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Among the poorest 20 percent of the population, almost two-thirds did not receive care, compared with 13 percent among the richest 20 percent of the population. Chapter 4 analyzes these trends and discusses a number of initiatives designed to improve coverage and quality of service. The chapter emphasizes the need for clearer standards and for greater transparency to strengthen accountability. Social Assistance As in health care, the coverage of social protection is high in some programs and low in others.

The quality of the targeting of these programs is analyzed in detail in Chapter 5. 7. A similar proportion implies a higher dollar value for the richer households. This probably implies that they use the MINSA hospitals for higher-cost interventions. 18 A World Bank Country Study than on its costs, and it is possible that the costs of improving the targeting of a program are greater than the additional resources that are transferred to the poor. Despite these limitations, three tentative conclusions can be drawn from the analysis in this section.

Unfortunately, the municipal investment did not materialize. The most significant change in spending after 2001 took place within the sectors. The programs created during the 1990s have been reduced to make space for significant increases in the payroll. In education, from 1999 to 2005 (estimates based on actual expenditures incurred until August), the payroll increased from 71 percent to 80 percent of total education expenditures. During this period, investments were reduced by 60 percent and the purchase of goods fell by 28 percent.

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