中非共和国主要人类发展部门的公共支出审查（英）

CENTRALAFRICANREPUBLIC PublicExpenditureReviewinKeyHumanDevelopmentSectors September2023 1 PublicDisclosureAuthorizedPublicDisclosureAuthorized 2 CENTRALAFRICANREPUBLIC PublicExpenditureReviewinKeyHumanDevelopmentSectors 3 TABLEOFCONTENTS ACKNOWLEDGEMENTS6 ABBREVIATIONS7 CHAPTER1.INTRODUCTION11 References17 CHAPTER2.MACRO/FISCAL19 2.1.Background20 2.2.RecentMacroeconomicTrendsandFiscalPolicy20 2.3.ConclusionsandRecommendations30 References33 CHAPTER3.PUBLICFINANCIALMANAGEMENT35 3.1.Introduction36 3.2.RecentHistoryofPublicFinancialManagementReforms37 3.3.Decentralization,Deconcentration,andPublicFinancialManagement38 3.4.BudgetPreparation,Approval,andEvaluation38 3.5.BudgetExecutionPerformance2017–2039 3.6.CorePublicFinancialManagementSystems42 3.7.Recommendations48 References51 CHAPTER4.EDUCATION53 4.1.Introduction54 4.2.OverviewoftheEducationSystem54 4.3.EducationSectorFinancing62 4.4.HumanResourceManagement73 4.5.FinancingNeedsandSustainabilityofPublicSpendingonEducation84 4.6.Recommendations89 4References95 CHAPTER5.HEALTH97 5.1.Introduction98 5.1.OverviewoftheHealthSectorinCARIncludingExistingGovernmentHealthPolicies,Plans,andStrategies98 5.2.StructureandOrganizationoftheHealthSector99 5.3.TrendsandStatusinHealthInputsandOutcomesinCAR100 5.4.Trend,Sources,andCompositionofTotalHealthExpendituresinCAR107 5.5.Equityinaccesstohealthservicesandfinancialprotection120 5.6.ImplicationsofCOVID-19forHealthFinancinginCAR124 5.7.OverviewofResultsBasedFinancingintheHealthSectorinCAR127 5.8.Recommendations129 References131 CHAPTER6.SOCIALPROTECTION133 6.1.Introduction134 6.2.OverviewofManagementandInstitutionalContextoftheSocialProtectionSector136 6.3.PublicExpenditureonSocialProtection141 6.4.Recommendations154 References157 APPENDIXES159 A1.Education160 A2.SocialProtection185 A3.Health190 REFERENCES208 5 ABBREVIATIONS 6 ThisreporthasbeenpreparedbyateamledbyYevgeniyaSavchenko.Theteamincluded(inalphabeticalorder)AyeshaKhanKaiser,BoubakarLompo,CristelleKouame,ElyséeAristideHoundetoungan,FriedaVandeninden,MarianneCaballeroParra,Pierre-EmmanuelCouralet,SoazicEliseWangSonne,andTomiDiderot.ThereportwaspreparedundertheguidanceofHanFraeters,AbdoulayeSeck,HalilDundar,MagnusLindelow,IffathSharif,FranciscoCarneiro,ManuelVargas,CarineClert,andCleliaRontoyanni.TheteamreceivedinvaluableadviceandsupportfromNathalieLahire,PhilippeAuffret,PaolaCerutti,MahokoKamatsuchi,DrissZineEddine,AvrilKaplan,GervaisYama,WilfriedKouame,OulaCoulibaly,MaudKouadio,ZoéAllier-GagneurandOulimataNdiaye.TheteamwouldalsoliketothankthepeerreviewersElenaGeorgieva-Andonovska,MelissaAdelman,EllenVanDePoel,BobanVarghesePaul,VolkanCetinkayaandYasuhikoMatsudafortheirveryvaluableinsights.TheteamwassupportedbyArseneGassyDjamba,ElifYukseker,InassAyoub–programassistants.Inaddition,theteamgreatlybenefitedfromconsultationswithkeypolicymakersandanalystsinCAR,includingofficialsfromtheMinistryofEconomy,PlanandCooperation;theMinistryofFinanceandBudget;theCentralAfricanRepublicInstituteofStatisticsandEconomicandSocialStudies;theMinistriesinchargeofEducation;theMinistryofHealth;andtheBankofCentralAfricanStates.MichaelAlwaneditedthereport,ValerieMolinatranslateditintoFrench,SarahAlameddineleditsgraphicdesign,andOdiliaHebgaprovidedcommunicationssupport. ACKNOWLEDGEMENTS ACCT-CentralTreasuryAccountingAgency[AgenceComptableCentraleduTrésor] ACS-Agentsandcivilservants AF-Additionalfinancing AFD-AgenceFrançaisedeDéveloppement AGETIP-CAF-CARAgencyfortheExecutionofWorksofPublicInterest AGIR-PublicExpenditureandInvestmentManagementReformProject[Projetd’AppuiàlaGestiondeDépensesetInvestissementsetauxReformes] AGR-Incomegeneratingactivities[ActivitéGénératricesdeRevenus] APPR-AgreementforPeaceandReconciliation ARMP-PublicProcurementRegulatoryAgency[Autoritéderégulationdesmarchéspublics] ARI-AcuterespiratoryinfectionsBMA-BanguiMetropolitanAreaCAR-CentralAfricanRepublic CEART-CommitteeofExpertsontheApplicationoftheRecommendationsconcerningTeaching CEM-MutualCommitmentFramework[Cadred’EngagementMutuel] CEMAC-EconomicandMonetaryCommunityofCentralAfrica CFA-Compulsoryfinancingarrangements CFAF-CFAfrancs CHI-Compulsoryhealthinsurance CHW-Communityhealthworkers CIFS-Inter-ministerialUnitforSSNCoordination[CelluleInterministérielledeCoordinationdesFiletsSociaux] CKD-Chronickidneydisease CNSS-NationalFundforSocialSecurity[CaisseNationaledeSecuritéSociale] COFOG-ClassificationoftheFunctionsofGovernment CPR-Teachertrainingcenter[CentresPédagogiquesRégionaux] CRD-CommitteefortheManagementofComplaints[ComitédeRèglementdesDifférends] CT-Cash-transfer DALYs-Disability-adjustedlifeyears DGBS-GeneralofScholarshipsandInternships DGESP-GeneralDirectorateforStudies,Statistics,andPlanning[Directiongénéraledesétudes,desstatistiquesetdelaplanification] DGMP-GeneralDirectorateforProcurement[DirectionGénéraledesMarchésPublics] DH-DistrictHospital DPMP-DirectorateofProcurementManagementPolicy DPF-DevelopmentPolicyFinancing DRG-Diagnosticrelatedgroup DRM-Domesticresourcemobilization EBESP-EmergencyBasicE