A New Social Contract for Peru: An Agenda for Improving Education, Health Care, and the Social Safety Net

There is a growing consensus in Peru that the country needs to increase its efforts to achieve greater equity and that a strong social policy must be part of those efforts. The objective of this book is to make available an analysis of the issues that need to be tackled to improve the delivery of education, health care, and antipoverty programs, and to describe the main options available to deal with those issues. The book is being published in the months prior to the 2006 elections to make this information available to inform the debate about social policy and suggest options for the design of a more equitable social policy.

The book is the result of two years of the collaborative work of many people It summa- rizes the main findings and conclusions of a project that examined issues of accountability in the delivery of public services. The project, known by its Spanish acronym, RECURSO (REndición de CUentas para la Reforma SOcial), was financed by the World Bank and the Department for International Development (DFID), and had four characteristics.

First, it brought together people with a detailed knowledge about the issues con- fronting the delivery of education, health care, and social protection services in Peru with people with knowledge about how similar issues are being managed in other countries. The identification of the issues and of the possible solutions to those issues in each sector was based on a technical analysis of the available data and on a detailed review of the literature produced by Peruvian analysts. The teams that produced the analysis summarized in each chapter involved Peruvian professionals and international experts.

Second, the project attempted to go beyond a purely technical and economic analysis of each sector. Each chapter of the book incorporates, in addition to a technical, economic, and statistical analysis, an analysis of the institutional context for service delivery. In some instances some elements of anthropological analysis were also incorporated. A common theme that cuts across sectors is the attempt to discuss issues of accountability in each sec- tor using a common framework. This framework, described in Chapter 1, was originally developed by the World Bank in its World Development Report: Making Services Work for Poor People (2004) and first applied to Latin America in Citizens, Politicians, and Providers (Fiszbein 2005). This book is the first attempt to use this approach in a single country, and the Bank is now likely to replicate the approach in other countries.

Third, there was a significant effort to go beyond the typical analysis that results from a review of each individual sector on its own. Instead, a comparative approach was used, seeking lessons by looking for historical patterns that are similar in several sectors and for other similarities and contrasts among the sectors. Specifically, there was an effort to sys- tematically review each sector: the trends and the distribution of public expenditure, the impact of social participation in the delivery of services, and the incentive framework for the management of human resources.

Finally, the project attempted to develop the analysis and recommendations in a par- ticipatory manner that incorporated the views of as many stakeholders as possible. Policy- makers, academics, civil society leaders, and providers of services were consulted at the planning stage of the project and again when the initial results became available. The book does not seek to give the “definitive answer” to or the “international recipe” for the various

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