The report emphasizes the importance of breaking the cycle of inequitable investment in human capital and lack of well-paying job opportunities that trap the poor in poverty, generation after generation. Children from poor households start life at a disadvantage. Malnourished and stunted, with poor access to quality health care, they are less likely to learn the skills they need and fulfill their potential. As adults, therefore, they earn low incomes and cannot afford to invest in their own children. They have little to meet their basic needs and nothing to save against emergencies. Frequent natural disasters buffet the poor, whose limited means to cope and disproportionate suffering push them deeper into poverty. Poverty is a threat to peace. In the parts of the country affected by conflict, where physical assets have been destroyed, families displaced, and human capital eroded, people are trapped in a cycle of conflict and poverty. In addition to the challenges of addressing poverty, the Philippines is hindered by the limited expansion of its middle class. In the East Asia region over 2002-2015, the share of population that is economically secure and middle class increased from just over one fifth to nearly two-thirds, but the share in the Philippines increased from 37 percent to just 44 percent. The lack of well-paying jobs limited the gains for labor from structural transformation. Every year, 1 percent of the employment shifted out of agriculture, but most of those workers end up in low-end services jobs. Such limited gains for labor could negatively affect the country’s long-term competitiveness. The report concludes that making the pattern of growth more inclusive and providing more well-paying jobs will be crucial to helping people achieve higher and more stable incomes. It claims that steps to accelerate poverty reduction include creating more well-paying jobs; improving productivity in all sectors, including agriculture; reducing income and wealth inequality through more investments in people and skills development, enhancing the ability of the poor to participate in growth; rebuilding conflict-affected areas; and better management of risks and protection of the vulnerable. (Philippines)
The health sector of Papua New Guinea (PNG) has seen significant positive developments in recent years. These include investments in critical infrastructure (especially medical stores, training facilities, and hospitals), the establishment of key policies, the steady rollout of the Provincial Health Authority (PHA) model, and a reduction in the incidence of malaria. Key indicators of health access and quality have, however, barely improved or have even declined (for example, maternal and child health) from 2006 to 2015 (National Department of Health, NDoH 2016). In addition, the availability of resources for health financing will be limited in the medium term as the government grapples with constraints such as domestic revenue mobilization, achieving a balanced budget, and restoration of macroeconomic stability. Overall, the pace of long-term progress in key health indicators is slowing down and, given the reduced expenditure projections, the health sector is in a critical phase. During this time, the government will be expected to increase its share of co-financing for vaccines, while Gavi gradually decreases their contribution. By 2021, the Government of PNG (GoPNG) will graduate from Gavi support, while maintaining access to Gavi prices. The government also needs to continue to meet its co-financing obligations with GFATM and prepare for the eventual transition from the program. Given this backdrop, the Health Financing System Assessment (HFSA), which evaluates the financing system and institutional sustainability, comes at an opportune time. The report begins by providing a comprehensive background, including an overview of PNG’s economic situation, health demographics, health financing, human resources for health and the health system. It then analyses two areas critical to sustainable health financing: (i) PNG expenditure, with a focus on levels and sources of health expenditure, as well as resource allocation; and (ii) PNG reliance on donor resources, in particular, the GFATM and Gavi. (Papua New Guinea)
The development objective of the Health Services Reinforcement Project for Burkina Faso is to increase the quality and utilization of health services with a particular focus on maternal, child and adolescent health, nutrition and disease surveillance.It has three components. First component, strengthening health system capacity aims to support the strengthening and integration of several pre-existing and planned health financing policies, namely the launch of the national health insurance scheme and optimization of strategic purchasing mechanisms already in place, such as free care for women and children and performance-based financing (PBF). It has three sub-component. (i) establishment of the national health insurance fund subcomponent aims at strengthening the pooling function of the health financing system, hence bringing more equity in access through increased financial risk protection, especially of the poor. (ii) scale-up and strengthening of purchasing mechanisms will support the strengthening and scaling-up of purchasing mechanisms already in place such as PBF and free health care, based on experience gathered at national level and international best practice; (iii) verification and cross-cutting interventions in health financing will also finance technical assistance to improve the efficiency and effectiveness of the free healthcare scheme; Second component, strengthening delivery of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) aims to promote UHC and enable the acceleration of the demographic transition to maximize human capital and economic growth through a comprehensive approach to Reproductive, Maternal, Newborn, Child and Adolescent Health and nutrition.It has four sub-components. (i) strengthening maternal, newborn, child and adolescent health service delivery; (ii) investing in the early years and nutrition; (iii) supporting civil registration and vital statistics; and (iv) supporting multisectoral coordination for RMNCAH+N; Third component, reinforcing health security and supporting institutional strengthening will support institutional capacity needed at national, regional, and district levels to prevent, detect, be prepared, and respond to health security risks, hazards and emergencies, as well as overall project implementation and coordination support. It addresses the key weaknesses revealed by a recent Joint External Evaluation (JEE) of Burkina Faso. It has three sub-components. (i) strengthening of National Public Health Surveillance and information systems; (ii) strengthening health system preparedness and emergency response capacity; and (iii) institutional capacity building, project management, coordination and communication. (Burkina Faso)
