世界银行-中非共和国主要人类发展部门的公共支出审查（英）

CENTRAL

AFRICAN

REPUBLICPublic

ExpenditureReview

in

Key

HumanDevelopment

SectorsSeptember

20231CENTRAL

AFRICAN

REPUBLICPublic

ExpenditureReview

in

Key

HumanDevelopment

Sectors23TABLE

OF

CONTENTSACKNOWLEDGEMENTS6ABBREVIATIONS

7CHAPTER

5.

HEALTH

975.1.

Introduction985.1.

OverviewoftheHealthSectorinCARIncludingExistingGovernmentHealthPolicies,Plans,andStrategies98CHAPTER

1.

INTRODUCTION115.2.StructureandOrganizationoftheHealthSector995.3.Trends

andStatusinHealthInputsandOutcomesinCAR

1005.4.Trend,

Sources,andCompositionofTotal

HealthExpendituresinCAR1075.5.Equityinaccesstohealthservicesandfinancialprotection1205.6.ImplicationsofCOVID-19

forHealthFinancinginCAR1245.7.

OverviewofResultsBasedFinancingintheHealthSectorinCAR

1275.8.Recommendations

129References

131References

17CHAPTER

2.

MACRO/FISCAL192.1.

Background202.2.RecentMacroeconomicTrends

andFiscalPolicy

202.3.ConclusionsandRecommendations

30References33CHAPTER

3.

PUBLIC

FINANCIAL

MANAGEMENT

35CHAPTER

6.

SOCIAL

PROTECTION1333.1.

Introduction366.1.

Introduction1343.2.RecentHistoryofPublicFinancialManagementReforms

373.3.Decentralization,Deconcentration,andPublicFinancialManagement

383.4.BudgetPreparation,Approval,andEvaluation

383.5.BudgetExecutionPerformance2017–20393.6.CorePublicFinancialManagementSystems

423.7.

Recommendations48References516.2.OverviewofManagementandInstitutionalContextoftheSocialProtectionSector

1366.3.PublicExpenditureonSocialProtection

1416.4.Recommendations

154References157APPENDIXES

159A1.

Education

160A2.SocialProtection

185A3.Health190CHAPTER

4.

EDUCATION

534.1.

Introduction

544.2.OverviewoftheEducationSystem

544.3.EducationSectorFinancing

624.4.HumanResourceManagement734.5.FinancingNeedsandSustainabilityofPublicSpendingonEducation844.6.Recommendations89References95REFERENCES

20845ABBREVIATIONSACCT

-CentralTreasuryAccountingAgency[AgenceDALYs

-Disability-adjustedlifeyearsComptableCentraleduTrésor]DGBS

-GeneralofScholarshipsandInternshipsACS

-AgentsandcivilservantsAF

-AdditionalfinancingDGESP

-GeneralDirectorateforStudies,Statistics,andPlanning[Directiongénéraledesétudes,desstatistiquesetdelaplanification]AFD

-AgenceFrançaisedeDéveloppementDGMP

-GeneralDirectorateforProcurement[DirectionAGETIP-CAF

-CARAgencyfortheExecutionofWorksofGénéraledesMarchésPublics]PublicInterestDH

-DistrictHospitalAGIR

-PublicExpenditureandInvestmentManagementReformProject[Projetd’Appui

àlaGestiondeDépensesetInvestissementsetauxReformes]DPMP

-DirectorateofProcurementManagementPolicyDPF

-DevelopmentPolicyFinancingACKNOWLEDGEMENTSAGR

-Incomegeneratingactivities[ActivitéGénératricesdeDRG

-DiagnosticrelatedgroupRevenus]DRM

-DomesticresourcemobilizationEBESP

-EmergencyBasicEducationSupportProjectECCD

-EarlyChildhoodCareandDevelopmentECF

-ExtendedCreditFacilityAPPR

-AgreementforPeaceandReconciliationARMP

-PublicProcurementRegulatoryAgency[Autoritéderégulationdesmarchéspublics]ARI

-AcuterespiratoryinfectionsBMA

-BanguiMetropolitanAreaCAR

-CentralAfricanRepublicEGRA

-EarlyGradeReadingAssessmentEMIS

-EducationManagementInformationSystemThis

report

has

been

prepared

by

a

team

led

by

Yevgeniya

Savchenko.

