The development objective of Essential Health Services Access Project for Myanmar is to increase coverage of essential health services of adequate quality, with a focus on maternal, newborn and child health (MNCH), and, in the event of an eligible crisis or emergency, to provide immediate and effective response to said eligible crisis or emergency. This restructuring requires the following changes: (a) extension of the project period by twenty one months, from June 30, 2019 to March 31, 2021, to adjust to the change in the government’s fiscal year, as well as to allow sufficient time for component 2 implementation, requiring a change in implementation schedule; (b) recalibration of the Disbursement Linked Indicator (DLI) targets for year 3 and year 4, which involves lowering the target number of townships meeting the DLIs; (c) modification of the results framework for two reasons: (i) DLI targets, which are a part of the RF, are to be changed; and (ii) as a result of reallocation from IRM, the indicator on procurement of goods under IRM will be deleted; (d) extension of the Interim Unaudited Financial Report (IFR) reporting period from 45 days to 60 days, the primary reason being that the collecting of financial data from township continues to be done manually and this lengthens the time required for the union level to compile and submit the IFR; (e) reallocations between disbursement categories to reflect from category (3) to category (2), which was initially reallocated from category (2) to category (3) for purposes of the immediate response mechanism to respond to the 2015 floods and landslides, based on the government’s ultimate decision not to utilize project funds for this purpose. (Myanmar)
Despite progress over the past quarter-century, millions of newborns, children and young adolescents die every year, mostly of preventable or treatable causes such as infectious diseasesand injuries. These deaths reflect the limited access of children and communities to basichealth interventions such as vaccination, medical treatment of infectious diseases, adequatenutrition and clean water and sanitation. Therefore, mortality rates among children and young adolescents are not only key indicators for child and young adolescent well-being, but, more broadly, for sustainable social and economic development. While concerted efforts aimed at improving child survival have driven large reductions in mortality levels among children under 5 years of age as well as for children and young adolescents aged 5–14 in recent decades, persistent and intolerably high numbers of child and young adolescent deaths mean more work remains to be done to address the specific survival needs of children and young adolescents. The global community recognizes the crucial need to end preventable child deaths, making it an essential part of the Global Strategy for Women’s, Children’s, and Adolescent’s Health (2016–2030) and the third Sustainable Development Goal (SDG) to ensure healthy lives and promote wellbeing for all people at all ages. Achieving the ambitious child survival goals requires ensuring universal access to safe,effective, high-quality and affordable care for women, children and adolescents. It alsorequires an understanding of the levels and trends in child mortality as well as the underlyingcauses of child and young adolescent deaths. The monitoring of child and young adolescentsurvival requires continual improvement in the measurement of mortality, particularly incountries that lack timely and accurate mortality data. Reliable estimates of child and youngadolescent mortality at the national, regional and global level are necessary for evidence-based policymaking to improve the survival chances of the world’s children. In the absence of reliable vital registration data in many countries, modelling and monitoring of child and young adolescent mortality rates remains a necessary resource for policymaking and priority setting. The United Nations Interagency Group for Child Mortality Estimation (UN IGME) produces estimates of child andyoung adolescent mortality annually, reconciling the differences across data sources and takinginto account the systematic biases associated with the various types of data on child and adolescent mortality. This report presents the UN IGME’s latest estimates – up to the year 2017 – of under five, infant, and neonatal mortality as well as mortality among children aged 5–14. It assesses progress in the reduction of child and young adolescent mortality at the country, regional and global levels, and provides an overview of the methods used to estimate the child mortality indicators mentioned above. (World)
