103
PSP Discussion Paper Series
19713
January 1997
Who Uses Basic Services in Rural El Salvador?
Florencia Castro-Leal
Kalpana Mehra
January 1997
-Poverty and Social Policy Deparment
Human Capital Development
The World Bank
PSP Discussion Papers reflect work in progress. They are intended to make lessons emerging from the I
current work program available to operational staff quickly and easily, as well as to stimulate discussion i
and comment. They also serve as the building blocks for subsequent policy and best practice papers. The
views expressed here are those of the authors and should not be attributed to the World Bank or its Board
of Executive Directors or the countries they represent.
ABSTRACT
Recent policy changes in El Salvador have laid the basis for sustained growth.
However, poverty is still widespread and inequality appears to be increasing. To address
this situation, the poor need to have access to the benefits of growth. In particular, public
investments in human capital and basic infrastructure need to be targeted to the poor in
disadvantaged areas. This paper examines the use of basic services in rural El Salvador.
It provides information on the regional distribution of disadvantaged groups across El
Salvador, contrasting the use of basic services by poor and non-poor groups in the rural
and the urban areas and in San Salvador. This study also investigates inequality in the
distribution of basic services in rural areas.
The analysis suggests that rural areas in El Salvador urgently need improved
infrastructure, particularly those hit hardest by the civil war are lagging considerably
behind. Regionally, the poorest regions, rural Central II and rural Eastern, have the worst
coverage of basic infrastructure. The study shows that primary school attendance is
extremely low among rural children. The main constraint is high school expenses. Thus,
reducing the burden of direct costs of primary education on rural families with primary
school-aged children is crucial for improving this indicator. The study also shows that
EDUCO schools reach the poor but not the poorest rural children. Improved targeting of
the EDUCO program implies correcting for undercoverage of poor children and
simultaneously cutting down leakage to non-poor children. The study notes that public
health services are not targeted to the poor or disadvantaged areas. Improved access to
affordable health care services is an urgent need of poor rural children. Finally, the study
reviews the various public food programs and finds that targeting is almost non-existent.
Redesigning these programs can enhance the benefits to the poor and improve their cost-
effectiveness.
ACKNOWLEDGMENTS
This study is a backgrournd paper to the Rural Study in El Salvador, currently in
progress, being prepared at the request of the Government of El Salvador by the World
Bank in cooperation with the Ftndacion Salvadorena para el Desarrollo Economico y
Social (FUSADES).
The authors gratefully acknowledge the support received from Cora Shaw and
Ana Maria Arriagada in producing this paper. The authors also wish to thank i:he
generous and timely information provided by Diane Steele on the health and education
modules of the El Salvador national household survey, as well as her helpful comments
on an earlier draft, and by Susana Sanchez on rural credit and the distribution of
provinces in El Salvador. Many thanks to Precy Lizarondo for providing quick and
efficient word processing assistance.
The views expressed in this study are those of the authors and should not be
attributed in any manner to the World Bank, to members of its Board of Executive
Directors, or to the countries they represent.
ii
CONTENTS
ABSTRACT ..............................................................i
ACKNOWLEDGMENTS ............................................................. ii
CONTENTS .............................................................. iii
I. INTRODUCTION ..............................................................1
II. EDUCATION ..............................................................3
More than one-third of the rural population cannot read and write ..................................3
Females in rural areas have had the highest increase in years of schooling, but both
males and females in rural areas have the lowest average overall ....................................4
Primary school students older than the appropriate age group prevail across
all income groups and regions ...............................................................5
The poorest girls in rural areas are more likely to attend primary school than
boys but least likely to continue into secondary education ............................................6
School enrollments are strongly pro-poor at the primary level only ................................7
EDUCO schools reach the poor but not the poorest rural children ..................................8
EDUCO schools need to increase enrollments among the poorest rural children,
particularly in the Central II and the Eastern regions .......................................................9
More than one-third of rural poor primary school-aged children are out-of-school ....... 10
Almost half of rural poor primary school-aged children who are out-of-school report
that school expenses are too high ...................... ....................................... 1I
III. HEALTH ............................................................. 13
Public health services are not targeted to the poor or to disadvantaged areas ................ 13
Poor rural children are three times more likely to be ill than the non-poor while
social security is almost as unequal as household income ........................................... 14
IV. BASIC NEEDS ............................................................. 16
The rural poor in El Salvador have the worst basic needs indicators . ............................. 6
All rural families in El Salvador are severely underserved by basic infrastructure ........ 16
Rural areas in the poorest regions of El Salvador, Central II and Eastern,
have the worst coverage of basic infrastructure ............................................................ 17
iii
V. IN-KIND TRANSFERS .......................................................... 19
Targeting of public food programs to the poor is almost non-existent ........................... 19
Almost half of all in-kind transfers to, rural areas are in food and of these
more than half go through the school feeding program, but this program is not
targeted to the poor .......................................................... 19
Less than one-tenth of beneficiaries of the school feeding program are in the
Central II, the poorest region, but almost half are in the Eastern, the second
poorest region ........................................................... 21
VI. POLICY IMPLICATIONS .......................................................... 22
REFERENCES .......................................................... 25
APPENDIX A .......................................................... 26
iv
I. INTRODUCTION
Recent policy changes in El Salvador have laid the basis for sustained growth.