Theteam

included

(in

alphabetical

order)

Ayesha

Khan

Kaiser,

Boubakar

Lompo,Cristelle

Kouame,

Elysée

Aristide

Houndetoungan,

Frieda

Vandeninden,Marianne

Caballero

Parra,

Pierre-Emmanuel

Couralet,

Soazic

Elise

WangSonne,

and

Tomi

Diderot.

The

report

was

prepared

under

the

guidance

ofHanFraeters,AbdoulayeSeck,HalilDundar,

MagnusLindelow,IffathSharif,Francisco

Carneiro,

Manuel

Vargas,

Carine

Clert,

and

Clelia

Rontoyanni.

Theteam

received

invaluable

advice

and

support

from

Nathalie

Lahire,

PhilippeAuffret,

Paola

Cerutti,

Mahoko

Kamatsuchi,

Driss

Zine

Eddine,

Avril

Kaplan,Gervais

Yama,

Wilfried

Kouame,

Oula

Coulibaly,

Maud

Kouadio,

Zoé

Allier-Gagneur

and

Oulimata

Ndiaye.

The

team

would

also

like

to

thank

the

peerreviewers

Elena

Georgieva-Andonovska,

Melissa

Adelman,

Ellen

Van

De

Poel,Boban

Varghese

Paul,

Volkan

Cetinkaya

and

Yasuhiko

Matsuda

for

their

veryvaluable

insights.

The

team

was

supported

by

Arsene

Gassy

Djamba,

ElifYukseker,

Inass

Ayoub–

program

assistants.

In

addition,

the

team

greatlybenefited

from

consultations

with

key

policymakers

and

analysts

in

CAR,including

officials

from

the

Ministry

of

Economy,

Plan

and

Cooperation;the

Ministry

of

Finance

and

Budget;

the

Central

African

Republic

Instituteof

Statistics

and

Economic

and

Social

Studies;

the

Ministries

in

charge

ofEducation;

the

Ministry

of

Health;

and

the

Bank

of

Central

African

States.Michael

Alwan

edited

the

report,

Valerie

Molina

translated

it

into

French,Sarah

Alameddine

led

its

graphic

design,

and

Odilia

Hebga

providedcommunicationssupport.ENAM

-NationalAdministrativeandJusticeSchool[EcoleCEART

-CommitteeofExpertsontheApplicationoftheNationaled’AdministrationetdeMagistrature]RecommendationsconcerningTeachingENI

-Trainingcollege[EcoleNormaledesInstituteurs]CEM

-MutualCommitmentFramework[Cadred’EngagementMutuel]ENMC

-NationalCommunalMonographySurvey[EnquêteNationalesurlesMonographiesCommunales]CEMAC

-EconomicandMonetaryCommunityofCentralAfricaENS

-trainingcollegeforsecondaryteachersandeducationmanagers[EcoleNormaleSupérieure]CFA

-CompulsoryfinancingarrangementsCFAF

-CFA

francsEPSR

-EmergencyPublicServicesResponseESP

-EducationSectorPlanCHI

-CompulsoryhealthinsuranceCHW

-CommunityhealthworkersESPSP

-EducationSectorPolicySupportProgrammeETAPE

-Temporaryclassrooms[EspacestemporairesCIFS

-Inter-ministerialUnitforSSNCoordination[Celluled’apprentissageetdeprotectiondel’enfant]InterministérielledeCoordinationdesFiletsSociaux]EU