Enteric pathogens can be transmitted through multiple environmental pathways, yet little is known about the relative contribution of each pathway to diarrhea risk among children. The authors aimed to identify fecal transmission pathways in the household environment associated with prospectively measured child diarrhea in rural Bangladesh. The authors measured the presence and levels of Escherichia coli in tube wells, stored drinking water, pond water, child hand rinses, courtyard soil, flies, and food in 1843 households. Gastrointestinal symptoms among children ages 0−60 months were recorded concurrently at the time of environmental sample collection and again a median of 6 days later. Incident diarrhea was positively associated with the concentration of E. coli on child hands measured on the first visit, while other pathways were not associated. In cross-sectional analysis, there were no associations between concurrently measured environmental contamination and diarrhea. The authors findings suggest higher levels of E. coli on child hands are strongly associated with subsequent diarrheal illness rates among children in rural Bangladesh. (Bangladesh)
This report spans three projects. Ratings for the first project, Health Sector Reform (APL 1) is as follows: Outcome is satisfactory, risk to development outcome is moderate, Bank and Borrower performance is both moderately satisfactory. Ratings for the second project, Sector Phase of the Health Sector Reform Program (APL II) is as follows: Outcome is moderately satisfactory, risk to development outcome is moderate, Bank and Borrower performance is both moderately satisfactory. Ratings for the third project, Expanding Access to Reduce Health Inequities (APL III) is as follows: Outcome is moderately satisfactory, risk to development outcome is moderate, Bank and Borrower performance is both moderately satisfactory. Lessons from these projects include: (i) The definition of a common results framework is useful to align the efforts of different government levels. (ii) A robust results-based approach needs to define a clear mechanism of rewards/sanctions to function well. Otherwise it risks turning into a mere monitoring tool that could lead to perverse incentives. (iii) Project design coordinating efforts with parallel programs that have similar goals has a great potential for efficiency, but it raises methodological concerns about the attribution of outcomes. (iv) While continued focus on quality objectives is certainly commendable, it needs to be accompanied by more robust outcome measures to prove quality enhancements. (v) Programmatic approaches are suitable where sector knowledge is strong, program objectives are long-term and clear, and country ownership is established. (vi) Ambitious projects partially relying on a government promise to pass a reform law are likely to need a restructuring. Reallocation of project funds in response to ad hoc government requests may lessen the logic of the results chain and risk the M&E framework from providing sufficient evidence of project achievements. (Bolivia)
A multi sector effort is essential to improve the nutritional status of children and women. For effective and efficient implementation of multi sector interventions, each sector should be well positioned to deliver the required services. With the aim to understand the bottlenecks to effective implementation of nutrition operations in Nepal and provide strategies and recommendations to overcome these challenges, researchers from the World Bank conducted a qualitative study in 2016/17 entitled: "Study of Operational Strategies to Reduce Malnutrition in Nepal". This research brief highlights various institutional structures and non-government partnership arrangements that contribute to effective implementation of nutrition related activities. (Nepal)
The development objective of Social and Economic Inclusion Project for Kenya is to enhance access of poor and vulnerable to integrated social and economic inclusion as well as shock-responsive social protection. Some of the negative impacts include: i) increased tension between beneficiaries and non-beneficiaries; ii) over-reliance on cash transfers and failure to engage in livelihood activities that build resilience to climate change; iii) absence of broad community support; iv) inadequate engagement in decision-making processes; v) poor targeting of beneficiaries and exclusion; vi) broken promises and unmet expectations of benefits; vii) disruption to amenities and lifestyle; viii) loss of livelihood; ix) violation of human rights; x) social dislocation; Some of the mitigation measures include: (i) increased access to self-employment opportunities through investments; (ii) development of entrepreneurial skills for setting up businesses but also to access devolved funds (UWEZO, Youth and Women Funds); (iii) skills development in leadership, managing groups and civic education, and (iv) training on personal and community development; (v) Government has committed to universal NHIF coverage, but KSEIP would only target existing National Safety Net Program (NSNP) beneficiaries; (vi) ensure proper targeting so that multiple HHs are not considered as one; (vii) Economic inclusion interventions would also include some non-NSNP beneficiaries; (viii) nutrition counseling to include guidance on nutritional food and importance of parents providing their children with nutritional food; (ix) economic inclusion interventions would also include some non-NSNP beneficiaries; (x) beneficiary outreach strategy, enhancing the understanding of communities on the need for inclusion of all VMGs; (xi) create better awareness among beneficiaries that the CT programs are resilience building and should not be seen as humanitarian assistance; (xii) Involve both majority and minority groups in project design, planning and implementation; (Kenya)