However, poverty is still widespread and inequality appears to be increasing. To address
this situation, the poor need to have access to the benefits of growth. In particular, public
investments in human capital and basic infrastructure need to be targeted to the poor in
disadvantaged areas.
This paper examines the use of basic services in rural El Salvador. A Benefit
Incidence Analysis of public services was not elaborated because of the lack of
information on per unit public spending within each sector. The distribution of public
spending across different socioeconomic groups and regions can be analyzed when two
main sources of information are brought together. First, utilization patterns of public
services. Second, the allocation of government resources within each sector. The
determinants of the use of basic services are not analyzed since the household surveys did
not contain information on the quality and price of basic services.
This study examines the use of basic services in rural El Salvador. It uses the
1994-III Encuesta de Hogares de Propositos Multiples (EHPM) to contrast utilization
patterns of public services in rural and urban areas and in San Salvador, disaggregated
into poor and non-poor groups.1"2 Thus, it provides information on the regional
distribution of disadvantaged groups across El Salvador. The paper also investigates
inequality in the distribution of basic services within rural areas by socioeconomic group.
It uses the 1996 Encuesta Rural to analyze the degree of targeting of basic services across
income quintiles in rural areas.3'4'5
I EHPM 1994-III is a nationally representative sample of El Salvador containing 4,220 households and
19,914 individuals.
2 The poverty lines used for EHPM are 325 colones per person per month for those households covered by
the long consumption questionnaire, and 286 colones per person per month for those covered by the short
questionnaire. The welfare measure for ranking individuals in EHPM is total household expenditure per
capita. The national poor are the poorest 40 percent of all individuals who fall below these poverty lines,
which is the percentage of the population reported as being poor by Lanjouw (1996).
3 The Encuesta Rural is a representative sample of rural areas in El Salvador containing 738 households
and 4,349 individuals.
4 We use income and expenditure interchangeably throughout the paper, but bear in mind that the welfare
measure used for ranking individuals is total household expenditure per capita for EHPM and total
household income per capita for the Encuesta Rural. Therefore, poor and non-poor groups from the
national survey are not strictly comparable with these same groupings in the rural survey.
5 Inequality in rural areas is analyzed by creating income quintiles through ranking every individual from
the poorest to the richest and then dividing the population into five groups each containing exactly 20
percent of all individuals. Thus, the poorest income quintile contains the poorest one-fifth of the
population while the richest income quintile contains the richest one-fifth of the population. The welfare
measure for ranking individuals in the Encuesta Rural is total household income per capita per annum.
I
This paper looks at educational indicators in Section II. Health indicators are
explored in Section III. Section IV looks at basic needs. In-kind transfers are analyzed in
Section V. The last Section discusses the most relevant policy implications coming from
this study.
The Encuesta Rural did not have a household consumption expenditure module. When referring to the
rural poor, we refer to the poorest two quintiles or poorest 40 percent of all individuals. The level of
income per person per annum at this poverty cut-off is 1975 colones (see Lopez, 1996).
2
II. EDUCATION
* More than one-third of the rural population cannot read and write
More than one in three rural inhabitants in El Salvador older than ten years old
cannot read and write, compared to less than one in ten in San Salvador and less than one
in five in other urban areas (see Figure 1). The poor in rural areas fare even worse, more
than 40 percent of them are illiterate.
Figure I
Illiteracy rate for poor and non-poor, 1994
by area of residence
(percentage)
45
40
~35
~25
1.5
Rural Other San El
Urban Salvador Satvador
; Poor g Non-poor mAll
Source: Annex Table A. 1 (EHPM, 1994-III)
Almost half of the poor population in the Eastern region cannot read and write
(see Figure 2).6 This group has the highest illiteracy rate in El Salvador. Among all
regional poor and non-poor inhabitants in El Salvador, illiteracy rates are highest in the
Eastern and the Western regions, 33 and 29 percent respectively. Literacy programs need
to target the rural population, particularly the poor in Eastern El Salvador.
6 This paper uses the five regional division with the following departments: Western = Ahuachapan, Santa
Ana and Sonsonate; Central I = Chalatenango and La Libertad; Central II = Cuscatlan, La Paz, Cabanas,
San Vicente; Eastern =- Usulutan, San Miguel, Morazan and La Union; and, San Salvador
3
Figure 2
Illiteracy rate for poor and non-poor, 1994
by region
(percentage)
45 __ _ _ _ _ _ _ _ __ _ _ _
i -, 40
35I
3D0 itI
25
-~20
T
10
0
jPoor giVon-poor gAll
Source: Annex Table A.2 (EHPM, 1994-111)
* Females in rural areas have had the highest increase in years of schooling, but
both males and females in rural areas have the lowest average overall
The gender gap in mean years of schooling has almost closed in rural areas.
Females in rural areas aged between 15 and 34 years old have attended school for 3.6
years, on average, compared to 3.8 years attended by males in the same age group (see
Figure 3). Gender disparities for the older age group, those aged 35 years or more, are
the widest in rural areas.
Overall, the younger age group in rural areas has achieved the highest increase iin
mean years of schooling compared to San Salvador and to other urban areas. Those in
the younger age group have attended almost four years of school compared to about a
year and a half among those in the older age group. However, the average number of
years in school for the younger group in rural areas lags behind by three and by five years
compared to the younger groups in otheir urban areas and in San Salvador, respectively.