-EuropeanUnionCKD

-ChronickidneydiseaseFCV

-Fragile,conflict,andviolenceGBV

-Gender-basedviolenceGBD

-GlobalBurdenofDiseaseGDP

-GrossdomesticproductGER

-GrossenrollmentrateCNSS

-NationalFundforSocialSecurity[CaisseNationaledeSecuritéSociale]COFOG

-ClassificationoftheFunctionsofGovernmentCPR

-Teacher

trainingcenter[CentresPédagogiquesRégionaux]CRD

-CommitteefortheManagementofComplaintsGGE

-GeneralgovernmentexpendituresGHE

-GovernmenthealthexpenditureGoCAR

-TheGovernmentofCAR[ComitédeRèglementdesDifférends]CT

-Cash-transfer67GPE

-GlobalPartnershipforEducationHCI

-HumanCapitalIndexMPSE

-MinistryofPrimaryandSecondaryEducationPACAD

-SupporttoCommunitiesAffectedbyDisplacementSPMPs

-Deconcentratedserviceagencies[ServicesdePassationdesMarchésPublics]MEPSTA

-Ministèredel’EnseignementPrimaireSecondairePAM-UNWorldFoodProgram[ProgrammeAlimentaireTechniqueetdel’Alphabétisation(formernameofMEPS)Mondial]SSA

-Sub-SaharanAfricaHER

-HighereducationandresearchMES

-MinistryofHigherEducationMFB

-MinistryofFinanceandBudgetMHE

-MinistryofHigherEducationMICS

-MultiIndicatorClusterSurveysPARET

-ReturnandReintegrationSupportProjectintheSSN

-SocialsafetynetHeRAMS

-HealthResourcesandServicesAvailabilityCentralAfricanRepublicMonitoringSystemSTI

-SexuallytransmittedinfectionSTR

-Student-teacherratiosTB

-TuberculosisPBF

-Performance-BasedFinancingPER

-PublicExpenditureReviewHG

-HistoryandgeographyHP

-HealthpostsPFM

-PublicfinancialmanagementPIM

-PublicinvestmentmanagementPIMA

-PublicInvestmentManagementAssessmentPPA

-PerformancePurchasingAgencyPPP

-Public-privatepartnershipsHR

-HumanresourcesMINUSCA

-UnitedNationsMultidimensionalIntegratedTFP

-TechnicalandfinancialpartnersTVET

-TechnicalvocationaleducationandtrainingUCAD

-CheikhAntaDiopUniversityStabilizationMissionintheCentralAfricanRepublicHRMIS

-HumanResourceManagementInformationSystemMMR

-MaternalmortalityratioIBM

-IterativeBeneficiaryMonitoringMNCH

-Maternal,neonatal,andchildhealthUCM

-Nationalmedicinesupplyunit[UnitédeCessionsdesIA

-SchoolInspectorate[InspectionAcadémique]MPFFPE

-MinistryfortheAdvancementWomen’sandChildren’sAffairs[MinistèredelaPromotiondelaFemmedelaFamilleetdelaProtectiondel’Enfant]Médicaments]ICASEES

-NationalInstituteofStatistics[InstitutCentrafricaindesStatistiquesetdesEtudesEconomiquesetSociales]RBF

-ResultsBasedFinancingUIS

-UNESCOInstituteofStatisticsUN

-UnitedNationsRCPCA

-NationalRecoveryandPeacebuildingPlanfortheCentralAfricanRepublic[PlandeRelèvementetdeConsolidationdelaPaixenRépubliqueCentrafricaine]MPSE

-MinistryofPrimaryandSecondaryEducationUNCTAD

-UnitedNationsConferenceonTrade

andICT

-InformationandcommunicationtechnologyIDP

-InternallydisplacedpersonsMSP

-MinistryforHealthandPopulation[MinistèrechargéDevelopmentdelaSantéetdelaPopulation]RMET

-ResourceMappingandExpenditureTrackingRMCH

-Reproductive,Maternal,andChildHealthRS

-HealthRegions[RégionsSanitaire]RUH

-RegionalUniversityHospitalsUNESCO

-UnitedNationsEducational,ScientificandMSRTI

-MinistryofScientificResearchandTechnologicalIGF

-GeneralInspectorateofFinance[InspectionGénéraleCulturalOrganizationInnovationdesfinances]UNHCR

