Search

Improved outcomes for women and children - more education, lower fertility rates, higher nutritional status, and lower incidence of illness, among other outcomes - have broad individual, family, and societal benefits. For nearly 15 years, the targets of the millennium development goals (MDGs) have been a bellwether for progress, particularly for maternal and child health (MCH) - a two-thirds reduction in under-five mortality in MDG 4 and a three-quarters reduction in the maternal mortality ratio in MDG 5. This systematic review by the Independent Evaluation Group (IEG) is a learning exercise that looks beyond World Bank experience. It is intended to be used a reference for practitioners in the Bank and elsewhere with an interest in interventions that have demonstrated attributable improvements in skilled birth attendance and reductions in maternal and child mortality. This review also identifies important gaps in the impact evaluation evidence for interventions that may be effective in reducing maternal and child mortality but whose impacts have not yet been tested using robust impact evaluation methods. The systematic review provides findings on what is known about the effects of interventions on skilled birth attendance, maternal mortality, neonatal mortality, infant mortality, and under-five mortality, as well as the effect of skilled birth attendance on these and other intermediate MCH outcomes. Finally, the review highlights the main gaps in the body of impact evaluation knowledge for maternal and child mortality.

The purpose of this study is to clarify the actual dietary habits of infants and perinatal woman on Kalimantan Island, where particularly high infant and maternal mortality rates are observed, in comparison with the rest of Indonesia and to understand the problems. The survey was conducted in ten mother and child couples of Dayak's race, which is a mountaindwelling tribe of Christian faith. The methods comprised of structured interviews and observational investigations.

Traditional benchmarks to assess performance rely on unconditional rankings or regional averages. This paper uses a recently developed methodology based on quantile regressions and initial conditions to propose alternative benchmarks for social sectors in Kyrgyz Republic. Covering a wide set of indicators, the analysis reveals mixed results for Kyrgyz Republic. The country has made important strides in many social areas, with outstanding results in reducing child mortality and undernourishment. However, other areas are still key challenges and demand further attention and resources, as evidenced by the underachievement in maternal mortality, educational performance, and increasing informality in labor markets.

Panama has experienced impressive and significant economic growth, emerging as one of the better performers in Central America in recent years and one of the fastest growing economies worldwide. From 2003 to 2013, Panama has averaged an annual GDP growth rate of approximately 7 percent, surpassing the average GDP growth in Central America. It has also emerged as one of the fastest growing economies worldwide. Even during the economic crisis of 2008-2009, its economy continued to grow albeit at a lower rate. This note recommends that Panama prioritize three main aspects: a) improving the effectiveness of social public spending by further enhancing the pro-poor and pro-indigenous features of targeting mechanisms; b) reducing inefficiencies in the various sectors, for example, by improving the coordination between the Ministries of Education, Health, Social Development, and CSS to minimize duplication of efforts and resources; and c) strengthening planning, budgeting, and information tools and systems, legislation, and institutions to support implementation and track progress toward Government goals.

The ongoing Ebola outbreak in West Africa has put a huge strain on already weak health systems. Ebola deaths have been disproportionately concentrated among health care workers, exacerbating existing skill shortages in Guinea, Liberia, and Sierra Leone in a way that will negatively affect the health of the populations even after Ebola has been eliminated. This paper combines data on cumulative health care worker deaths from Ebola, the stock of health care workers and mortality rates pre-Ebola, and coefficients that summarize the relationship between health care workers in a given country and rates of maternal, infant, and under-five mortality. The paper estimates how the loss of health care workers to Ebola will likely affect non-Ebola mortality even after the disease is eliminated. It then estimates the size of the resource gap that needs to be filled to avoid these deaths, and to reach the minimum thresholds of health coverage described in the Millennium Development Goals. Maternal mortality could increase by 38 percent in Guinea, 74 percent in Sierra Leone, and 111 percent in Liberia due to the reduction in health personnel caused by the epidemic. This translates to an additional 4,022 women dying per year across the three most affected countries. To avoid these deaths, 240 doctors, nurses, and midwives would need to be immediately hired across the three countries. This is a small fraction of the 43,565 doctors, nurses, and midwives that would need to be hired to achieve the adequate health coverage implied by the Millennium Development Goals. Substantial investment in health systems is urgently required not only to improve future epidemic preparedness, but also to limit the secondary health effects of the current epidemic owing to the depletion of the health workforce.