Thus, it is crucial to put in place incentives for retention in rural primary schools.
4
Figure 3
Mean years of schooling for adults in two age groups, 1994
by area of residence and gender
10
9 8~~~~~~~~~~~~~~.2
8 ~~~~~~~~6.9
7'
6 UMate
L. A~~~~~~~.
2 3.6 Femal
0
35+ 15-34 35+ 15-34 35+ 15-34
Rural Other urban San Salvador
Area of residence and age group
Source: EHPM (1994-111)
Primary school students older than the appropriate age group prevail across al
income groups and regions
Gross enrollment rates at the primary level in El Salvador are considerably higher
than net enrollment rates across all income groups and regions (see Table 1). This
indicates that many of the school places are filled by students who are older than the
appropriate age group. Thus, the primary education system in El Salvador needs to
improve internal efficiency by promoting early enrollment and decreasing repetition rates
across the country, but focusing particularly on the rural poor.
Attending primary school at an older age has a particular perverse impact on the
poor by decreasing completion rates in this educational level and lowering enrollments in
the following educational cycle. High gross enrollment rates in primary school are a
disincentive for the poor because poor children are often needed to help to support the
household. In El Salvador, net and gross enrollment rates in secondary school are
considerably lower among the poor compared to the non-poor (see Table 1). In addition,
gross enrollment rates in secondary education are higher arnong non-poor students and
students from better-off regions. This indicates that non-poor students proceed to higher
educational levels even at an older age than the appropriate age group.
5
Table I
Net and gross enrollment rates in pre-school, primary and secondary, 1994
for poor and non-poor by area of residence
(percentage)
Area of Net Enrollment Rates Gross Enrollment Rates
residence Pre-schooll Primary Secondary Pre-schooll Primary |secondary
ural
poor 12 70 15 12 96 25
non-poor 20 83 34 20 ]11 54
all 14 74 22 14 101 35
Other urban
poor 17 80 30 17 105 50
non-poor 37 89 52 37 114 85
all 29 86 45 29 111 74
San Salvador
poor 32 86 23 32 120 46
non-poor 52 90 56 52 110 83
all 50 89 53 50 11] 79
El Salvador
poor 14 73 19 14 99 31
non-poor 38 88 48 38 112 75
all 26 81 35 26 106 55
Source: EHPM (I 994-Ill)
Notes:
(a) Net enrollment rates in pre-school, primary and secondary: 4 to 6, 7 to 12 and 13 to 15 year olds
enrolled in pre-school, primary and secondary, respectively, as percentage of 4 to 6, 7 to 12 and 13 to 15
year old population, respectively.
(b) Gross enrollment rates in pre-school, primary and secondary: All children enrolled in pre-school,
primary and secondary as percentage of 4 to 6, 7 to 12 and 13 to 15 year old population, respectively.
(c) Net and gross enrollment rates in pre-school are the same because EHPM did not report any children
younger than 4 or older than 6 years old attending pre-school.
* The poorest girls in rural areas are more likely to attend primary school than boys
but least likely to continue into secondary education
Poor girls in rural areas are more likely to attend primary school than poor boys.
The net enrollment rate for the poorest girls in primary education is ten percentage points
higher than the rate for the poorest boys (see Table 2). However, poor girls in rural areas
are least likely to continue into secondary education than poor boys. This is an indication
that girls are more likely than boys to drop out of school as they get older. Thus, it is
crucial to put in place incentives for early primary school enrollment for all school-age
children in rural areas, but particularly pay attention to the retention of the poorest girls.
6
Table 2
Net enrollment rates in primary and secondary, 1996
by rural quintile and gender
(percentage)
Rural Primary Secondary
quintile Girls Boys Girls Boys
Poorest 77 67 13 18
69 64 13 16
77 75 21 21
78 79 39 23
l chest 79 93 43 22
- 11 Rural 77 74 25 23
Source: Encuesta Rural (1996)
* School enrollments are strongly pro-poor at the primary level only
The distribution of enrollments in 1996 by educational levels and across income
quintiles is shown in Figure 4 together with the Lorenz distribution of household income.
The diagonal line (or 450 line) is also known as the line of absolute equality since it goes
through those points where the cumulative share of the population equals the cumulative
share of household income.
Figure 4
Distribution of school enrollments and household income, 1996
by rural quintile
l=o
180
Primary
~:601
~ 401 f// / , . , ouseholdl
| o | // < ,<< ,' , ~income |
| 20 1 K Uiversity
' ~~ I~ D - ' , # igh-schoolIl
I % i // v --' . X - \, re-school
0 - Secondary
Quintiles
Source: Encuesta Rural (1996)
7
In 1996, enrollments at the primary educational level are strongly pro-po,or
because their distribution is above the diagonal line and the Lorenz curve; which means
that the poor's share of enrollments is larger than their population share. Enrollments at
the pre-school, secondary and high-school educational levels are weakly pro-poor
because their distributions are in between the diagonal line and the Lorenz curve;
therefore, the poor's share of enrollments is smaller than their population share 'but
relatively larger than their household income share. The distribution of enrollments in
university education is considerably more inequitable than the Lorenz distribution of total
household income.
