Towards a Common Framework of Performance Measurement for Social Assistance Programs in Low-Income Countries in Transition: Rationale and Potential Structure

After the dissolution of the former Soviet Union, low-income countries in transition: Armenia, Azerbaijan, Georgia, Kyrgyzstan, Moldova, Tajikistan, and Uzbekistan have faced challenges of widespread poverty and sharp inequality. To reduce poverty and inequality, this group of countries, also known as CIS-7, has committed to rapid reforms in social assistance programs. This article proposes a new Common Framework of Performance Measurement for social assistance programs in CIS-7 countries that allows social administrators and policymakers to assess the performance of social assistance programs for the purposes of management improvement, encouraging accountability, and promoting benchmarking. Combining efficiency, quality, and effectiveness perspectives into a framework is a practical approach to assess the achievements of social assistance programs in CIS-7 towards poverty and inequality reduction

Social Assistance and the Challenges of Poverty and Inequality in Azerbaijan, a low-income country in transition

Although low-income countries in transition are facing the challenges of poverty and inequality, evidence on the performance of safety nets in these countries is scarce. This article uses micro-file data from a nationally representative household budget survey to analyze the existing social assistance programs in Azerbaijan, a low income country in transition, from the perspectives of poverty and inequality reduction. The empirical evidence presented in this paper indicates that the poverty and inequality reduction effectiveness of social assistance programs is inadequate. First, the benefits are very modest and the poor receive only a small proportion of them. Second, some programs are not aimed at poverty reduction by design. Third, the heterogeneous nature of poverty and the significant scale of shadow economy during transition make the identification of the poor complicated. Finally, the existing patchwork of numerous programs with small-scale benefits is costly and administratively demanding. A consolidated and better designed social assistance program is needed to effectively tackle the challenges of poverty and inequality in Azerbaijan

Social Assistance and the Challenges of Poverty and Inequality in Azerbaijan, a Low-Income Country in Transition Special Issue with Coping with Poverty

Although low-income countries in transition are facing the challenges of poverty and inequality, evidence on the performance of safety nets in these countries is scarce. This article uses micro-file data from a nationally representative household budget survey to analyze the existing social assistance programs in Azerbaijan, a low income country in transition, from the perspectives of poverty and inequality reduction. The empirical evidence presented in this paper indicates that the poverty and inequality reduction effectiveness of social assistance programs is inadequate. First, the benefits are very modest and the poor receive only a small proportion of them. Second, some programs are not aimed at poverty reduction by design. Third, the heterogeneous nature of poverty and the significant scale of shadow economy during transition make the identification of the poor complicated. Finally, the existing patchwork of numerous programs with small-scale benefits is costly and administratively demanding. A consolidated and better designed social assistance program is needed to effectively tackle the challenges of poverty and inequality in Azerbaijan

The Paradox of Institutional Trust and Entrepreneurship in Transitional Countries

The relationship between institutional trust and entrepreneurship is not straightforward but is intertwined with social context. This study explores this relationship by estimating the relationship between entrepreneurship and institutional trust together with a set of individual social demographics and the country of residence in 27 transitional countries in Eastern Europe and countries of the former Soviet Union using the data of the 2016 Life in Transition Survey (LiTS). The analytical framework in this study is that individuals make their decisions in choosing the type of employment by weighing the level of institutional trust in their communities, a set of democratic factors and social indicators.The results of our 2SLS estimations indicate a consistent negative association between institutional trust and entrepreneurship for all the sub-datasets. However, this cannot be interpreted as evidence for the negative effect of institutional trust on entrepreneurship. Given our analytical framework, this counter common-sense phenomenon would be interpreted as when the institutional trust was high, individuals would rather choose to have a paid job instead of running their own business in these transitional countries. This study provides evidence of how far these countries have gone on the path of transition three decades after the transition

Self-rated health and social capital in transitional countries: Multilevel analysis of comparative surveys in Armenia, Azerbaijan, and Georgia

The objective of this study is to analyze the effect of social capital on self-rated health in transitional countries of the South Caucasus region. The study is based on recent, 2009, cross-sectional nationally-representative surveys of 2082 respondents in Armenia, 2014 in Azerbaijan, and 1837 in Georgia with response rate of 78-80%. Two-level random-coefficient ordered logistic regression, modeling individual and community variations in subjective health was estimated to account for the hierarchical structure of the data set which includes individuals nested within communities. The results allow several interesting conclusions to be drawn. First, a proportion of the total variation in self-rated health explained at the community level is 0.23 for Azerbaijan, 0.10 for Georgia, and 0.08 for Armenia. These findings highlight the importance of more decentralized community-based healthcare interventions in the region. Second, human capital covariates remained significant predictors of health status even after controlling for social capital both at individual and community levels. Likewise, social capital variables are significant predictors of health status when used alone and when they are controlled by human capital covariates. These findings suggest that human capital and social capital influence health status independently of each other. Finally, this study sheds light on whether social capital collectively benefits members of a community in transitional countries beyond the individual benefits. In Armenia and Azerbaijan, community level differences in health status are rooted in "compositional" differences between social capital of individuals in the communities rather than at the community "contextual" level. In Georgia, by contrast, the beneficial effect of social capital can be simultaneously observed at the individual "compositional", and community "contextual" levels. These findings suggest that neither "compositional" nor "contextual" models of the social capital effect of health status can apply to all transitional societies universally.Armenia Azerbaijan Georgia Multilevel regression Health status Health policy Community-based health care Social capital Self-rated health Transitional countries

Out-of-pocket expenditures for primary health care in Tajikistan : a time-trend analysis

BACKGROUND: Aligned with the international call for universal coverage of affordable and quality health care, the government of Tajikistan is undertaking reforms of its health system aiming amongst others at reducing the out-of-pocket expenditures (OPE) of patients seeking care. Household surveys were conducted in 2005, 2007, 2008 and 2011 to explore the scale and determinants of OPE of users in four district of Tajikistan, where health care is legally free of charge at the primary level. METHODS: Using the data from four cross-sectional household surveys conducted between 2005 and 2011, time trends in OPE for consultation fees, drugs and transport costs of adult users of family medicine services were analysed. To investigate differences along the economic status, an asset index was constructed using principal component analysis. RESULTS: Adjusted for inflation, OPE for primary care have substantially increased in the period 2005 to 2011. While the proportion of patients reporting the payment of informal consultation fees to providers and their amount were constant over time, the proportion of patients reporting expenditures for drugs has increased, and the median amounts have doubled from 5.3 US$to 10.7 US$. Thus, the expenditures on medicine represent the biggest financial burden for patients accessing a primary care facility. Regression models showed that in 2011 patients from the most remote district with spread-out villages reported significant higher expenditures on medicine. Besides the steady increase in the median amount for OPE, the proportion of patients reporting making an informal payment to their care provider showed great variations across district of residence (between 20% and 73%) and economic status (between 33% among the 'worst-off' group and 68% among the 'better-off' group). CONCLUSIONS: In a context of limited governmental funds allocated to health and financing reforms aiming to improve financial access to primary care, the present paper indicates that in Tajikistan OPE – especially in relation to expenditures for drugs – have increased over time, and vary substantially across geographical areas and economic status. The fact that better-off households report disbursing more and in higher proportions hints towards a discrimination along the capacity to pay from providers. Increased public investments in the health sector, incentives for family doctors to provide PHC services free of charge and a strengthened drug control and supply system are necessary strategies to improve access of patients to services