Despite positive economic growth trends in the past years, Mali is supposed to spend more efforts to achieve the expected level of performance. In summary, conflict and political instability, coupled with Mali’s regular vulnerability to shocks (including both international prices and climate changes), have aggravated the already poor living conditions of a large majority of the country’s population. If this situation continues, the Malian population will experience a significant deterioration in well-being, including increased levels and prevalence of chronic malnutrition, which will have a negative impact on human capital and productivity in the long term. The 2016 Social Protection Policy expands its targets to all, moving away from a simple contributory scheme for public servants and military to protect all children; the unemployed; the workers (active or retired); the public servants (civilian and military, active, or retired); The workers from informal and agricultural sectors including the independents. Moreover, the policy gives special attention to certain categories of people in difficult circumstances, including seniors, persons with disabilities, children and women, pupils in Mali, the unemployed, and those who are human immunodeficiency virus (HIV) positive. Finally, the National Social Protection Policy also aims to adaptively help management of government responses to calamities, disasters, and other humanitarian crises. Nevertheless, the difficult economic situation of the country will have a negative impact on the implementation of this policy. Increase in spending on security, high vulnerability to world market, and limited economic growth are constraints to have adequate budget for social protection programs. The estimated cost for the operationalization of the action plan (2016–2018) is estimated at CFAF 794 billion over three years but the government contribution represents 11.3 percent while 82.4 percent is from the cost recovery of the social security system through institutions of social security and about 6 percent from international development partners. However, except for the World Bank support, most of the current international development partners’ financial support is for temporary or emergency schemes. Therefore, a deeper review of financial health of social protection is needed to help the government to achieve its objectives. To achieve the goal of having an articulated set of programs under a social protection system to reduce poverty, hunger, and food insecurity; promote resilience against shocks; and promote equity requires large investment or a budget reallocation from ineffective to effective policies. The review of the current government expenditures on social protection, including the emergency programs supported by international development partners, will help assess the financing structure of social protection programs in Mali and then provide recommendations on improving the efficiency of spending and fiscal sustainability of the Social Protection and Labor system (SPL system). (Mali)
This report was prepared to make an inventory of key social protection (SP) programs (over 60) in the Philippines, with the main objective to inform the ongoing review of the country SP Framework and to determine their relevance. The overall level of effort and institutional development is high, with a coherent architecture around the three typical pillars in SP: social assistance, social insurance, and labor market interventions.SP programming is mature across all pillars, and especially in social assistance, and has proven to be resilient to recent changes in administration after the 2016 presidential elections. There is also a serious commitment to SP by the level of spending. In recent years, there has been a significant increase in spending levels and improvement in allocations. However, the insurance pillar shows relatively low coverage rates. Like in many countries, SP in the Philippines is not governed by a single unified group of legislation, but rather by a collection of sector- or program specific laws that evolve over time. covering areas such as child protection, poverty alleviation, labor regulation, health insurance, and pensions. The stated focus on both protection from short-term collapses in consumption/income and alleviation of chronic poverty is aligned with both considerable and well identifiable share of the population unable to meet its basic needs (at least 20 percent) and almost equal share of those who suffer from consequences of shocks in a country where natural disasters are a regular occurrence, and employment levels are fairly sensitive to shifting international economic forces. The stated objectives of building adaptability and capacity for human capital accumulation are sensible, given the human capital deficiencies especially with respect to education and nutrition.Finally, SP programs in the Philippines are flexible and can respond to emergencies, shocks, or crisis. Some of the SP programs in this report can respond quickly to emergencies, but not all have embedded a sound monitoring and evaluation (M&E) system that allows them to provide regular monitoring and periodic evaluation of their implementation during emergencies. Also, an overall framework for predictable response to shocks is still missing. Similarly, it is notable that none of the SP programs have in place an automatic process of indexation of benefits. Information dissemination varies across programs, with some having strong communication channels and staff adequately trained to effectively communicate modifications or adjustments, while others lack these mechanisms. (Philippines)
