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Deficit in education, health, services weighs down CCT
SOCIAL WATCH Co-Convener Marivic Raquiza considers it very one-sided
that the government monitors compliance by beneficiaries the so-called
demand side of the Conditional Cash Transfer (CCT) program, but not the
supply side, which the national and local government should take care of.
After all, a lack in the latter would make it harder for the beneficiaries to
comply with the conditions tied to their cash grants and for the governments
stop-gap poverty alleviation program to meet its goals.
If we want the participants to do their end of the bargain, says Raquiza,
government should do its end of the bargain. And that has to be
monitored.
That, however, could take some doing. As of last January, the CCT was
already being implemented in about 98.7 percent of the countrys provinces,
half its cities, and 62 percent of its municipalities. But by the assessment of
the Department of Social Welfare and Developments (DSWD), which is the
head agency in implementing the CCT, education facilities are often
inadequate if not totally absent, and health and education personnel and
supplies scant in majority of the CCT areas.
This has led many observers and development experts to say that the haste
in which President Benigno Simeon Noynoy C. Aquino III, as well as his
immediate predecessor Gloria Macapagal Arroyo, has expanded the CCTs
scope not only seems to defy logic, but could also end up counterproductive.
Indeed, almost three years ago, Philippine Institute for Development Studies
(PIDS) senior research fellow Dr. Gilberto Llanto had warned the then Arroyo
government against a rapid expansion of the CCT given the limited fiscal
space. Instead, he said, the government should sit down and look at both
supply and demand issues so people can start talking about absorptive
capacity and other things.
But the Arroyo administration failed to heed his advice, and the Aquino
government has since followed the lead of its predecessor. Since 2008, the
number of CCT beneficiary-families has increased annually by more than half
a million on average, and there seems no stopping that trend.
Today the program that began with just 4,459 beneficiary-families in March
2007 now has about 1.4 million. The government wants that figure to reach
2.3 million by this December, a number that is nearly seven times the
programs beneficiaries in 2008.
Full throttle
The government is racing ahead and we were running behind it, says Bert
Hofman, country director of the World Bank, which has been financing earlier
CCT programs in other countries like Brazil and Mexico. That, I think, is a fair
way of putting it.

The initiative, he says, was supposed to start very slow. So when the
Philippine government began expanding its CCT program sometime in 2009,
Hofman says that even officials of the international lending institution got a
little nervous.
According to the World Bank executive, the move diverted from the original
plan, which was to evaluate (the initial run of the program) and test the
proceduresand then gradually expand it.
In fact, DSWD had originally planned the CCTs yearly expansion at a much
more conservative 350,000 beneficiary-families at a cost of around P5 billion
each time. Even then, the agency was already struggling to cope with the
onslaught of additional duties that each batch brought in.
Hofman, however, says that when food and fuel crises struck the country in
2008, it became such an urgency to have a better social protection
system. By the next year, he says, the Philippines was asking the World
Bank for a loan to finance part of the rapidly expanding CCT.
Apparently, the Arroyo government wanted CCT beneficiary-families to reach
one million by the end of that year. But it would not reach the target within
that time frame; DSWD records show only 665,542 beneficiary-families in the
program by end-2009, for which a total of P8.3 billion was disbursed. The last
budget signed by Arroyo meanwhile would include a P10-billion allocation for
the CCT, or an eight-fold rise in just three years.
A DSWD insider says people at the agency had been surprised by then
President Arroyos announcement of having a million CCT families within
2009. But since it was the year before national elections were to be held, the
insider figures the decision may have been politically motivated.
Funds ready but
That theory was echoed by World Bank officials in Manila, according to an
Aquino Cabinet secretary. The loan for the expanded phase of the CCT was
ready for release in early 2010, or during the last months of the Arroyo
administration, but the Aquino Cabinet member says that the Bank decided
to buy some time before releasing the money. As the official recalls it, the
unsaid argument was that since the May 2010 elections would surely usher
in a new government, it would be better that the funds not be used to prop
the campaign of the Arroyo-backed candidates.
Interestingly, the DSWD personnel also thinks politics is behind President
Aquinos move to expand the program even more, as soon as he came to
Malacaang in June 2010. This is despite the fact that save for the
Autonomous Region in Muslim Mindanao (ARMM) the country is not going to
have elections until 2013 yet.
DSWD Secretary Corazon Dinky Soliman says, though, The reason why we
continued and expanded it to bigger numbers is because (considering) the
sheer number of those in need, of the impoverished, we needed to do a
strategic intervention on two key areas of concern that will help very poor
families move out of poverty. Thats education and health.
Another reason, says Soliman, is that the government is trying its best to
meet the Millennium Development Goals (MDGs), which include poverty

