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)
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)