Inequalities in the opportunity to obtain a good education in low-income countries are widely understood to be related to household resources and schooling quality. Yet, to date, most researchers have investigated the contributions of these two factors separately. This paper considers them jointly, paying special attention to their covariation, which indicates whether schools exacerbate or compensate for existing household-based inequalities. The paper develops a new variance decomposition framework and applies it to data on more than one million children in three low-income East African countries. The empirical results show that although household factors account for a significant share of total test score variation, variation in school quality and positive sorting between households and schools are, together, no less important. The analysis also finds evidence of substantial geographical heterogeneity in schooling quality. The paper concludes that promoting equity in education in East Africa requires policies that go beyond raising average school quality and should attend to the distribution of school quality as well as assortative matching between households and schools. (World)
The development objective of the Second Rural Economic Development Initiative Project for Jamaica is to enhance access to markets and to climate resilient approaches for targeted beneficiaries. Some of the negative impacts include: (i) unnecessary removal of vegetation cover; (ii) creation of soil slippage and soil erosion conditions from excavation and inappropriate placing of excavated matter on slopes; (iii) blockage of drains from construction waste and excavatedmaterials; (iv) ground and surface water pollution; (v) pesticide pollution of soil, ground and surface water; (vi) exposure of workers/farmers to pesticides; (vii) eutrophication of surface water from sewage discharge; (viii) excessive run-off where drainage on roads and off buildingsis inadequate; (ix) inappropriate disposal of solid waste; (x) interruption of vehicular and pedestrian traffic flow or access to amenities; (xi) loss of indigenous or native species; (xii) exposure of workers to occupational health and safety risks; (xiii) discrimination against vulnerable groups including women, children of working age and people with disability; (xiv) forced labour and child labour; Some of the mitigation measures include: (i) re-vegetate cleared area immediately after construction; (ii) excavate impact soil until no trace of petroleum is observed; (iii) all waste must be disposed in an approved landfill or disposal site, in consultation with the National Solid Waste Management Authority (NSWMA); (iv) stored waste should be covered with plastic sheeting or other suitable material to minimize dust dispersion; (v) communities must be given prior notice of intended road closures and designated detours; (vi) remote worksites must be equipped with portable chemical toilets, which must be supplied and serviced by an approved contractor; (vii) material delivery must be confined to early mornings/lateevenings (outside of peak periods); (viii) use clean equipment to excavate pit especially there isa risk of coming in contact with groundwater; (ix) trees should be removed only when present a health and safety risk or risk of damage to infrastructure; (x) contractor will be required topreserve trees and other wildlife habitats, which have been identified as natural habitat or well preserved vegetation zones; (xi) store materials and waste to avoid hindrance to traffic and pedestrian movement; (xii) contractor must provide workers with the appropriate safety equipment including hardhats, safety boots, security vest, dust mask, and gloves and ensure that they are worn properly; (xiii) dispose of contaminated and unsuitable material in safe areas and cart away for off-site disposal at approved landfill site; (xiv) contractor must notify the public of any alternative to their normal routes during the construction activities (Jamaica)
The development objective of Enhancing Natural Forest and Agroforest Landscapes Project is to improve forest and tree management practices by cocoa farmers, CREMA communities and forest reserve managers to reduce forest loss and degradation in selected landscapes in Ghana. Some of the negative impacts include: (i) lack of access to protective clothing and spray equipment in repair; (ii) no proper labeling of pesticide products;; (iii) reuse of pesticide containers; (iv) pre-harvest interval violations; (v) unsafe storage, transport and handling; (vi) application by women and children; (vii) potential for using pesticides more than necessary; (viii) use of higher-toxicity products; (ix) pesticide spraying near homes; (x) potential for pesticide poisoning; and (xi) poor disposal of used pesticide containers. Some of the mitigation measures include: (i) avoid crops (varieties) that create reliance on pesticides; (ii) spray equipment must be regularly checked and serviced by qualified spray equipment mechanic who should undertake routine equipment maintenance on a clearly defined work program; (iii) continue to engage farmers and train them on the safe storage and use of the chemicals; (iv) prevent reuse of pesticide containers; (v) all spray operators should also be trained in the proper handling of pesticides; (vi) the EPA should be involved in the training of women in the application of pesticides to avoid the incidence; (vii) chemical pesticides must only be as a last resort, in the case of unexpected pest invasion by migratory pests such as armyworms and grasshoppers or grain eating birds; (viii) the surroundings of homes should always be avoided when spraying pesticides, except in vector control programs when it is necessary to undertake indoor spraying with pesticides on walls of homes, and under very strict supervision and monitoring by officials from the ministry of health; and (ix) every precaution must be taken to minimize spraying near standing water bodies or streams or pouring pesticides on the ground around homes, near wells and playing grounds. (Ghana)