* EDUCO schools reach the poor but not the poorest rural children
A larger proportion of poor children attend EDUCO schools compared to non-
poor children. However, only eight percent of the poorest children attend EDUCO
schools compared to 16 percent of children in the second quintile (see Figure 5).
Improved targeting of the EDUCO program in El Salvador implies correcting
undercoverage of poor children and simultaneously cutting down the leakage to non-poor
children.
Figure 5
Primary school children attending EDUCO schools, 1996
by rural quintile
('percentage)
Z 20 _ _,__
1 8~ 16
5 16'
14 14
12 I 10 10
10
.~8
~6~
41 2j
~2
0
Quintiles
Source: Table A.3
Note: Percentage share of all primary school enrollments in each rural quintile
8
* EDUCO schools need to increase enrollments among the poorest rural children,
particularly in the Central II and the Eastern regions
The Central II and the Eastern regions have the highest poverty rates for the rural
population as a whole and also the highest poverty rates for school age children (see
Figure 6). Almost two-thirds of rural children aged 7 to 10 years old are poor in the
Central II region and this proportion is more than half in the Eastern region. In addition,
together these two provinces contain about 60 percent of all poor rural children in the
primary school age group (see Appendix Figure A. 1).
Figure 6
Poverty rates for all andfor school-age children by rural region, 1996
(% ofpopulation and % of children 7 to 1O years old
in each rural region who are poor)
AU rural 49
t Western -8
t Centra/l 44
S.Central 11_ 64
Eastern 54_ _ 4 5
Rural S.S. 32
0 20 40 60 80 100
Poverty rate (percentage)
AIl * Children
Source: Encuesta Rural, 1996
EDUCO schools capture only 7 percent of primary school children in the Eastern
region and eleven percent in the Central II region (see Figure 7). Targeting these regions
Wan improve the poverty focus of the EDUCO program, but it will also be necessary to
geographically identify poor areas within these provinces.
9
Figure 7
Primary school children attending EDUCO schools, 1996
by rural region
(percentage)
All rural 10
> Western 10
Central I 1
v Centrali 11
Eastern _ 7
f
Rural S.S. 0
0 5 10 15 20
EDUCO enrollments (percentage)
Source: Table A.4
Note: Percentage share of all primary school enrollments in each rural quintile
* More than one-third of ruralpoor p,rimary school-aged children are out-of-school
Twice as many poor children aged between 7 and 10 years old in rural areas are
out-of-school as compared to non-poor children (see Figure 8). In addition, primary
school-aged children in rural areas are most likely to be out-of-school in contrast to those
in any other area of residence in El Salvador. One in every three poor primary school-
aged children is out-of-school in rural areas compared to two out of ten in other urban
areas and less than two out of ten in San Salvador.
10
Figure 8
Poor and non-poor children 7 to 10 years old who are out-of-school, 1994
by area of residence
(percentage)
I ~ 35~
30
l |25
20
t 'J 15
a 5
a 0
Rural Other San El
Urban Salvador Salvador
IPoor aNon-poor SAM
Source: Annex Table A.5 (EHPM, 1994-111)
a Almost hafof rural poor primary school-aged children who are out-of-school
report that school expenses are too high
The most important reason for being out-of-school for both poor and non-poor
children in rural areas is that school expenses are too high7. However, almost half of
rural poor primary school-aged children who are out-of-school report that school
expenses are too high (see Table 3). Improving primary school attendance among the
poor requires actions on both the demand for and the supply of education. Thus, easing
the financial constraints on the demand for education faced by poor households could
significantly increase their children's enrollments at the primary level.
Uniforms and stationary expenses for children attending primary schools in El
Salvador are seven times as large as school fees for the poor and three times as large for
the non-poor. Thus, an alternative for reducing the burden of direct costs of primarv
education on families with primary school-aged children, targeted particularly to the
poor, can be to provide school materials to and to ease requirements on wearing uniforms
in disadvantaged rural areas of the country.
7 The second most important reason for being out-of-school for both poor and non-poor children in rural
areas is that the age of the child is considered inappropriate. This is an issue to be further explored in rural
areas because the sample over which we analyzed the reasons for being out-of-school is already restricted
to children 7 to 10 years old, who are of primary school age.
11
Table 3
Reason for being out-of-schoolfor poor and non-poor children
7 to 10 years old in rural areas, 1994
(as % of non-enrolled in population group)
Reason for being out-of-school Poor Non-poor
Needed to work 0 0
School expenses are too high 45 39
School is too far 14 9
No teacher at school 0 0
School has closed 0 0
Repeated too many times I 0
It is not worthy 4 2
Age is inappropriate 15 28
No night school available 0 0
Completed education 0 0
Required at home 6 12
No subsequent grades available 0 0
Other 15 10
Total non-enrolled 100 100
Non-enrolled as percentage of 28 8
population group
Source: EHPM (1994-111)
Note: Sample is restricted to children 7 to 10 years old living in rural areas
12
III. HEALTH
* Public health services are not targeted to the poor or to disadvantaged areas
About one-fourth of the population in El Salvador uses public health services
when falling ill (see Table 4). However, poor and non-poor residents alike have about the
same utilization rates of these services within rural areas, within other urban areas and in
San Salvador. Thus, public health services are not targeted to the poor. Evenmore,
utilization rates are lowest for rural areas, second lowest for other urban areas and highest
for San Salvador. Rural residents, poorer than residents from other urban areas and from
San Salvador, have the lowest utilization rates of public health services.
