Results: Projects in Action

Health  
  
The Technical Assistance and Hospital Rehabilitation Project and The Health Sector Reform Project, completed in 1997 and 1999 respectively, helped to decentralize health services from the Minister of Health to local Health Service Areas and improved overall efficiency in different agencies.

The Public Health Institute (Instituto de Salud Pública) made significant progress in regulating the quality of pharmaceuticals, food products, and laboratories. It reduced the time required for approval of new medical products from 281 days in 1997 to 180 days in 1998.

Changing its role from a budget-supported government supply facility to a self-financed purchasing intermediary organized like a business venture, the Health Procurement Center (Centro de Abastecimiento) computerized its auction-style bidding to prevent collusion and lowered prices significantly. As a result, it expanded its market share from 23 percent to 28 percent of all purchases in the public health system, and reduced response time by half.

The National Health Fund (Fondo Nacional de Salud) also modernized its administrative and financial controls and reduced subsidies to the private sector by using an information system to identify public and private health users. The Fund also advanced in its role as insurer by defining a bill of rights for its beneficiaries.

With help from the sector reform loan, the Chilean Government was able to launch special programs like the cervical cancer program. Expanded and better screenings, together with more timely laboratory reporting, contributed to a four percent decline in the incidence of cervical cancer between 1990 and 1995.  
   
Education

Between 1991 and 2001, two World Bank loans, the Primary Education Improvement Project and the Secondary Education Quality Improvement Project supported reforms to the educational system which increased enrollment, lowered repetition rates and improved cognitive achievements throughout Chilean schools.

The number of 5 year olds enrolled in primary education jumped from 28 percent in 1991 to 82 percent in 1996 and the average time to graduate from primary school fell from 12.4 years to 9.7 years during the same period. Other accomplishments include the introduction of special education for disabled children, school-based health screening, and computer-Internet based communications through the Enlaces network.

Coverage and completion rates also improved in secondary education. A particular accomplishment during the 1990s was the expansion of coverage in rural areas from 50 percent in 1990 to 77 percent in 2000.

However, lingering gaps between the performance of private and public schools, and rural and urban areas, indicate there is still room for improvement. The ongoing Higher Education Improvement Project is helping the Government of Chile to attain greater levels of efficiency, quality, relevance, and equity. This project develops quality assurance mechanisms, builds capacity for management at various educational institutions, and revises the loan and scholarship schemes to increase access and opportunities for poorer students. 
  
Infrastructure

Neglected for several years, Chile's roads were in disrepair by the mid-1980s. The lack of an appropriate road system hindered the growth of domestic and international trade. Three World Bank road sector loans, running between 1985 and 2002, helped to bring about road recovery. These projects supported the transformation of the highway agency into an effective organization, and financed the construction, upgrading, rehabilitation and maintenance of 79,000 kilometers of road. Private sector participation through the BOT model (Build, Operate, Transfer) not only improved the efficiency of road construction and maintenance, but also liberated resources for the government to use on other national priorities. The World Bank continues to support institutional reforms through the ongoing Third Road Sector Project.

Environment

Aided by the World Bank's Environmental Institutions Development Project (1992-1999), the Chilean government has raised the priority of environmental protection and modernized environmental management. In the early 1990s, there were only six government staff working on environmental issues and there were no comprehensive laws, regulations or procedures. By the end of the decade, there was a central environment agency with 350 staff, environmental units in ten ministries, and a solid track record on impact assessment, policy analysis and information systems. The central environment agency (CONAMA) has gained public recognition and is respected by other government agencies, the media, civil society, and the private sector. Although it faces considerable challenges, like the management of air quality in Santiago, CONAMA is building its institutional capacity and advancing environmental management in priority sectors like forestry, mining and industry.