Europe and Central Asia Knowledge Brief

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This is a regular series of notes highlighting recent analyses, good practices, and lessons learned from the development work program of the World Bank’s Europe and Central Asia Region.

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Empowering Communities : The Local Initiatives Support Program in Russia

2014-06, Shulga, Ivan, Sukhova, Anna, Khachatryan, Gagik

Prosperity from economic growth is not shared evenly among Russia's population and regions. Local communities and rural territories face serious development challenges: including poor living conditions, infrastructure, and services and lack of citizens' participation in decision-making processes. The Russian Federation Local Initiatives Support Program (RF LISP) aims to address community challenges by introducing a participatory approach to the development and rehabilitation of local-level social infrastructure. Specifically, LISP channels funds from regional budgets to finance participatory projects in poorer local communities. For the period 2009-14, LISP has been implemented in six regions and has resulted in more than 1,200 projects with over 1 million beneficiaries. Key factors for LISP success are the following: (i) mainstreaming of LISP into the national administrative system and budget process, and (ii) providing the Bank's technical assistance at all stages of project implementation to share international experience in community-driven development (CDD) projects, and ensuring transparency and quality of LISP procedures.

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Social Safety Nets in Europe and Central Asia : Preparing for Crisis, Adapting to Demographic Change, and Promoting Employability

2012-04, Williams, Penny, Larrison, Jennica, Strokova, Victoria, Lindert, Kathy

Social safety nets in the Europe and Central Asia (ECA) region responded to protect people's incomes during the global recession, especially in countries where systems were developed before the crisis. As population's age and labor forces shrink, the elderly will increasingly rely on general revenues to supplement contributory pensions, competing with assistance for other vulnerable groups. Social safety nets that link to employment and other services can help people transition from reliance on social transfers to employability. Countries should not wait to confront these challenges. To further strengthen social safety nets, governments in ECA should consolidate and harmonize benefits, invest in systems improvements for greater efficiency, link social assistance and employment services, and actively communicate these reforms to their populations.

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Restructuring Regional Health Systems In Russia

2010-10, Marquez, Patricio V., Lebedeva, Nadezhda

The delivery of health services in Russia is a federal, regional and municipal responsibility. Reform of the regional health systems, which suffer from over-reliance on curative and inpatient care, deteriorating infrastructure and equipment, and poor quality of services, is a major challenge for the country. From 2003-2008, the World Bank helped strengthen the stewardship capacity of Russia's Federal Ministry of Health and Social Development (MOHSD) and restructure health systems in two pilot regions: the Chuvash Republic and Voronezh oblast. In both regions, hospital bed numbers were reduced while simultaneously increasing service delivery capacity at the primary care, specialized ambulatory, and long-term care facility levels through the introduction of new technologies, clinical protocols, and resource allocation mechanisms that link payments to performance.

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Redesigning Health Care in ECA : Some Lessons from the UK

2010-06, Marquez, Patricio, Chalkidou, Kalipso, Cutler, Derek, Doyle, Nick

The countries in Europe and Central Asia (ECA) have been struggling to deliver good, affordable health care to their populations. Indeed, life expectancy gains in the region have been significantly lower than in other middle or high-income countries, and in some ECA countries the relative low level of public sector funding to cover the cost of free medical care that is already promised by the governments to their citizens has consistently hindered access to quality services and led to a significant increase in out-of-pocket spending by patients for healthcare. The main challenge now is to redesign health systems to effectively address the changing health needs of the population, chiefly the increase in non-communicable diseases such as cardiovascular diseases, cancer, and injuries, as the leading causes of ill-health, premature mortality and disability.

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Tajikistan : Reinvigorating Growth in Khatlon Oblast

2014-06, Carneiro, Francisco

This report supports a joint World Bank-IFC initiative to review and evaluate economic growth prospects for Khatlon oblast in order to develop a private sector-driven strategy for accelerating the region's growth over the medium term.

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The ECA’s Diaspora Populations Can Aid Growth and Development

2012-04, Heleniak, Timothy, Canagarajah, Sudharshan

The diaspora populations from Europe and Central Asia (ECA) countries are large in both absolute and relative terms. Nearly 11 percent of the population in the region resides outside the country of birth (compared to 3.1 percent globally). The ECA diaspora populations are highly educated and skilled. Formulation of diaspora policies in the region is in its early stages; most ECA countries started developing diaspora policies and institutions only after the year 2000. ECA countries need to identify their diaspora goals, map diaspora geography and skills, create a relationship of trust between diasporas and governments of both origin and destination countries, and mobilize their diasporas to contribute to sustainable development.

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Battle Against Tuberculosis : Some Gains in Russia

2010-09, Marquez, Patricio V., Jakubowiak, Wieslaw, Pashkevich, Dmitry D., Grechukha, Vladimir A.

Across Russia, the deep socio-economic crisis of the 1990s and early 2000s provided fertile ground for the spread of Tuberculosis (TB). Indeed, as noted, 'people who were already living very precariously saw their real incomes drop by 25 percent to 30 percent at a time when government spending was also falling.' As a result, social and health conditions deteriorated, and TB spread rapidly. Russia also had one of the highest rates of imprisonment in the world that, coupled with adverse conditions in prisons, increased the risk of TB, HIV and other infectious diseases among prisoners. The Project was designed in accordance with the federal targeted social disease prevention and control program (2002-2006). About 80 percent of project funds were allocated for TB control with the goal of contributing to a leveling-off or reduction in morbidity, mortality and transmission of TB. The project covered 79 of the 83 regions across the vast Russian territory - from the Baltic Sea to the Pacific Ocean, strengthening both the civilian and prison health systems.

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Addressing the Gender Gap in Europe and Central Asia

2012-06, Sattar, Sarosh

The Europe and Central Asia (ECA) region's relative advantage in gender equality compared to other regions eroded in the 1999-2009 period. As a result, the region now looks more similar to the rest of the world in terms of women's education and labor force participation. Moreover, gender gaps continue to exist in some minority communities and in poor rural areas. Structural changes in the economies of the region have both opened up economic and employment opportunities for women and reduced some avenues of prosperity for men. However, women's gains from such opportunities are limited as occupational segregation and wage gaps persist, despite comparable human capital endowments. The dramatic demographic changes affecting the ECA region, such as aging, have different implications for men and women. In particular, (i) old age poverty will especially affect women, and (ii) the shrinking labor force will make it necessary to stimulate the labor participation rate of women.

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Employment Recovery in Europe and Central Asia

2011-06, Koettl, Johannes, Santos, Indhira

Despite high unemployment in most Eastern Europe and Central Asia (ECA) countries, people have not withdrawn from the labor market but continue to actively look for jobs. Unemployment increased significantly in ECA countries during the crisis, particularly among youth. However, young people are also the ones benefiting most from the recovery. Labor market recovery remained sluggish up to the third quarter of 2010. Many countries have seen only a slight recovery in unemployment rates, although output is recovering everywhere. Up to the third quarter of 2010, the Gross Domestic Product (GDP) upturn in most ECA countries appeared to be driven by increases in productivity and hours worked; however, these are still below pre-crisis levels. This suggests that there is room in most countries for further increases in productivity and hours worked, which could delay the recovery in employment.

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Setting Incentives for Health Care Providers in Serbia

2010-07, Cashin, Cheryl, Koettl, Johannes, Schneider, Pia

The Serbian Government plans to reform its provider payment system for health care by setting incentives for providers to improve the quality and efficiency of care. Funds for health care are currently allocated on the basis of the number of staff and beds at health facilities. This encourages health care providers to use more staff and beds to define their budgets but does not reward improvements in productivity, quality of care or health outcomes.