Table 4
Illness rate and place of consultation, 1994
for poor and non-poor by area of residence
(percentage)
Area of Illness Place of consultation
residence rate None Private Public Other Allplaces
Rural
poor 33 10 7 21 62 100
non-poor 36 6 16 22 57 100
all 34 9 10 21 60 100
Other Urban
poor 28 11 6 27 57 100
non-poor 31 14 20 26 50 100
all 30 6 16 26 52 100
San Salvador
poor 26 5 5 30 61 100
non-poor 25 2 26 30 42 100
all 25 2 24 30 43 100
El Salvador
poor 32 10 7 23 61 100
non-poor 30 4 21 26 50 100
all 31 7 15 24 54 100
Source: EH-PM (1994-111)
Notes:
(a) Public = public health centers and public hospitals; private = private hospital/clinic, private doctor and nurse; and,
other = pharmacy, healer and self-medication.
(b) Illness rate is for last 30 days.
13
In rural areas the illness rate is the highest compared to other urban, second
highest, and San Salvador, the lowest rate. Although, more than one-third of the rural
population reported some type of illness, more than one-third of those falling ill do not
use modem health care. About one in every ten rural residents that reports falling ill does
not use any type of medical care and six out of ten use pharmacies, healers or self-
medication.
The Central II and the Eastem regions, the two poorest in El Salvador, have the
highest rates of illness (see Appendix Table A.6). Close to 40 percent and about 33
percent of the residents in these regions, respectively, report some type of illness.
Targeting mechanisms of public health services towards the poor and rural areas neecl to
be put in place. In addition to having the highest illness rates, these population groups
are severely undercoveraged by modem health services.
- Poor rural children are three times more likely to be ill than the non-poor while
social security is almost as unequal as household income
Rural children in the poorest income quintile are three times more likely to be ill
than children in the highest income quintile. Close to 30 percent of the rural poorest
children under ten years old report an illness that put them in bed for at least a week in
1995 compared to less than 10 percent of the richest children. Thus, the illness rate for
rural children is strongly pro-poor (see Figure 9). This means that the poor's share of
illness is larger than their population share by income quintiles. Graphically, the
distribution of the illness rate by quintiles is above the diagonal line and the Lorenz
distribution of household income.8 The illness rate for the rural population as a whole is
also strongly pro-poor.
8 The diagonal line (or 450 line) is also known as the line of absolute equality since it goes through those
points where the cumulative share of the population equals the cumulative share of household income.
14
Figure 9
Distribution of health indicatorsfor all ages and children under 10years old
and household income by rural quintile, 1996
100
I 80 Illness all
{ illness v '
$ 60 children I
40 S~~~~,
t - i, Household
I */ , , mincome
20j
o {wg b i Socialsecurity
Quintiles
Source: Encuesta Rural (1996)
By contrast, access to social security is weakly pro-poor. Only one in every ten
rural residents in the poorest income quintile has social security compared to four in
every ten for the population in the highest quintile. Thus, the poor's share of social
security is smaller than their population share but relatively larger than their household
income share. Graphically, the distribution of access to social security is in between the
diagonal line and the Lorenz curve.
High illness rates in rural and poor areas of El Salvador are compounded by lack
of targeting of public health facilities and by the scarcity of health care financing
mechanisms. The findings on illness rates and social security in rural areas by income
groups together with the patterns of health facility use indicate that the burden of
financing health care is higher on the household budgets of the poor than the non-poor.
There is an urgent need in rural El Salvador to increase the access of affordable health
care services for poor children.
15
IV. BASIC NEEDS
* The rural poor in El Salvador have the worst basic needs indicators
The rural poor in El Salvador have the worst basic needs indicators.9 More than
one-third of school-age children are out-of-school; three-fourths of poor rural residents
live in overcrowded homes; only 15 percent of them have access to piped water
(including communal sources); only 2 percent of them have access to modem sanitation;
and, only about one-third of them have access to electricity (see Table 5). 10
Table 5
Basic needs for poor and non-poor, 1994
by area of residence
(percentage)'
Ch ildren 7-1 0 Access to
whoare ou7-of0 Overcrowding Access to piped modern Access to
Area of school a o f water sanitation electricity
residence Poor Non- Poo N Non- Poor Non- Poor Non- Poor Non-
poor poor poor poor poor
Rural 32 15 75 42 14 28 2 8 35 61
Other urban 21 7 71 28 35 69 15 53 77 95
San Salvador 15 7 7o0 J8 44 87 41 82 80 98
El Salvador 28 8 74 28 20 65 7 53 46 87
Notes:
(a) Overcrowding occurs in households with more than three people per bedroom.
(b) Piped water is either inside or outside the home or piped to a common faucet.
(c) Modem sanitation is private or shared toilet connected either to the public sewerage system or to a septic tank
Children 7 to 10 who are out-of-school is measured at the individual level, the rest of the basic needs indicators are measured for
individuals living in households with the characteristic.