-theUnitedNationsHighCommissionerforMTEL

-MinistryofTechnicalEducationandLiteracyIHME

-InstituteofHealthMetricsIMCI

-IntegratedManagementofChildhoodIllnessIMF

-InternationalMonetaryFundLIC

-Low-incomecountryRefugeesMTEPSFP

-MinistryofLabor,

JobsandSocialProtection[MinistèreduTravail,del’EmploietdelaProtectionSocialeetdelaFormationProfessionnelle]UNICEF

-UnitedNationsChildren’sFundUNOPS

-UnitedNationsOfficeforProjectServicesUS

-UnitedStatesSA

-SocialassistanceSARA

-ServiceAvailabilityandReadinessAssessmentSurveyMTEFPS

-MinistryofLabor,

Employment,TrainingandSocialProtection[MinistèreduTravail,del’EmploietdelaProtectionSocialeetdelaFormationProfessionnelle]LIPW

-Labor-intensivepublicworksLM

-LabormarketSCR

-Student-classroomratioSD

-StandardDeviationUSAID

-UnitedStatesAgencyforInternationalDevelopmentNCD

-Non-communicablediseasesVFA

-VoluntaryfinancingarrangementsWB

-WorldBankMAP

-MinimumActivityPackageSDG

-SustainableDevelopmentGoalSENI

-HealthSystemsStrengtheningSupportProjectSHI

-SocialhealthinsuranceNGO

-nongovernmentalorganizationNHA

-NationalHealthAccountsMAHRN

-MinistryofHumanActionandNationalReconciliation[Ministèredel’ActionHumanitaireetdelaRéconciliationNationale]WDI

-WorldDevelopmentIndicatorsWEO

-WorldEconomicOutlookWHO

-WorldHealthOrganizationYLD

-Years

livedwithdisabilitiesYLL

-Years

oflifelostOCHA

-OfficefortheCoordinationofHumanitarianAffairsSI

-SchoolinspectoratesMASRN

-MinistryofSocialAffairsandNationalReconciliation[MinistèredesAffairesSocialesetdelaRéconciliationNationale]OECD

-OrganisationforEconomicCo-operationandSMNIA

-Maternal,child,neonatal,andadolescenthealthDevelopmentservicesODI

-OverseasDevelopmentInstituteSNETFP

-NationalStrategyforTechnicalEducationandVocationalTrainingintheCentralAfricanRepublicMETL

-MinistryofLabour,EmploymentandSocialProtection[MinistèreduTravail,del’EmploietdelaProtectionSociale]ONI

-NationalTechnologyOffice[OfficeNationald’Informatique]SP

-SocialprotectionOOP

-Out-of-pocketMEPC

-MinistryofEconomy,Planning,andCooperation89CHAPTER

1.INTRODUCTION11TheauthorsoftheintroductionareAyeshaKhanKaiserandYevgeniyaSa1011The

Central

African

Republic

(CAR)

is

one

of

the

poorest

and

most

fragile

countries

in

the

world.

Signs

of

positiveeconomic

growth

and

peacebuilding,

evident

since

2015,

have

since

faltered

in

the

face

of

a

deteriorating

securityenvironment

and

the

COVID-19

pandemic.

The

Political

Agreement

for

Peace

and

Reconciliation

(APPR

Accord),signed

in

February

2019

between

the

government

and

14

armed

groups

and

seen

as

a

positive

step

toward

buildingpeace,

did

not

hold.

Post-December

2020

election

unrest

led

to

armed

clashes

that

completely

disrupted

thecountry,

leading

to

a

further

deterioration

in

the

humanitarian

situation.

Violence

continued

immediately

afterthe

election

on

the

outskirts

of

the

capital

of

Bangui

and

in

the

North-West

and

Center

of

the

country.

