Africa Human Development

This paper, based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity, aims at understanding the performance of primary health care providers in four states in Nigeria. As possible ways to improve performance, the paper concludes that clearly defining lines of responsibility, implementing performance-based financing of local governments and providers, and collecting, analyzing, and sharing information are some options that can help realign incentives and improve accountability in the service delivery chain and service provision. This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharma-ceuticals, Governance and Service Delivery, and Infrastructure and ICT.

This paper presents unique evidence on health workers' career choices in Ethiopia. It shows that challenges like health workers' limited willingness to work in rural areas, as well as their likelihood to migrate abroad vary substantially and are correlated with background, motivation, and job satisfaction. Governments in Africa have identified human resources for health as a priority to improve health outcomes. This study is a valuable resource to better understand health worker choices and help toward the design of more effective human resource policies. This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT.

The Democratic Republic of Congo faces the challenge of providing universal primary education and expanding opportunities for post-secondary education and training for its youth, ages 12 to 24. This study analyzes the current educational attainment and school enrollment status of youth, as well as the formal and informal post-secondary educational and training opportunities available to them. The study uses the results of a simulation model that incorporates enrollment in alternative education programs and considers alternative scenarios for developing the post-primary sector. Each scenario is evaluated for the impact on the human capital accumulation of young people and the sustainability of public expenditures. The report offers policy options for rapidly raising the educational attainment of young people who will be entering the labor force in the next two decades, including expanding opportunities for alternative education and training for out-of-school children, the extension of primary education, and the reorganization of secondary and technical/vocational training to reduce early specialization.

Bridging the Gap: Addressing Health Worker Imbalances in Sub-Saharan AfricaThis working paper tackles the critical issue of geographical imbalances in the health workforce across Sub-Saharan Africa. It analyzes labor market dynamics and their impact on urban-rural inequities, offering a fresh perspective on why these imbalances persist. Discover effective policy options for improving health resource allocation and achieving better health outcomes. This is for researchers, policy analysts, and policymakers seeking to understand and address health workforce challenges in the developing world. Learn how to: - Analyze health labor markets using economic principles - Evaluate the effectiveness of different policy interventions - Improve health system efficiency and reduce poverty

A deep dive into Rwanda's budget and economic reforms. This working paper offers a comprehensive analysis of Rwanda's budgeting practices and public expenditure management from 2004-2007. It examines the effectiveness of general budget support, the impact of economic reforms, and the challenges of aid dependency. Discover how Rwanda has navigated its transition from reconstruction to reform. Explore resource allocation strategies, ministry-level spending, and the influence of international aid. This report is for government officials, policy makers, and anyone seeking - Insights into Rwanda's economic development - Analysis of public finance management - Understanding of aid effectiveness in practice

With challenges similar to those faced by a number of low income countries, Madagascar faces critical policy choices with respect to post-basic education. Enrolment ratios in senior secondary education and tertiary education are 10 percent and 3 percent, respectively, among the lowest in the world. Critical skill shortages and pervasive inequities in access necessitate changes in the quantity and quality of education and skills. The increasing number of basic education completers and demographic growth are mounting pressure on the government to expand access to post-basic education. Responding to these economic and social challenges, the government has made the transformation of education one of the key priorities of the Madagascar Action Plan. However, low domestic revenues and competing demands from other sectors, including basic education, limit the room for maneuver. Caught between these two pincers, policy makers often choose to sacrifice quality over expanding access or are unable to develop a long term vision. 'Developing the Workforce, Shaping the Future' presents Madagascar's core challenges and argues persuasively that the time for transforming the post-basic education system is now. It documents the poor performance of the post-basic education system in the areas of quality and relevance, internal efficiency, equity and financial inefficiency. The report presents a sequence of prioritization of reforms, focusing on improving education content and linkages with the economy, increasing coverage cost-effectively through the adoption of new planning norms for public institutions, utilization of the private sector and innovations in open/flexible learning and creating the enabling framework through reforms of governance, finance and management. The report provides a convincing reform scenario for a low income country, with actions to be undertaken in the medium and long term to sustain the development of post-basic education in an environment of limited public resources and implementation capacity. Policy makers in other developing countries will find this report useful to gauge their own strategies for post basic education.