Source: EHPM (1994-111)
* All ruralfamilies in El Salvador are severely underserved by basic infrastructure
All rural residents are severely underserved by basic infrastructure services. The
low degree of inequality in the coverage of these services to rural households does not
indicate that these services are weakly pro-poor, but that families from all income groups
are underserved (see Figure 10). Overall, only about 60 percent of non-poor residents in
rural areas have access to electricity, less than 10 percent of them have access to moden1
9 Although basic needs indicators involve a certain degree of subjectivity in determining adequate levels of
access to services, they allow the identification of more permanent characteristics of poverty as well as the
need for basic infrastructure.
10 Children 7 to 10 who are out-of-school is measured at the individual level, the rest of the basic needs
indicators are measured for individuals living in households with the characteristic.
16
sanitation and one-third of them have access to piped water. By contrast, the proportion
of children 7 to 10 who are out-of school and the proportion of residents living in
overcrowded homes are highly unequal in rural areas. Non-poor rural families fare
considerably better than poor rural families in keeping their primary-school age children
enrolled and living in non-overcrowded homes.
Figure 10
Distribution of basic needs indicators and household income, 1996
by rural quintile
100
Children
out-of-school
80~ +
Overcroi
601
40 A
m4 - THK \ . ouehuld
. I ; income
20 / ater
c /j28 \ ~~~~~~~Electricity l
> o Xgf x~~ -- r' Santation
0 -) -' -
Quintiles
Note: See notes and footnote for Table x.
Source: Encuesta Rural (1996)
* Rural areas in the poorest regions of El Salvador, Central II and Eastern, have the
worst coverage of basic infrastructure
Consistently, rural areas in the poorest regions of El Salvador, Central II and
Eastern, have the worst coverage of basic infrastructure services (see Table 6). Only
about half of the rural residents in these regions have access to electricity, less than one-
tenth of them have access to modem sanitation and only a fifth of them have access to
piped water. In addition, the average distance to paved roads is highest in the Eastern
region, more than 9 kms, and second highest in the Central II region, more than 6 kms
Rural areas in general in El Salvador urgently need improved infrastructure, but
particularly those hit hardest by the civil war are lagging considerably behind.
17
Table 6
Basic needs by rural region, 1996
(percentage)a
Basic Needs R u r a I R e g i o n
Indicator Western Central I Central Eastern Rural San
n Salvador
Children 7-J0 out-of-school 25 II 16 25 22
Overcrowding 55 67 66 66 58
Access to piped water 30 31 22 21 27
Access to modern sanitation 14 6 8 6 11
Access to electricity 56 63 48 50 65
Average distance to paved road (kcin) 4.5 6.1 6.4 9.2 3.1
Notes:
(a) Overcrowding occurs in households with more than three people per bedroom.
(b) Piped water is either inside or outside the home or piped to a common faucet.
(c) Modem sanitation is private or shared toilet connected either to the public sewerage system or to a septic tank
aChildren 7 to 10 who are out-of-school is measured at the individual level, the rest of the basic needs indicators are measured
for individuals living in households with the characteristic.
Source: Encuesta Rural (1996)
18
V. IN-KIND TRANSFERS
* Targeting of public food programs to the poor is almost non-existent
Food programs at public schools, at public primary schools and at public health
facilities need to improve on their targeting to the poor.'1 Leakages to non-poor
households prevail in every area of residence and for all public food programs, the
proportion of non-poor recipients is more than half the proportion of poor recipients (see
Table 7). The proportions of poor and non-poor families receiving food transfers at
public primary schools in rural areas are slightly higher than in other areas of El Salvador,
but targeting to the poor is almost non-existent. Public food transfers at public primary
schools is not a universal program either. Thus, improved targeting of public food
programs in El Salvador, without increasing current transfers, implies correcting for
undercoverage of poor households and cutting down on leakage to non-poor families.
Table 7
Food recipients by type ofpublic institution, 1994
for poor and non-poor by area of residence (percentage)
Area of F o o d r e c i p i e n t s
residence At public schools At public primary schools Atpublic health facilities
Poor Non-poor Poor Non-poor Poor Non-poor
Rural 40 32 43 36 20 12
Other urban 11 5 14 14 15 11
San Salvador 26 11 31 16 0* 6
El Salvador 32 18 36 23 17 10
Source: EHPM (1994-111)
Note: n < 10 households
* Almost hafof all in-kind transfers to rural areas are in food and of these more
than half go through the schoolfeeding program, but this program is not targeted
to the poor
Almost half of all in-kind transfers to rural areas are in food and of these more
than half go through the school feeding program (see Figure 11). Although the program
mainly benefits primary school students,'2 educational level in which enrollments are
strongly pro-poor,'3 the minority of recipients are in poor households. Less than one-
fourth of all beneficiaries of the school feeding program are in the poorest two income
I IEHPM (1994-III) does not specify any particular food program. This section of the paper aggregates all
responses of food recipients at public education and health facilities.
12 The distribution of households benefitting from the school feeding program is: 81.8 percent have
primary school students, 6.8 percent have pre-school students and 11.3 percent are in neither groups.
13 See Figure 4.
19
quintiles (see Figure 12). Thus, improved targeting of the school feeding program in
rural El Salvador implies either creating a system of means tests or targeting schools in
poor areas.