By

theend

of

May

2021,

the

government,

with

the

support

of

allied

troops

from

the

Russian

Federation

and

Rwanda,had

pushed

back

the

rebels

and

reported

that

most

of

the

country

was

under

government

control.

The

newgovernmentwasformedinJune2021.CAR’s

fragility

explains

its

lower-than-expected

Human

Capital

outcomes.

At

the

root

of

the

country’s

conflictsis

the

struggle

between

its

political

elites

to

pursue

power

and

capture

natural

resources,

undermining

socialcohesion

and

capitalizing

on

local

grievances

to

gain

legitimacy

(figure

1.1).

The

weak

presence

of

the

state

andits

security

forces

outside

Bangui

has

contributed

to

a

vicious

cycle

of

fragility,

which

in

turn

affects

the

abilityof

the

government

to

provide

adequate

public

services.

CAR’s

vast

natural

resource

wealth

and

dependency,coupled

with

weak

governance

and

management

of

the

natural

resource

sector,

are

prevailing

sources

of

fragility.Furthermore,thecountry’s

porousbordersanddependencyonforeignsecurity,

humanitarian,anddevelopmentassistance

make

it

prone

to

regional

and

international

geopolitical

tensions.

These

conditions

are

unconducive

tostability,peace,andmuch-neededstructuralreformsforsustainedgrowthanddevelopment(WorldBank2022).Human

capital

gaps

in

CAR

are

painfully

evident

in

both

health

and

education.

Life

expectancy

remains

thesecondlowestworldwide,at52.9yearsin2017(WorldBank2019).CAR’s

maternalmortalityratio(MMR)isoneofthehighestintheworldwith829deathsper100,000

livebirthsin2017(WorldBank2020a,b).ItsHumanCapitalIndex

(HCI)

score

places

CAR

below

the

fragile,

conflict,

and

violence

affected

(FCV)

countries’

average

of

41

percentandSub-SaharanAfrican(SSA)countries’averageof40percent,andbelowitspeersintheregion(figure1.2).The

country’s

successive

episodes

of

conflicts

and

violence

have

led

to

enormous

challenges,

and

thehumanitarian

situation

remains

dire.

Since

gaining

independence

in

1960,

CAR

has

not

experienced

a

sustainedperiod

of

economic

growth

or

peace.

GDP

per

capita

has

dropped

by

almost

half

since

independence,

from

US$620in

1961

to

US$384

in

2019.

Even

though

extreme

poverty

as

a

share

of

the

population

declined

from

75.7

percentin2014to71.4percentin2019,itremainshighcomparedtopeercountries.2

Despitethehighlevelofpoverty,justover

20

percent

of

the

population

received

a

social

security

net

(SSN)

benefit

in

2020;

and

the

SSN

consists

mainlyof

emergency

projects.

Progress

toward

Sustainable

Development

Goals

(SDGs)

is

also

limited

—

CAR

ranked166

out

of

193

countries

in

2020.

As

of

January

20,

2021,

more

than

half

of

the

population

needed

humanitarianassistance

and

protection

and

40

percent

of

Central

African

households

are

in

a

situation

of

acute

food

insecurity(OCHA

2021).

As

of

April

30,

2021,

the

number

of

internally

displaced

persons

(IDPs)

due

to

the

post-electionsunrest

was

estimated

at

729,005,

which

is

6.9

percent

higher

than

in

end-December

2020.

In

addition,

as

of

May31,

2021,therewere694,904refugeesrepresentingapproximately14percentofCAR’spopulation.3FIGURE

1.2.

HUMAN

CAPITAL

INDEX

SCORES

(2019)45404240353630323029252015105FIGURE

1.1.