This thematic study consists of case studies of Ghana, Malawi, and Uganda, as well as, a review of studies undertaken over the past ten years on education in Africa with particular attention to girls' and secondary education. Gender equity at the primary level has been the focus of considerable attention within the Education for All Framework of Action, but much less so at the secondary level. Evidence of gender inequity and inequality in terms of access, retention and performance in secondary education in SSA raises many questions. While transition rates from primary to secondary are higher for girls than boys, and the repetition rates are lower, girls still significantly trail behind boys in graduation and enrollment rates. The purpose of this study is to document and analyze the extent and nature of gender disadvantage in junior and senior secondary education, to analyze the causes of this disadvantage, and to identify strategies that may be effective in reducing or eliminating it. This study was prepared as part of the Secondary Education and Training in Africa (SEIA) initiative which aims to assist countries to develop sustainable strategies for expansion and quality improvements in secondary education and training. All SEIA products are available on its website: www.worldbank.org/afr/seia.

This study is based on research on secondary textbook and school library provision in Botswana, Cameroon, Cote d'Ivoire, Ghana, Kenya, Malawi, Rwanda, Tanzania, and Togo, as well as existing recent country reports on textbook provision and an extensive desk research. Considerable variations exist in Sub-Saharan African textbook requirements needed to meet secondary curriculum specifications just as significant differences exist between and within countries in regard to the average price of recommended textbooks. Some countries have no approved textbooks list. This World Bank Working Paper aims to discuss the textbook situation in Sub-Saharan Africa with a special focus on secondary textbook availability, cost and financing, distribution and publishing, and the status of school libraries. Its objective is to analyze the issues in secondary textbook and school library provision and to provide some options and strategies for improvement.

Increasingly the role of management and governance is recognized as important for providing and delivering effective services at all levels of education. In view of the growing demand for more and better services at secondary education levels, these are crucial issues that must be addressed urgently. Sub-Saharan Africa's secondary education and training systems must become more efficient and more effective. The current (unit) costs of junior and senior secondary education in most African countries prevent massive expansion of post-primary education. This demands a holistic approach to governance and management issues. In parallel, there is a demand from civil society and governments for greater accountability. This study aims to present best practices and identify sustainable development plans for expansion and improved quality and efficiency in the delivery of secondary education in Sub-Saharan Africa through better governance, management, and accountability.

Achieving Better Service Delivery Through Decentralization in Ethiopia examines the role decentralization has played in the improvement of human development indicators in Ethiopia. Ethiopia has made major strides in improving its human development indicators in the past 15 years, achieving significant increases in the coverage of basic education and health services in a short period of time. Improvements took place during a period of massive decentralization of fiscal resources, to the regions in 1994 and to woredas in 2002-03. The devolution of power and resources from the federal and regional governments to woredas appears to have improved the delivery of basic services. Surveys of beneficiaries reveal that they perceive that service coverage and quality have improved. Beneficiary satisfaction has increased markedly in education, and less conspicuously in water and health services. In the south, the decentralization to woredas in 2002-03 tended to narrow differences in per capita expenditures on education and health across woredas. Decentralization disproportionately favored woredas that are remote (more than 50 kilometers from a zonal capital), food-insecure, and pastoral, suggesting that decentralization has been pro-poor. Decentralization also narrowed the gap in educational outcomes between disadvantage and better-off woredas, especially in the south. Pastoral, food-insecure, and remote woredas gained in terms of the educational outcomes examined (gross enrollment rates, grade 8 examination pass rates, repetition rates, pupil-teacher ratios, and teacher-section ratios).

Policy makers recognize that developing capacity for knowledge and technology driven growth is necessary for Swaziland to integrate into the global economy and to be competitive; in particular because Swaziland is not rich in exploitable natural resources. The Education Training and Skills Development Sector (ETSDS), the educational sector of Swaziland's long-term development and reform program, covers all levels of education, from early childhood to post-secondary education. This paper evaluates the adequacy of the ETSDS in light of the enhanced educational goal for the country. Acknowledging that financing reforms will be a challenge, this paper makes recommendations to enhance the program's effectiveness, such as expanding access, strengthening delivery modes, and minimizing financial barriers to education and training.

