The development objective of the Women's Economic Empowerment Rural Development Project is to increase social and economic empowerment of poor rural women in selected communities of Afghanistan. Some of the negative impacts are include: (i) production or trade in any product or activity deemed illegal under host country laws or regulations or international conventions and agreements; (ii) investments detrimental to the environment; (iii) any activity on land that is considered dangerous due to security hazards or the presence of unexploded ordnance (mines, bombs); (iv) child labour should be discouraged as much as possible and where children are asked to contribute to the household income, assurance must be made that schooling and child health is not adversely affected; (v) crop and soil biocides (pesticides, herbicides, fungicides, miticides) delivered manually or with machinery that are shown to have toxic or noxious effects on humans (soaps; diatomaceous earth; and non-toxic applications may be used after hazard training); (vi) production or trade in pharmaceuticals and pesticides/ herbicides subject to international phase outs or bans; (vii) fishing in the marine environment using electric shocks and explosive materials; (viii) production or trade in wood or other forestry products from unmanaged forests including purchase of logging equipment (e.g. chainsaws) for use in cutting forest; Some of the mitigation measures are include: (i) education and awareness for related disease vectors; (ii) safe water sedimentation basins before disposal in channels, well away from springs and water storage areas; (iii) traps will be provided at fuelling points to prevent water contamination; (iv) identification of spoil disposal areas in consultation with locals, preferably in waste lands; (v) plan for tree plantations & landscaping; (vi) preventive and precautionary measures against disease spread; (vii) careful stacking of top soil and its re-application after work completion; (viii) fuel storage and refuelling will be kept away from water channels; (ix) all construction camps will be located away from built-up areas, in consultation with local; (x) trees requiring removal will be paint-marked; (xi) All construction machinery and equipment will be stationed in designated areas to prevent vegetation compaction. (Afghanistan)
Nigeria has the highest population of unimmunized children in the world and is one of few countries with less than half the population covered with essential health services. Low coverage of services poses a threat to the health and well-being of Nigerian children, but this threat becomes even more pronounced against a backdrop of the ‘health financing transition’, including the transition from support from the Gavi Alliance, the main source of financing for the country’s immunization program. The Nigeria Immunization Financing Assessment shows how the factors at multiple levels of government and the health system interact to affect four dimensions of health and immunization financing: adequacy; sustainability; efficiency; and predictability. The findings informed the design of the Nigeria Strategy for Immunization and PHC System Strengthening (NSIPSS), which will be used to guide the country as it transitions from Gavi support. This paper emphasizes the need to implement the NSIPSS in close coordination with the current reforms underway in the health sector. Currently, the government of Nigeria is piloting reforms at federal, state, and local levels to fast track implementation of the National Health Act, which aims to bring additional and ‘smarter’ domestic resources for health to the facility level. Also needed are systematic linking of health plans to budgets, more efficient allocation of resources, coordinated advocacy, exploration of demand-side barriers to service delivery, capacity building, and strengthened accountability mechanisms that ensure investments in health lead to improved health outcomes. A transition planning process that is grounded, backed by evidence, monitored and adapted regularly, and backed by the highest level of the government of Nigeria will be critical for changing the trajectory for the children of Nigeria. (Nigeria)
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)