A

FRAMEWORK

FOR

ANALYZING

FRAGILITY

AND

CONFLICT

IN

CAR0CameroonChadROCLiberiaSierra

LeoneCARFCV

average

SSA

averageSTATEACTORSCenter-peripheryrelationshipsSource:

HumanCapitalIndex2020CountryData.CollaborationorcontestationSociallegitimacyordisobedienceUnsurprisingly,

CAR

performs

poorly

on

all

six

of

the

HCI

component

indicators,

reflective

of

the

serious

systemicissuespresentandachroniclackofinvestmentinhumancapitalkeysectors.State

presenceand

insecurityInhealth(WorldBank2021a):•••Eighty-eight

(88)

percent

of

children

born

in

CAR

survive

to

the

age

of

five.

This

is

lower

than

the

averagesurvival

rates

of

SSA,

CEMAC,

and

FCV

countries.

Contributors

to

child

mortality

include

food

insecurity,inadequate

feeding

practices,

lack

of

hygiene

and

access

to

safe

water,

female

illiteracy,

early

pregnancy,

andlow

access

to

essential

health

and

nutrition

services

and

commodities.

Public

investments

will

have

to

bemadeonhealth,socialsecurity,andeducationtoreduceCAR’schildmortality.Natural

resourceand

elite

captureEXTERNALACTORSCITIZENSPorous

bordersInCAR,59percentof15-year-olds

willsurvive

untilage60,

oneofthelowest

adultsurvivalratesintheworld.In

2019,

the

average

for

FCV

and

SSA

countries

was

77

percent

and

73

percent,

respectively.

Prevalent

causes

ofhigh

adult

mortality

in

CAR

are

preventable,

treatable,

and

curable—reflective

of

the

historic

underinvestmentin

the

country’s

health

system.

Among

the

major

causes

of

adult

mortality

are

conflict,

HIV/AIDS,

malaria,malnutrition,andtuberculosis.ExtractionandexploitationPeacemakeroragitatorInterestrepresentationARMEDGROUPSHealthygrowth(notstuntedrate)inCARis60.2

percent(MICS2018,20194),whichmeansthatfouroutoftenchildren

under

five

years

of

age

are

stunted—higher

than

the

FCV

and

SSA

averages

in

2018.

These

childrenareatriskofcognitiveandphysicallimitationsthatcouldlastalifetime,thushamperingCAR’shumancapitaldevelopment.

The

primary

causes

of

stunting

are

a

lack

of

food

(quality

and

quantity),

frequent

illness,

poormaternal

and

childcare

practices

including

early

pregnancy

and

high

fertility,

inadequate

access

to

nutritionandhealthservices,andunhygienicenvironments.Source:

WorldBank2022.2Peer

countries

include

Economic

and

Monetary

Community

of

Central

Africa

(CEMAC

in

French),

as

well

as

fragility,

conflict,

and

violence

(FCV)countriesinSSA.See/en/situations/car1234/surveys13Ineducation,CAR’soutcomesdonotfaremuchbetter(WorldBank2021a):RecoveryandConsolidationPlanandtheMutualCommitmentFramework2017–2023

(Plan

de

Relèvement

et

deConsolidation

de

la

Paix

en

République

Centrafricaine

et

le

Cadre

d’Engagement

Mutuel—RCPCA-CEM).•A

child

who

starts

school

at

age

four

can

expect

to

complete

4.6

years

of

school

by

his

18th

birthday—half

the

SSAaverage.

Factoring

in

what

children

actually

learn,

they

receive

only

2.7

learning-adjusted

years

of

schooling,about

half

of

the

levels

in

peers

such

as

Cameroon

and

the

Republic

of

Congo.

In

terms

of

harmonized

testscores,

students

in

CAR

rank

369

on

a

scale

where

625

represents

advanced

attainment

and

300

representsminimumattainment.Moreover,

providing

public

goods

and

services,

especially

in

the

social

sectors,

will

be

crucial

to

restore

thelegitimacy

of

state

authority

in

CAR.

The

provision

of

public

service

delivery

signals

the

presence

of

the

stateand

could

improve

social

cohesion.

Addressing

grievances,

inequality

(especially

spatial

disparities

betweenBangui

and

the

provinces),

and

corruption

will

be

essential

to

strengthen

the

trust

CAR’s

population

have

intheir

government

and

to

help

establish

solid

foundations

for

social

contract

and

ensure

long-lasting

peace.