El Salvador’s development over the past decade has been dichotomous. On the one hand, economic growth has remained persistently low, employment and labor force participation have barely increased, and progress on poverty reduction has slowed. On the other hand, inequality has fallen, and shared prosperity improved together with advances in many social indicators, such as pre-primary enrollment rates, access to prenatal care, immunizations, and water and sanitation. The increase in the use of social spending, which now accounts for 12.4 percent of GDP, together with an improvement in the quality of social spending, explain at least part of this dichotomy of redistributive and social gains despite low growth, a tight fiscal situation and generally low government revenues and spending. Looking forward, the key challenges El Salvador faces are related to continuing improving the quality and efficiency in the social sectors, while maintaining the overall level of social spending within an increasingly constrained fiscal environment, where fiscal constraints, low revenues, and the need to cut the deficit by 3 percent of GDP are significant elements, as well. Priority will have to be given to reallocations and improvements within the spending envelope for the social sectors to maximize impact. This document analyzes social spending for El Salvador for the education, health and social protection and labor sectors in depth and explores a series of policy options for El Salvador to reallocate social spending for more effective impacts, to enhance and reform social policies and social service delivery, and to improve the management of public spending and budget execution in the social sectors.

Honduras has experienced moderate economic growth in the past decade, in line with the rest of the region. Despite this growth track record, limited opportunities for decent jobs for the majority of workers have resulted in stagnant poverty and inequality rates that are still the highest in Central America (CA). In parallel, progress in human development indicators has also been mixed in the last decade. In education, while primary enrollment has significantly increased, low coverage at all other levels of education, inequalities in access and low quality persist. In health, Honduras is close to achieving the 2015 child mortality Millennium Development Goals (MDGs), but maternal mortality, noncommunicable diseases (NCDs), and violence pose additional challenges. And despite advances in setting up a social protection system, fiscal sustainability and lack of coordination among interventions prevail, undermining poverty reduction efforts. The ability of the Honduras government to expand safety nets, to increase the access and quality of public education and health services, to engage in active labor market policies, and to improve human development indicators in general, remains limited for a number of reasons. First, overall real social public spending has been on the decline in the last few years. Second, low revenues and fiscal deterioration pose challenges to adequately financing needed social sector improvements. Third, challenges in budget formulation and execution (mainly due to institutional factors) also diminish the impact of social spending. But more importantly, Honduras needs to significantly improve the effectiveness and efficiency of its social spending. This note argues that moving forward Honduras should prioritize three main aspects: a) to rationalize and increase the effectiveness of social public spending by enhancing the pro-poor features of targeting mechanisms; b) to significantly redress the imbalance between recurrent spending, especially the wage bill, and capital expenditure; and c) to continue strengthening information systems tools, legislation, and institutions in an effort to consolidate programs into fewer and higher impact interventions. Sector-specific challenges aligned with these broad objectives are addressed below.

The evolution of Costa Rica’s social sectors over the past decade has been dichotomous. On the one hand, economic growth has remained relatively high, however poverty and inequality have not declined (moreover, they have increased), and persistent employment challenges remain. On the other hand, the country has continued experiences advances in many social indicators, such as pre-primary and tertiary enrollment rates, access to improved sanitation, and labor force participation, though not in others (secondary school completion, immunizations, employment). Higher economic growth and (to a lesser extent) revenues seem to have allowed a substantial increase in public social spending. Looking forward, the key challenges Costa Rica faces are related to continuing improving the quality and efficiency in the social sectors, while improving targeting to serve the most in need, in a tight and severe fiscal context. To expand coverage of excluded population, priority will have to be given to reallocations and improvements within the spending envelope for the social sectors to maximize impact. With a fiscal deficit of more than 6 percent of GDP, further expanding public social spending is no longer an option and budget cuts are looming. Improvements in public spending management and budget execution, including the need of institutional reform to consolidate programs and improve coordination among executing agencies is equally important. In a country that has long been the champion in expanding universal welfare state, sustainability concerns will imply that hard fiscal decisions would need to be made to increase the social returns of budget allocation.

