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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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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Action Needed : Spiraling Drug Prices Empty Russian Pockets

2010-02, Marquez, Patricio, Bonch-Osmolovskiy, Mikhail

In large measure, this is due to the relatively low level of public health spending in the country (about 3.6 percent of gross domestic product (GDP) in 2008) that underlines the significant gap between the constitutional commitment to a range of medical care services and the actual funding to pay for them. While drugs are supposed to be provided to hospital patients free of charge, an estimated 80 percent of inpatients still have to pay part of the costs of their medicines and most outpatients must purchase them from pharmacies. The outpatient drug program under mandatory health insurance covers only around 16 million people (11 percent of the total population in the country), with more than half of them opting to receive cash rather than in-kind benefits under the 2005 'monetization' of prescription drug benefits. Those who continue with the in-kind benefits appear to be the ones greatest in need of drugs. The situation is further aggravated by the country's ineffective enforcement of controls on wholesale and retail mark-ups for medicines. Household expenditure on drugs accounted for about 30 percent of total health expenditure in Russia, as compared to 12 percent in Organization for Economic Co-operation and Development (OECD) countries in 2008.

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Russian - Strengthening Access to Justice : A JSDF Grant to Empower Vulnerable Groups

2013-01, Mukherjee, Amit, Poznanskaya, Ljudmilla, Rosha, Anjum, Schwartz, Olga

Despite Russia's strong economic growth, over 14 percent of its population, more than 20 million people, still live in poverty. In 2008, the Japan Social Development Fund (JSDF) provided a grant of US$1.98 million to help make the justice system in Russia more accessible and accountable to the poorest and most vulnerable groups in two regions of the country, Leningrad Oblast and Perm Krai. The grant was strongly supported by the Embassy of Japan and Russian regional authorities, who were involved from conceptualization to completion. The grant piloted two models of legal aid in these two areas, and it launched a collaborative initiative that enabled local executive and judicial branch officials and nongovernmental organizations (NGOs) to work together to achieve common goals. This JSDF grant has yielded some promising results. However, the sustainability of the legal aid networks established under the grant depends on ongoing support from the local authorities in each region.

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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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Improving Protection in Financial Services for Russian Consumers

2009-12, Rutledge, Sue

Over the last decade, consumer credit in the Russian Federation has expanded from almost nothing to 9.2 percent of Gross Domestic Product (GDP) in 2008. This is an average increase of 84 percent a year for five years. Recent developments in financial markets have highlighted the need for consumer protection and financial literacy for the long-term health of the financial sector. The rapid growth of household lending has been accompanied by an increase in the number of households that have difficulty in understanding the risks and obligations that they assume, or the full range of choices available. In the United States mortgage markets for instance, complex financial contracts were sold to borrowers, some of whom had weak credit histories. The consequences were disastrous, and highlight the importance of consumer protection and financial education to prevent other similar events.

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Russian Federation Customs Development Project : Measurable Progress

2011-07, Johns, Kimberly, Kristensen, Jens Kromann, McLinden, Gerard

The Russian Federation Customs Development Project (CDP), launched in 2003, has been helping reform and modernizes the country's federal customs service. Reforms under the CDP have resulted in improved performance: both customs clearance times and rent-seeking incidents have been reduced. However, despite major progress in critical areas, global rankings such as the world economic forum's enabling trade index and the World Bank's logistics performance index suggest there is still significant room for further improvement in customs administration.

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Dangerous Roads : Russia’s Safety Challenge

2010-07, Marquez, Patricio V., Bliss, Anthony G.

As in many countries of the Europe and Central Asia Region (ECA), vehicle ownership in Russia has grown faster in the last decade than the decline in the rate of fatalities per vehicle. At the same time, road safety policies and interventions have not kept pace with the boom in motorization. In 2008, the motor vehicle fleet in the country exceeded 41 million cars, up 24 percent from 2004, and the number of drivers licensed increased by 40 percent during this period. In 2008, Russia saw nearly 30,000 road traffic deaths and about 271,000 non-fatal road traffic injuries. While these figures represent a drop of 13 percent from 2004, Russia's road traffic mortality rate is still five times higher than what is seen in several European Union (EU) countries, about twice more than in the United States, higher than in other Eastern European countries such as Poland and Hungary, and higher than the average for Commonwealth of Independent States (CIS) countries.