Figure 11
Food transfers by type of institution/program in rural El Salvador, 1996
(% of total by type of institution/program)
School
feeding
} _ ~~~~~~~~program
Other 0000;0_
12%
Private
31%
Source: Table A.7
Figure 12
Distribution of transfers cf the schoolfeeding program, 1996
by r ural quintile
(f� of total by quintile)
30__
27 27
i 25 23
202
1 52 14
9
10_
~ 52
0
Quintiles
Source: Table A.8
20
* Less than one-tenth of beneficiaries of the schoolfeeding program are in the
Central II, the poorest region, but almost half are in the Eastern, the second
poorest region
The poorest region in El Salvador, the Central II, receives less than one-tenth of
the transfers from the school feeding program. However, the second poorest region, the
Eastern, receives almost half of these transfers. Expanding and strengthening the rural
school feeding program in the Central II region, particularly to benefit primary school
children in poor communities, can improve its poverty focus.
Figure 13
Distribution of transfers of the schoolfeeding program, 1996
by rural region
(% of total by rural region)
Western 32
Central I 14
t Central H 9
t
-N Eastern 46
Rural S.S. 0
0 10 20 30 40 50
In-kind transfer (% of total)
Source: Table A.9
21
VI. POLICY IMPLICATIONS
EDUCATION
* More than one-third of the rural population cannot read and write. Regionally, the
Eastern and the Western regions have the highest illiteracy rates. Thus, literacy
programs need to be targeted to the rural population, particularly the poor in these
regions.
* The primary school system in El Salvador needs to improve internal efficiency by
promoting early enrollment and decreasing repetition rates across the country,
focusing particularly on the rural poor. Primary school students older than the
appropriate age group are common aicross all income groups and regions.
- Mean years of schooling in rural areas is the lowest in El Salvador. It is crucial to put
in place incentives for retention in rural primary schools. In particular, poor girls are
more likely to drop out of school as they get older. Thus, retention incentives at the
primary school level should target the poorest girls.
* EDUCO schools reach the poor but not the poorest rural children. Improved targeting
of the EDUCO program in El Salvador implies correcting undercoverage of poor
children and simultaneously cutting clown leakage to non-poor children.
� Less than one-fourth of EDUCO children are in the two poorest regions. Targeting
these regions can improve the poverty focus of the EDUCO program, but it will also
be necessary to geographically identify poor areas within these provinces.
* One in every three poor primary school-aged children is out-of-school in rural areas.
Almost half of rural poor primary school-aged children who are out-of-school report
that school expenses are too high. An alternative for reducing the burden of direct
costs of primary education on families with primary school-aged children, targeted
particularly to the poor, can be to provide school materials to and to ease
requirements on wearing uniforms in disadvantaged rural areas of the country.
22
HEALTH
* Public health services are not targeted to the poor or to disadvantaged areas. Rural
residents have the lowest utilization rates of public health services and the highest
illness rates. In addition this population group is severely undercoveraged by modem
health services. Targeting mechanisms of public health services towards the poor and
rural areas need to be put in place, particularly for the residents of the Central II and
the Eastern regions.
* Poor rural children are three times more likely to be ill than non-poor children. High
illness rates are compounded by lack of targeting of public health facilities and by the
scarcity of health care financing mechanisms. There is an urgent need in rural El
Salvador to increase the access to affordable health care services for poor children.
BASIC NEEDS
* The rural poor in El Salvador have the worst basic needs indicators. Non-poor rural
families fare considerably better than poor rural families in keeping their primary-
school age children enrolled and living in non-overcrowded homes, but all rural
families are severely underserved by basic infrastructure services. Regionally, the
poorest regions, rural Central II and rural Eastern, have the worst coverage of basic
infrastructure. Rural areas in general in El Salvador urgently need improved
infrastructure, but particularly those hit hardest by the civil war are lagging
considerably behind.
IN-KIND TRANSFERS
* Targeting of food programs at public schools, at public primary schools and at public
health facilities is almost non-existent. Public food transfers at public primary
schools is not a universal program either. Thus, improved targeting of public food
programs in El Salvador, without increasing current transfers, implies correcting for
undercoverage of poor households and cutting down on leakage to non-poor families.
* Almost half of all in-kind transfers to rural areas are in food and of these more than
half go through the school feeding program, but this program is not targeted to the
poor. Less than one-fourth of all beneficiaries are among the poor. Thus, improved
targeting of the school feeding program in rural El Salvador implies either creating a
system of means tests or targeting schools in poor areas.
23
* The poorest region in El Salvador, Central II, receives less than one-tenth of the
transfers from the school feeding program. Expanding and strengthening the program
in the Central II region, particularly to benefit primary school children in poor
communities, can improve its poverty focus.
24
REFERENCES
Encuesta de Hogares de Propositos Multiples (EHPM). 1994-III. Departamento de
Investigaciones Muestrales. Ministerio de Planificacion y Coordinacion del
Desarollo Economico y Social. Republica de El Salvador.
Encuesta Rural. 1996. Fundacion Salvadorena para el Desarrollo Economico y Social
(FUSADES). Republica de El Salvador.
Lanjouw, P. 1996. Towards a Poverty Profile for El Salvador: Preliminary Results from
the 1994 Encuesta de Hogares. Policy Research Department, The World Bank
(mimeo).