This paper reviews the performance of the health sector in Uganda. It addresses concerns in the Ugandan health community that health financing must be increased to improve health, nutrition, and population outcomes, especially given the rapid increase in the country's population. Although international development aid targeted to health has increased dramatically, Uganda's first priority is actions to reduce waste and inefficiency in existing health expenditures. Such actions could include improved management of human resources in the health sector, strengthened procurement and logistics management for medicines and medical supplies, and better programming of development assistance of health. This paper is targeted to health policy makers and those involved in health services financing, both in the government and in donor agencies. This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT.

By international standards, health workers in Ethiopia are in short supply. In addition, those who do enter the health fields and remain in the country disproportionately live and work in the capital, Addis Ababa. This paper uses detailed data gathered from nearly 1,000 health workers to examine the incentives and constraints that health workers face when choosing where to work, the likely responses of workers to alternative incentive packages, and the longer term performance of the health worker labor market. This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT.

Understanding the career choices of future health workers in Rwanda is crucial for effective health policy. This working paper delves into the diverse preferences of medical and nursing students, examining their motivations, income expectations, and willingness to serve in rural areas or high-HIV prevalence regions. It sheds light on the factors influencing their decisions, from altruism and intrinsic motivation to economic incentives and personal circumstances. Drawing on unique survey data, this analysis provides valuable insights for government officials and health policymakers seeking to address workforce shortages and improve the distribution of healthcare professionals. Discover how these future health workers weigh their options and what strategies can be employed to attract and retain talent in underserved communities. This study offers a roadmap for building a stronger, more equitable healthcare system in Rwanda.

Economic and social changes, fast evolution of technology, and the growing importance of Internet services and international communications--all these require secondary education providers to adapt what is taught and learned in schools. However, in Africa the content of secondary curricula is in most cases ill-adapted to 21st century challenges, where young people are mobile, have access to 'more and instant information,' and face health threats such as HIV/AIDS. In addition, implementation problems exist, and the time for instruction is often much less then what is required by the prescribed secondary curriculum. In Africa there is a need to develop a secondary education curriculum adapted to the local economic and social environment, but with international-comparable performance indicators. This study analyzes that challenge: the quality of curricula and assessment, and their development processes in secondary education in Africa against the background of existing contexts, conditions, and ambitions on the one hand and current pedagogical thinking on the other. This World Bank Working Paper was prepared as part of the Secondary Education and Training in Africa (SEIA) initiative which aims to assist countries to develop sustainable strategies for expansion and quality improvements in secondary education and training.

Forty-four African ministers of finance and of education from 28 countries met in Tunis at a July 2009 conference on "Sustaining the Education and Economic Momentum in Africa amidst the Current Global Financial Crisis." The conference attendees discussed why and how they must exercise joint political leadership during the current global economic crisis to protect the educational development achieved during the past decade. They acknowledged that educational reform is an agenda for the entire government and that strong leadership to foster cross-ministry collaboration, coordination, and mutual accountability is required to ensure that education and training investments are effective in advancing national development and economic progress.

This World Bank Working Paper discusses equity and efficiency issues in secondary education transitions in Sub-Saharan Africa. Its main purpose is to identify and analyze national, regional, and local measures that may lead to the development of more efficient and seamless transitions between post-primary education pathways. In most African countries student transition from primary to junior secondary is still accompanied by significant repetition and dropout. Transitions within the secondary cycle also cause significant losses and should use more effective assessment and selection methodologies. According to global trends, Africa needs to revisit its post-primary structures to provide more diversified (academic and non-academic) pathways of learning which respond better to the continent's present economic and social realities. In the end, the main goal should be to produce young people who can become productive citizens and lead healthy lives, as demonstrated by middle and higher-income economies.

'Female Genital Cutting, Women's Health, and Development' provides a comprehensive understanding of the issue of femal genital mutiliation/cutting-scope, challenges, opportunities, best practices, and how communities, development agencies, and national governments can work together to eliminate the practices on the ground. The World Bank is committed to assisting governments in ending the practice of female genital cutting, as the practice has direct, negative impact on the health and well-being of women around the world. The recommendations set forth in this paper take advantage of the World Bank's comparative advantage in dealing with governments. Continued silence perpetuates the practice, thereby undermining women's productivity.