Nutritional problems often occur in Indonesia due to the lack of knowledge, believes, values and norms in the community. Eating nutritious food is an important habit for children’s health and development. Over a third of children and infants’ death as well as eleven percent of diseases in the world are caused by under nutrition in pregnant women and children. Furthermore, under nutrition in pregnant women could lead to physical, mental and intellectual development impairments for the child. A stunted and wasted newborn will have a substandard growth and become an adult with a short body as well as low intelligence and income. In order to have a smart child with optimum growth, a family needs to pay close attention to the critical period of first 1000 days of life (1000 Hari Pertama Kehidupan), from the pregnancy period to first 2 years since the child is born. The first 1000 days are critical period where any occurring impairment will have a permanent and untreatable effect. This session will discuss the healthy behaviors that need to be adopted during pregnancy (9 months or 270 days). (Indonesia)
Too many girls drop out of school prematurely, especially in low income countries. Low educational attainment for girls has negative consequences not only for them, but also for their children and household, as well as for their community and society. This study documents the potential impacts of educational attainment for girls and women in six domains: (1) earnings and standards of living; (2) child marriage and early childbearing; (3) fertility and population growth; (4) health, nutrition, and well-being; (5) agency and decision-making; and (6) social capital and institutions. The results are sobering: the potential economic and social costs of not educating girls are large. Low educational attainment reduces expected earnings in adulthood, and it depresses labor force participation, leading to lower standards of living. When girls drop out of school prematurely, they are much more likely to marry as children, and have their first child before the age of 18 when they may not yet be ready to be wife and mothers. This in turn is associated with higher rates of fertility and population growth, which in low income countries are major impediments for reaping the benefits of the demographic dividend. Low educational attainment is also associated with worse health and nutrition outcomes for women and their children, leading among others to higher under-five mortality and stunting. Girls who drop out of school also suffer in adulthood from a lack of agency and decision-making ability within the household, and in society more generally. They are also less likely to report engaging in altruistic behaviors such as donating to charity, volunteering, or helping others. Finally, when girls and women are better educated, they may be better able to assess the quality of the basic services they rely on and the quality of their country’s institutions and leaders. These negative impacts have large economic costs, leading among others to losses in human capital wealth (future lifetime earnings of the labor force) estimated at 15 trillion to 30 trillion US dollars. Educating girls is not only the right thing to do: it is also a smart economic investment. (World)
Ratings for the Second Education Quality Improvement Program Project for Afghanistan were as follows: outcomes were moderately satisfactory, the risk to development outcome was low or negligible, the Bank performance was satisfactory. and the monitoring and evaluation quality was substantial. Some lessons learned included: projects with large construction components need capacity to develop detailed construction and procurement plans as well as strong management and supervision teams to be successful. Under EQUIP II, MoE had: (i) very low capacity for developing construction and procurement plans, (ii) school designs were followed that were not suitable to local conditions; (iii) school drawings and technical specifications were not detailed enough making monitoring difficult; (iv) limited procurement knowledge leading to substantial delays; and (v) very poor construction supervision and its monitoring as most of supervision staff was poorly qualified and to make it worse even they could not access many sites due to security conditions. EQUIP II included supply and demand features to increase girls’ enrollment with the inclusion of infrastructure investments (i.e. boundary wall, toilet, water) and well as scholarships for girls to attend TTC. The EQRA project will expand on these activities to further increase girls’ enrollment and retention. The EQUIP project played a significant role in increasing the number of trained teachers and improving the qualification level of teachers. This was a good beginning to improving the quality of education in Afghanistan but only a small proportion of teacher college graduates entered the teaching force. EQUIPII had a nationwide focus which presented difficulties for completing civil works and monitoring given the increased security concerns during project implementation. Moreover, the nationwide focus spread resources thinly over the country. Going forward, the new EQRA project will focus resources specifically on lagging provinces with regard to access interventions where the proportion of out-of-school girls is the highest. (Afghanistan)
