Previous research conducted jointly by ODI and DI found that subnational financing is not well targeted on the poorest regions . Access to quality, affordable or free health services and education is vital, but in some countries, the number of teachers and health workers in the very poorest areas is as much as ten times less than the national average, increasing the risk of leaving the poorest behind and continuing inequality.
This paper builds on that research, assessing how well subnational financing of health and education in all 82 low- and middle-income countries (including all LDCs) targets regions with the worst health and education outcomes. Many countries do not publish sufficient recent and comprehensive data, and analysis was possible in only 16 countries.
Findings
- There is little evidence of a progressive allocation of health and education resources by governments to the regions with the worst health and education outcomes. Instead, in most countries, the trend is for slightly less financing to be provided to areas with the worst outcomes – typically 12% below national average for health and 7% below for education. The consistency of the findings across different indicators – whether under-five or under-18 mortality, years of schooling or secondary completion rates – suggests that poor and/or inconsistent targeting is a broader problem.
- There is strong evidence that donors do target aid for health to regions with the worst under-five mortality rates – typically 29% higher. Results are more mixed in terms of under-18 mortality rates.
- There is no consistent trend in donor targeting of aid for education. There is strong positive targeting in some countries, and the reverse in others. The evidence that governments that do publish data do not target the neediest is all the more concerning as those countries that do not publish subnational expenditure data are likely to be even less concerned about targeting spending at the neediest regions.