Countries around the world have committed to implementing Sustainable Development Goals (SDGs).Implementation of UHC is a key element of goal number 3 “to ensure healthy lives and promote well-being for all, at all ages.” GHG is helping the Government of Georgia move toward achieving SDG 3 with a strategy that promotes greater access to healthcare, while providing financial protections to the most vulnerable populations. GHG is addressing the medical skills gap, and it is offering essential services including maternal, newborn, child health, infectious, and non-communicable diseases treatments in communities where Georgians live and work. As GHG expands the availability of quality primary care at outpatient polyclinics, it can help control costs and reduce premature mortality from non-communicable diseases through prevention. As countries are embracing UHC principles, all are struggling with affordability. Georgia’s model of cooperation proves that UHC can be delivered to a wide range of citizens very quickly and efficiently by leveraging the scalethat the private sector can deliver. (Georgia)
Liberia is a low-income country with a GNI per capita (Atlas method) of 380 US dollars in 2017. After a period of conflict and instability, Liberia’s Gross Domestic Product (GDP) grew at an average annual rate of 6.2 percent during 2003-2013. The ebola virus disease (EVD) crisis of 2014-2016 and a drop in global commodity prices resulted in slower average annual GDP growth of 2.1 percent with per capita annual GDP growth at -0.4 percent during 2013-2017. As a post conflict country aiming to achieve sustained broad-based growth, Liberia faces several development challenges: large infrastructure gaps, poor education and health indicators, a large youth cohort, lack of economic diversification, and weak public institutions. The World Bank Group’s country partnership strategy had three pillars: (i) economic transformation; (ii) human development; and (iii) governance and public sector institutions. In addition, the CPS had two cross-cutting themes of capacity development and gender equality. The CPS focus areas and objectives were well aligned with the government’s agenda for transformation with a strong focus on infrastructure. The CLR provided a succinct assessment of the achievement of program objectives. It identified the increases in IDA lending attributable to the EVD outbreak. The CLR review agrees with the CLR lessons: (i) ensure government’s strong commitment to the CPF program through close alignment with the country’s development plans; (ii) adapt and apply a sound post-conflict and fragile country lens in the design of CPF programs for post conflict countries; (iii) keep an eye on medium-term goals even in the face of a crisis such as EVD; (iv) being selective about cross-cutting themes and including outcomes associated with these themes helps maintain the Government’s and Country Team’s focus on them throughout implementation. IEG provides the following additional lessons: (i) flexibility of the CPS program enabled the WBG to respond to the EVD crisis in a timely manner; and (ii) trust fund activities need to have a well-articulated strategic focus and explicit selectivity filters to ensure that they contribute to the achievement of CPS objectives; (Liberia)
Despite progress over the last two decades, girls still have on average lower levels of educational attainment than boys in many African countries, especially at the secondary and tertiary levels. Girls dropping out of school are more likely to marry or have children early, before they may be physically and emotionally ready to become wives and mothers. This may affect their own health. It may also affect that of their children since children of mothers younger than 18 face higher risks of dying by age five and being malnourished. They may also do poorly in school. Other risks for girls and women associated with a lack of education as well as child marriage include intimate partner violence and a lack of decision-making ability in the household. Through lower expected earnings in adulthood and higher fertility over their lifetime, a lack of education for girls as well as child marriage lead to higher rates of poverty for households. This is due to both losses in incomes and higher basic needs from larger household sizes. Low educational attainment for girls may also weaken solidarity in communities and reduce women’s participation in society. Lack of education is associated with a lower proclivity to altruistic behaviors, and it curtails women’s voice and agency in the household, at work and in institutions. This report documents the negative impacts of low educational attainment for girls, child marriage, and early childbearing for girls in Africa and some of their associated economic costs. The message is clear: educating girls is not only the right thing to do. It also makes economic and strategic sense for countries to fulfill their development potential. (World)