Honduras has experienced moderate economic growth in the past decade, in line with the rest of the region. Despite this growth track record, limited opportunities for decent jobs for the majority of workers have resulted in stagnant poverty and inequality rates that are still the highest in Central America (CA). In parallel, progress in human development indicators has also been mixed in the last decade. In education, while primary enrollment has significantly increased, low coverage at all other levels of education, inequalities in access and low quality persist. In health, Honduras is close to achieving the 2015 child mortality Millennium Development Goals (MDGs), but maternal mortality, non-communicable diseases (NCDs), and violence pose additional challenges. And despite advances in setting up a social protection system, fiscal sustainability and lack of coordination among interventions prevail, undermining poverty reduction efforts. The ability of the Honduras government to expand safety nets, to increase the access and quality of public education and health services, to engage in active labor market policies, and to improve human development indicators in general, remains limited for a number of reasons. First, overall real social public spending has been on the decline in the last few years. Second, low revenues and fiscal deterioration pose challenges to adequately financing needed social sector improvements. Third, challenges in budget formulation and execution (mainly due to institutional factors) also diminish the impact of social spending. But more importantly, Honduras needs to significantly improve the effectiveness and efficiency of its social spending. This note argues that moving forward Honduras should prioritize three main aspects: a) to rationalize and increase the effectiveness of social public spending by enhancing the pro-poor features of targeting mechanisms; b) to significantly redress the imbalance between recurrent spending, especially the wage bill, and capital expenditure; and c) to continue strengthening information systems tools, legislation, and institutions in an effort to consolidate programs into fewer and higher impact interventions.

Investments in education, health and social protection are the key to improving the state of human development in any society. In recent years, Nepal too has invested heavily in these sectors, particularly in education and health. This note provides an overview of the progress and current state of access and equity in these three sectors. It also presents evidence on some aspects of quality in the education and social protection sectors. While the country has made substantial improvements in different indicators of access at the aggregate level, disaggregated data show that disparities in access continue to exist across demographic and geographical dimensions. There is some evidence of improvement in the quality of educational inputs over the years, but the quality of outcomes remains poor.

Kosovo is one of the poorest countries in Europe (World Bank 2010). In 2009, 35 percent of the population lived below the poverty line. This note was prepared primarily as a key input to the Kosovo country partnership strategy (FY2012 to FY2015) and aims to provide an overview of gender disparities in three major domains: human capital, labor market, and entrepreneurship. The note provides a broad picture of gender disparities in Kosovo in education, health, and access to economic opportunities. Lack of statistical data on Kosovo, and particularly of gender-disaggregated data, limits the depth and scope of this gender diagnostic. Men and women in Kosovo have lower education levels than men and women in the European Union (EU). Women comprise less than 10 percent of all entrepreneurs and 0.3 percent of top management positions. This note is organized as follows: section one highlights gender differences in human capital focusing on education and health outcomes; section two describes men's and women's relative employment patterns; section three focuses on gender disparities in entrepreneurship and career advancement in business and politics; and section four provides concluding observations.

The World Bank's Country Policy and Institutional Assessment (CPIA) is an important knowledge product that assesses the performance of 39 IDA countries along 16 dimensions of policy and institutional quality. This is the first in the series of annual reports. The 16 dimensions are grouped into four clusters: economic management; structural policies; policies for social inclusion and equity; and public sector management and institutions. The CPIA has been measuring and tracking the strength of policies and institutions in IDA-eligible countries since 1980, and releasing that information since 2006. Until now, the CPIA has been used mainly to inform IDA's allocation of resources to poor countries and in research. Yet the information contained in the CPIA is potentially valuable to governments, the private sector, civil society, researchers and the media as a tool to monitor their country's progress and benchmark it against progress in other countries. By presenting the CPIA scores for 38 African countries over six years in one easy-to-read document, this report aims to provide citizens with information that can support evidence-based debate that can, in turn, lead to better development outcomes. The scope of the report is motivated by the World Bank's open data initiative and the new Africa strategy, both of which seek to foster participation in development from a wide range of stakeholders by providing broader access to data and knowledge.