Thevicious

cycle

of

fragility,

inequality,

and

poverty

has

resulted

in

public

frustration

and

mistrust.

Expanding

publicservices—including

in

health

and

education—to

the

most

vulnerable,

including

IDPs,

youth-at-risk,

and

foodinsecurehouseholds,willbecritical(WorldBank2022).•The

drivers

behind

poor

education

performance

are

many.

Access

to

education

is

limited,

and

few

children,particularly

girls,

complete

primary

and

secondary

education.

Spending

on

education

is

low

and

insufficient

toaddress

sector

needs

such

as

teachers,

classrooms,

and

school

operating

expenses.

The

quality

of

educationis

extremely

poor.

Results

from

the

2018–19

Early

Grade

Reading

Assessment

(EGRA)

carried

out

in

Banguirevealed

that

the

proportion

of

students

who

could

not

read

a

single

familiar

word

in

French

in

one

minutewas57percentingrade2,41

percentingrade3,and20percentingrade4.Box

1.1.

How

can

human

capital

spending

be

protected

in

the

face

of

COVID-19?There

are

glaring

differences

in

access

to

basic

services

between

the

capital

of

Bangui

and

the

rest

of

the

country,fueling

tensions

and

feelings

of

social

exclusion.

District

administration

offices

are

understaffed

and

short

offunding—in

fact,

a

third

of

districts

indicated

not

having

received

any

budget

allocation

for

2016.

Most

districts

donot

have

security

staff.

Access

to

infrastructure—electricity,

mobile

phone

coverage,

banking

services,

and

roadnetworks—is

low.

For

instance,

only

10

percent

of

districts

have

network

electricity,

and

only

40

percent

of

districtcapitals

have

at

least

one

mobile

phone

provider

in

the

district

capital.

Half

of

the

districts

report

that

roads

toBangui

are

not

accessible

throughout

the

year.

Access

to

basic

social

services

such

as

public

primary

schools,health

centers,

and

clean

water

is

limited,

particularly

outside

district

capitals.

Even

in

the

10

largest

localities(villages/quartiers)

in

every

district,

only

half

have

a

functional

primary

school

and

18

percent

have

functionalhealth

centers,

implying

that

many

people

are

deprived

of

any

access

to

education

and

health

services.

Accessto

clean

water

and

sanitation

systems

is

a

challenge

even

in

the

district

capitals.

Only

36

percent

of

the

districtsreport

having

clean

water

access

points

in

the

capitals.

Several

provinces

in

the

country

have

been

economicallyand

politically

neglected,

leading

to

deep-seated

grievances

and

a

conducive

environment

for

the

emergence

ofarmedgroupsandconflict(WorldBank2022).The

pandemic

poses

substantial

risks

to

human

capital

through

several

pathways.

The

provision

of

basicservices

(health,

nutrition,

and

education)

has

been

disrupted.

Containment

measures

have

had

direconsequences

for

livelihoods

and

food

security.

Supply

disruptions

have

increased

the

price

of

essentialcommodities,

including

nutritious

food.

As

a

result,

the

COVID-19

crisis

is

expected

to

result

in

an

increasednumber

of

stunted

children,

as

well

as

widespread

learning

losses

as

children

have

lost

out

on

learningtime

due

to

school

closures.

Many

kids

may

never

return

to

school.

Global

poverty

is

expected

to

rise

forthefirsttimeintwodecades.The

fiscal

impact

of

the

pandemic

is

already

leading

to

significant

budget

cuts

across

sectors,

includingeducation.

Education

budgets

declined

after

the

onset

of

COVID-19

in

65

percent

of

low-income

countries.Government

spending

on

health

and

social

protection

(SP)

is

expected

to

decline

in

many

countries

asoverallfiscalcapacityshrinksunlessgovernmentscantakestepstoprotectspendinginthosesectors.Sustainable

recovery

from

the

impa