alleviation, as well as specific health and education targets, by a 2015

deadline.
Politics & poverty
Llanto of PIDS himself concedes that through the CCT, Aquino has been able
to respond effectively to the political challenge of addressing the immediate
needs of those who have put him in power.
Albay Governor and CCT advocate Jose Joey Salceda also argues that at the
very least, the program fulfills the satisfier variable for any development
intervention: First (people) must be alive. If (they) dont survive now, what
achievement are we talking about?
World Banks Hofman, for his part, says that the available evidence from
other countries CCT programs is enough proof that this type of program
really meets what the Philippines wants for their social protection system.
The question, he says, is not so much about whether it is the right thing to
do or not, but about the logistics of expanding the program in such a rapid
manner. Still, he is quick to add, initial evaluation reports commissioned by
the World Bank last year have given it confidence that the program would
work. (See Sidebar)
For all that, the governments folly of putting the cart before the horse seems
to be already showing. Even the evaluation reports cited by Hofman note
problems in the programs implementation among the mixed outcomes.
Done on selected pioneer CCT areas or those that were included in the very
first phase of the program in 2008, the reports were aimed at further
improving the program as it is being implemented, says Hofman. He also
clarifies that they were not a final evaluation or bottom line of the
(program).
Ateneo de Manila Universitys Institute of Philippine Culture (IPC) and the
Social Weather Stations (SWS) each conducted a study in early 2010 and
came up with similar observations. This was even though IPC looked into the
first 18 months of the CCT in six municipalities and three provinces from
January to May 2010 while SWS concentrated on CCT areas in Northern
Samar, one of the countrys poorest provinces, from January to March 2010.
Queries, glitches
Among IPCs findings was that even after having been part of the program
for a significant period of time, member households in general remained
lacking in knowledge of the details of the various conditions they were
supposed to meet. Some had even proceeded to create additional
conditions, such as maintaining a backyard vegetable garden, avoiding
gambling, and paying school fees in full.
Many queries from beneficiaries regarding various issues (ranging from the
cash grants to updates in household composition) also often went
unanswered by local and central government personnel alike, says the study.
But perhaps among the more basic glitches in the program found by IPC was
the exclusion of several families more deserving of being CCT beneficiaries

than those selected. In large part, this was because members of many
excluded households were not in their homes, but most likely out working at
the time of the survey to select the beneficiaries, the study says. Soliman
herself says that such targeting errors affected beneficiaries who began
receiving grants in 2008 and 2009.
Another possible factor that led to the exclusion of several deserving families
was the absence of a targeting system at the time. DSWDs targeting system
was installed only in the first quarter of 2009.
The database containing the names of those considered eligible for the CCT
will also be completed only this year even as the program is being
expanded at its fastest clip yet, and the DSWD is adding more beneficiaryfamilies than ever before.
As well, the DSWD happens to be still in the process of completing its SupplySide Assessment (SSA) in CCT areas. And yet there are already indications
that many of the programs beneficiaries may be receiving substandard
education or would be hardpressed in finding medical personnel to help them
fulfill the conditions enabling them to receive grants.
For instance, the DSWD has found that an overwhelming majority of
elementary schools in CCT places are not meeting seven out of the nine
quality benchmarks set by the Department of Education (DepEd). Majority of
municipalities and cities with CCT programs are also not meeting all three
benchmarks on health personnel set by the Department of Health (DOH).
Textbooks lack
So far, too, the DSWD has found a serious shortage of textbooks in all five
core elementary subjects. The biggest shortfall is in science textbooks, with
more than nine out of 10 municipalities/cities surveyed failing to meet
DepEds standard of one textbook per pupil. Eight out of every 10
municipalities/cities also do not have adequate textbooks in English, Math,
Filipino, and HEKASI. Only one out of every 10 municipalities, moreover, is
able to provide DepEds standard of two deworming pills per student.
In general, CCT areas are faring well in only two education indicators: the
teacher-to-pupil ratio and the classroom-to-student ratio. DSWDs figures
show that about nine in 10 CCT areas covered by the SSA so far have an
adequate number of teachers and classrooms based on DepEds standard of
one teacher per 45 students and one classroom per 45 students. And yet it
is highly possible that these healthy ratios were achieved only because in
many areas with huge student populations, public schools conduct two to
three shifts of classes for the same grade levels.
When it comes to health services, the SSA reveals that majority of CCT
municipalities and cities surveyed are short of health personnel. Only three
in every 10 CCT areas, in fact, have enough doctors (at least one doctor per
20,000 people). Only four in every 10 areas have an adequate number of
nurses (at least one nurse for every 20,000 people) and midwives (at least
one per 5,000 people).
Providing education and health facilities and services, though, is beyond
DSWDs mandate. Thus, says the agency, it created a technical working
group composed of representatives from the DOH, DepEd, Department of