The Philippines has made significant progress in empowering women and in advancing gender equality. The government's policy on gender equality and women's empowerment has prioritized women's economic empowerment, advancing human rights and enhancing gender-responsive local governance. All these priority concerns are integral components of poverty reduction programs in the Philippines. The Philippines has made significant progress in empowering women and in advancing gender equality. Since the government introduced a constitution in 1987 affirming the equality of women, it has pursued a number of initiatives to mainstream gender concerns in national policies and programs. A development plan for women was launched in 1987, followed by a plan for gender-responsive development, 1995-2025, coordinated by the National Commission on the Role of Filipino women. In 2004, the commission drafted a framework plan for women that identify three priority concerns to meet the objectives of gender equality and women's empowerment: economic empowerment of women, protection and fulfillment of women's human rights, and gender-responsive governance. Projects that support these priorities will facilitate more equitable development across the Philippines, including supporting the full participation of women in political processes and governance in the international and national local level, strengthening gender-sensitive and inclusive programs and mechanisms with civil society, and increasing women's access to economic resources such as capital, technology, information, markets, and training.

Nicaragua, a largely urban country (56 percent of the population lives in urban areas), is one of the least populous (5.53 million) and poorest countries in CentralAmerica. Following reforms in the 1980s, Nicaragua made remarkable progress in gender equity in education and the labor force, while the wide availability of primary health care initiated in the 1970's, including family planning services, led to improvements in infant and child mortality rates. Several lessons emerge from Nicaragua's success at reducing fertility. The government was committed to gender equity and female empowerment through educating girls and women and recruiting women into the labor force. Family planning services were provided within a well functioning primary health care system, including an extensive, efficient contraceptive distribution network that works with international donors, and international and national Non-Governmental Organizations (NGOs) to offer women a good mix of options. Demand must be created through a timely public education campaign. Success requires civic engagement with stakeholders, which may initially mean avoiding unnecessary confrontation and publicity of services for addressing the concerns of more conservative stakeholders.

This review of public expenditures on Social Protection (SP) in Nicaragua is based on the analytical framework of Social Risk Management (SRM) developed by the World Bank. The concept of managing social risk comes from the notion that certain groups in society are vulnerable to unexpected shocks which threaten their livelihood and/or survival. Social protection focuses on the poor since they are more vulnerable to the risks and normally do not have the instruments to handle these risks. This prevents the poor from taking more risky activities that usually yield higher returns and that could help them overcome gradually their poverty situation. Social risk management involves policies and programs aimed at reducing key risks, breaking inter-generational cycle of poverty and vulnerability. Risk management consists in the choice of appropriate risk prevention, mitigation and coping strategies to minimize the adverse impact of social risks. Social protection under SRM is defined as public interventions to assist individuals, households and communities to better manage risk and provide support to the critically poor. Thus Social protection should provide: a safety net, particularly for the poor that are likely to fall in the cracks of established programs; and a springboard for the poor to bounce out of poverty.

Bangladesh stands out as the shining new example in South Asia of a poor country achieving impressive gains in gender equality. Between 1971 and 2004, Bangladesh halved its fertility rates. In much of the country today, girls' secondary school attendance exceeds that of boys. The gender gap in infant mortality has been closed. The scholarly work that came out of the micro credit revolution is based on large and unique data sets and high quality ethnographic work and has set a high bar for evidence-based policy proposals. Beyond a doubt, Bangladesh has made great progress in achieving gender equality and enhancing the status of women. Its success in girls' education, reducing fertility and mortality and the famed microcredit revolution are some of the gains that set it apart from its neighbors and other countries of its income level. When young women and their families were asked what this meant for them and how their lives were different from their mothers', the unexpectedly common theme was "finding a voice" or "being able to speak" or "being listened to".