperative to with core policies using policy-relevant typologies. The ensure that all transfers under the proposed MCBP are Committee can also consider seeking input from the made through G2P. Since 2021, MoSW adopted mobile National Council for Women and Children Development to financial services as the primary form of payment, allowing guide allocations for early years. Furthermore, there needs beneficiaries to have access to a far greater number of cash- to be greater capacity at the local level to deliver services. out points given the coverage of mobile financial services This could be done through partnership arrangements with agents in the country. The arrangements adopted by MoSW ministries or NGOs or through the provision of recurrent may serve as an example for the proposed expansion of the funding and clear accountability mechanisms for local MCBP. Furthermore, the program could focus on improving government institutions. Capacity to coordinate the MCBP financial inclusion of target group through awareness with basic health services, birth registration, nutrition, and building and training on financial literacy and financial early childhood care and development is also critical; as is products. the establishment of a robust monitoring and evaluation system to be used by the Local Administration at the sub- • Promote greater citizen engagement through improved access to information and robust grievance management national level and the concerned Ministries at the national systems. In addition to strengthening reporting and level. monitoring processes and ensuring strong grievance • Strengthen financial reporting and auditing to improve mechanisms, promoting the use of social accountability implementation and program management. At the tools such as citizen-led social audits can contribute to local level, capacity needs to be developed to use central enhanced transparency and greater accountability in the reporting systems (including SPBMU and iBAS++) and process. effectively report actual expenses (using bank reconciliation statements). This would also allow for more informed 7 Efficiency of Planning, Programming and Delivery of Social Protection Programs on Early Years POLICY NOTE 1 World Bank, 2021. “Bangladesh Social Protection Public Expenditure Review”. Dhaka, Bangladesh. 2 Bhatta, S.D. et al. 2020. “The Landscape of Early Childhood Education in Bangladesh”, The World Bank, Washington DC. 3 Gertler, P. et al. 2014. “Labor Market Returns to an Early Childhood Stimulation Intervention in Jamaica.” Science 30, vol 344 (6187): 998-1001. 4 BBS and UNICEF, 2019. Progotir Pathey: Bangladesh Multiple Indicator Cluster Survey 2019, Survey Findings Report. Dhaka, Bangladesh. The prevalence of stunting, wasting and underweight fell to 31, 22 and 8 percent respectively in 2018. NIPORT and ICF, 2019. 5 NIPORT, ICDDR-B, and MEASURE Evaluation. 2017. “Bangladesh Maternal Mortality and Health Care Survey 2016: Preliminary Report”. Dhaka, Bangladesh, and Chapel Hill, NC, USA. 6 About 57 percent of households with children are poor in terms of the Multidimensional Poverty Index, while this is the case for 36 percent of the general population. GED, UNICEF, & OPHI (2020). Reduction in Multidimensional Poverty in Bangladesh: An Analysis of Trends between 2012/13 and 2019. 7 Using an asset index as proxy for consumption and a poverty rate of 26.7 percent for rural areas (19.3 percent for urban areas). 8 Ahmed et al, 2016. “Which kinds of social safety net transfers work best for the ultra-poor in Bangladesh?” International Food Policy Research Institution and World Food Programme. 9 World Bank, 2015. “World Development Report: Mind, Society and Behavior”, Washington DC. The time lag between the release of funds from the treasury and the receipt of funds by beneficiaries, through the implementing ministry, can reach 10 up to more than a year for the DSF-MHVS. World Bank, 2019. “Social Protection Fund Flow Analysis”. Analysis undertaken by EY Bangladesh for this analysis. 11 Under this scheme, the department, through its designated CAO, confirms digitized payment lists (with information on beneficiaries’ NID and bank account numbers) through the iBAS. 12 These include MAPP, AULM and Improved Maternity and Lactating Mother Allowance (IMLMA). 13 Transaction cost may include transport cost to travel to branches, costs associated with opening bank accounts etc. Agent banking aims to provide limited financial services to the underserved, under agency agreements with agents such as Union Digital Centers or 14 potentially local shops, mobile phone agents or others. 15 Anwar, Rubaba and Rahman, Aneeka, 2016. “Program Brief: Towards a Child Benefit Scheme in Bangladesh”. World Bank Group, Dhaka, Bangladesh. This Policy Note has been prepared by Mostafa Amir Sabbih, Aline Coudouel and Aneeka Rahman, Social Protection & Jobs Global Practice, World Bank. The Policy Note has also benefited significantly from information and feedback shared by Mekonnen Woldegorgis (Chief, SPEAR, UNICEF Bangladesh), Hasina Begum (Social Policy Specialist, UNICEF Bangladesh), Md Ashiq Iqbal (Social and Economic Analysis Specialist, UNICEF Bangladesh), Koen Everaert, European Union (Team Leader, Green Inclusive Development and Social Protection), Kishower Amin (Programme Manager, Public Financial Management & Social Protection), and Meher Nigar Bhuiyan (Programme Manager, Food and Nutrition Security, European Union). World Bank Office Dhaka Plot- E-32, Agargaon, Sher-e-Bangla Nagar World Bank, 2021. “Bangladesh Social Protection Public Expenditure Review (PER)”. Dhaka-1207, Bangladesh World Bank Group, Dhaka, Bangladesh. Tel: 880-2-5566-7777, Fax: 880-2-5566-7778 © World Bank. www.worldbank.org/bangladesh https://bit.ly/3qd5hZ1 8