Budget and Management (DBM), and the Department of the Interior and
Local Government (DILG) in order to find ways to address the identified
gaps on supply side. In addition, it says, its Regional Project Management
Team continuously engages the LGUs to address supply gaps.
DepEd Undersecretary for Legal and Legislative Affairs Alberto Muyot says
that the CCT areas are more or less, consistent with (DepEds) 40 priority
divisionswhere (DepEd) will focus (its) resources. These divisions are
being prioritized, he explains, because these are the areas scoring low on
achievement tests. 4Ps public relations officer Pamela Susara also says that
DepEd has already earmarked a certain portion of its 2011 budget for
additional classrooms, textbooks, and teachers in CCT areas.
The DOH has also partnered with local government units in implementing a
project dubbed Registered Nurses for Health Enhancement and Local
Service or RN HEALS. Under the project, 10,000 skilled nurses will be
hired and deployed for one year to 1,221 rural unserved or underserved
communities. The DOH will share the cost of providing the monthly cash
allowances for these nurses with LGUs. But it will be LGUs that will
supervise, provide board and lodging, and ensure the safety and security of
deployed nurses.
More effort, resources
Still, the huge gaps in the delivery of the most basic health and education
services point to the need for much more effort as well as more resources.
The SSA results even show that shortages afflict not only the poorest
provinces, but also the more affluent areas.
One striking example is the National Capital Region (NCR), which is usually
ranked among the countrys least poor areas. In all the four NCR districts
covered during CCTs phase two, a whopping eight out of every 10
elementary schools failed to meet DepEds pupil-to-classroom standard;
almost nine in 10 did not meet the pupil-to-science textbook standard.
Less of a surprise is the case of Zamboanga del Norte, which is among the
poorest provinces in the Philippines. Nearly every other resident there is
considered income poor. In all that provinces 13 municipalities that were
covered in the CCTs first phase, not a single elementary school met DepEds
textbook-to-pupil standard ratio. Neither did any municipality there meet the
standard doctor-to-population ratio set by the DOH, according to DSWDs
SSA.
The SSA for health, meantime, revealed peculiar results. Among the regions
covered in CCTs phase two, for example, Region I ranked consistently the
highest in terms of adequacy of health personnel (doctors, nurses, and
midwives). And yet, not a single province there was able to administer
enough vaccines for children below one year to meet the DOH standard.
By contrast, a 2009 World Bank policy research report says that in countries
where CCT programs have been deemed successful, initiatives to improve
access to, and coverage of, education and health services were implemented
in parallel with or as an integral part of the CCT.
In Mexico, for example, the governments efforts to improve educational
services included rehabilitating 50,000 schools, giving grants to parent

associations to pay for minor classroom maintenance and repairs, and

constructing secondary schools.
In Bangladesh, government spending on education almost doubled as a
proportion of social sector spending since the 1980s. Says the World Bank
report: This has allowed for a significant expansion in the capacity of the
schooling system.
The United Nations Food and Agriculture Organization (FAO) has also warned
against the phenomenon of the tail wagging the dog. FAO was referring to
the tendency of some governments to treat the CCTs as a complete solution
to the problem of inequities in human capital, thus taking resources and/or
attention away from essential investments in health and education which
may be the only way to sustain the long term investment in human
resources required to reduce poverty.
But the Aquino government seems to have finally woken up to the reality of a
yawning gap between demand and supply in the CCT and has been playing a
furious game of catch-up. At DepEd, for instance, Muyot says the agency will
fast track the construction of classrooms by encouraging investments
from the private sector either through outright grants, soft loans, or other
forms.
He also says that DepEd is entering into partnerships with local government
units (LGUs) for the construction of school buildings. The LGU will manage
the actual construction, Muyot says, while DepEd will monitor whether the
LGU is able to comply with its quality standards. Construction costs would be
shared by the LGU and DepEd.
Not to be outdone, the DOH is reportedly proposing health projects to the
Public-Private Partnership (PPP) Center, an attached office of the National
Economic and Development Authority (NEDA) tasked to coordinate and
monitor PPP programs and projects. These include the modernization of
public hospitals and the development of vaccines.
Just last May 13, too, Aquino signed Executive Order No. 43, which aims to
rationalize the Cabinet into clusters according to the administrations key
priority areas.
The cluster that will take charge of Aquinos anti-poverty efforts is dubbed
the Human Development and Poverty Reduction cluster and will be
composed of 14 government agencies. The DSWD secretary will lead the
cluster as its chair, while the National Anti-Poverty Commission (NAPC) will
serve as secretariat.
Cluster members are the chairpersons of the Housing and Urban
Development Coordinating Council (HUDCC) and the Commission on Higher
Education (CHED); and the secretaries of Education, Health, Agrarian Reform,
Agriculture, Environment and National Resources, Labor and Employment,
Interior and Local Government, Budget and Management, and NEDA.
It remains to be seen if all these moves would enable to solve the CCTs
supply-side problem. Obviously, though, CCT advocates here would rather
look at the bright side. Hofman, for one, underscores the positive outcomes
listed by the World Bank-commissioned studies, particularly better school

attendance and health-seeking behavior, as well as a decline in the incidence

of child labor.
Proclaiming these outcomes as much better than expected, Hofman says
that the Philippines is rolling out the CCT at par or even better than the
mature programs in Latin American countries.
But he also says, Whether people in the end live a richer and happier life
that, of course, is a longer-term perspective. PCIJ, May 2011