Lockheed, M., A. Verspoor and associates. 1991. Improving Primary Education in
Developing Countries. New York: Oxford University Press. Published for The
World Bank.
Lopez, R. 1996. Rural Poverty in El Salvador: A Quantitative Analysis. Department of
Agricultural and Resource Economics, University of Maryland at College Park
(mimeo).
World Bank. 1994. El Salvador: The Challenge of Poverty Alleviation. Report No.
12315-ES. Country Department II, Human Resources Operations Division, Latin
America and the Caribbean Regional Office. Washington, D.C.
25
APPENDIX A
Table A.l
Illiteracy ratejfor poor and non-poor, 1994
by area oJ residence (percentage)
Area of Poor -Non-poor - All
residence
Rural 41 26 35
Other Urban 28 14 17
San Salvador 24 8 9
Total 37 15 23
Source: EBPM (1994-1II)
Note: Population older than 10 years of age who cannot read and write
Table A.2
Illiteracy rate for poor and non-poor, 1994
by region (percentage)
Region Poor Non-poor All
Western 35 16 24
Central 1 35 17 25
Central 2 35 22 29
Eastern 455 23 33
San Salvador 24 8 9
El Salvador 37 15 23
Source: EHPM (1994-111]
Table A.3
Type of primary school attended, 1996
by rural quintile (percentage)
Rural quintile Public EDUCO Private Other
Poorest 88 8 2 1
nI 80 16 4 0
III - 88 12 1 0
IY 86 10 4 0
Richest 92 2 4 2
All Rural 86 10 3 1
Source: Encuesta Rural (1996)
Note: Private includes private schools as well as community and religious schools
26
Table A.4
Type of primary school attended, 1996
by rural region
(percentage)
Typeof R u r a l R e g i o n
school Western Central I Central 2 Eastern San Salvador All Rural
Public 85 81 86 90 89 86
EDUCO 10 18 11 7 0 10
Private 6 1 2 2 7 3
Other 0 0 I I 4 I
Source: Encuesta Rural (1996)
Note: Private includes private schools as well as community and religious schools
Figure A.1
Rural regional poverty shares for school-age children, 1996
(% of poor children 7 to 10 years old
in rural El Salvador by region)
San Salvador
6% Western
Eastern
30%
Central I
17%
Central ll
29%
Source: Encuesta Rural, 1996
27
Table A. 5
Poor and non-poor children 7,to 10years old who are out-of-school, 1994
by area of residence (percentage)
Area of residence Poor Non-poor All
Rural 32 IS 27
Other Urban 21 7 10
San Salvador 15 7 8
El Salvador 28 8 18
Source: EHPM (1 994-111)
Table A. 6
Illness rate and place of consultation, 1994
by region (percentage)
Area of Illness Place of consultation
residence rate None Private Public Other Al places
Western
poor 31 10 10 18 62 100
non-poor 32 6 20 22 53 100
all 32 8 15 20 57 100
Central I
poor 29 11 4 22 63 100
non-poor 33 5 16 25 55 100
all 31 8 10 24 58 100
Central HI
poor 39 10 4 24 62 100
non-poor 38 5 15 24 57 100
all 39 7 9 24 60 100
Eastern
poor 31 11 7 25 57 100
non-poor 34 5 20 25 51 100
all 33 8 14 25 54 100
San Salvador
poor 26 5 5 30 61 100
non-poor 25 2 26 30 42 100
all 25 2 24 30 43 100
Source: EHPM (1994-111)
Notes:
(a) Public = public health centers and public hospitals; private private hospital/clinic, private doctor and nurse; and,
other = pharmacy, healer and self-medication.
(b) Illness rate is for last 30 days.
28
Table A.7
Transfers in-kind by type of institution in rural El Salvador, 1996
(% by type of institution)
Type of Type of assistance
institution Food Clothing Health Education Housing Construction Other
Private 31 54 72 69 47 30 53
Public 6 0 0 8 0 20 7
FIS 0 0 10 15 7 30 7
Schoolfeeding program 51 15 9 8 0 0 0
Other 12 31 9 0 46 20 33
Total 100 100 100 100 100 100 100
Source: Encuesta Rural (1996)
Table A.8
Distribution of in-kind transfers, 1996
by rural quintile
,% by quintile)
Rural Type of transfer
quintile Private Public FIS School feeding Other All
l . . program transfers
Poorest 13 25 0 14 27 16
II 17 0 22 9 31 16
III 15 25 33 23 12 18
IV 24 38 33 27 8 23
Richest 32 13 11 27 23 26
Total 100 100 100 100 100 100
Source: Encuesta Rural (1996)
Note: * n < 10 households
Table A.9
Distribution of in-kind transfers, 1996
by rural region
(% by rural region)
Rural Type of Transfer
region Private Public FIS Schoolfeeding Other All
____l_l ____ program _ transfers
Western 30 0 33 32 23 28
Central l 32 25 22 14 15 22
Central2 13 38 0 9 15 13
Eastern 19 13 33 46 35 31
San Salvador 7 25 1 1 0 12 7
Total 100 100 100 100 100 100
Source: Encuesta Rural (1996)
Note: n < 10 households
29