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Publication
The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys
(Washington, DC: World Bank, 2021-11-18) Gatti, Roberta ; Andrews, Kathryn ; Avitabile, Ciro ; Conner, Ruben ; Sharma, Jigyasa ; Yi Chang, AndresHave teachers mastered the subject matter they are teaching? Can doctors accurately diagnose and treat critical health conditions? Are schools and health facilities sufficiently stocked with needed equipment and supplies? Are they sufficiently supported and staffed to optimize learning and health care outcomes? For the past decade, the World Bank’s Service Delivery Indicators (SDI) surveys have collected nationally representative data in countries across Africa to answer these questions. The surveys aim to measure the quality of services where they meet citizens: in schools and health facilities. The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys identifies areas of achievement and constraint in service delivery, shedding light on how service delivery may foster or stunt human capital accumulation. SDI surveys show that schools and health clinics across Africa are still falling short in some critical areas. The delivery of primary care services is very heterogenous between and within countries. Many health facilities lack the basic necessities to provide proper care, such as essential medicines, basic diagnostic equipment, and adequate water and sanitation. Moreover, health care providers’ ability to diagnose and treat common health conditions correctly is low and distributed unevenly. Health personnel’s absence from health facilities remains a concern across the surveyed countries. Learning is low, and, not unlike health care, levels of student learning vary significantly across countries: less than half of grade 4 students can recite a simple sentence or perform basic mathematical operations. This deficient learning is correlated with teachers’ low levels of content knowledge and sub-par pedagogy skills. Some schools are also missing crucial inputs, such as blackboards or private and gendered toilets, and struggle with high pupil-teacher ratios. Despite these challenges, success stories in both sectors illustrate the quality of service delivery that could be achieved and showcase the dedication of teachers and medical staff across Africa. By studying data from thousands of facilities, considering the local context, and drawing insights from the literature, this book offers important insights for how countries can strengthen health and education systems and build back better in the wake of the massive disruptions brought about by the COVID-19 pandemic. -
Publication
Strengthening Post-Ebola Health Systems: From Response to Resilience in Guinea, Liberia, and Sierra Leone
(Washington, DC: World Bank, 2018) Govindaraj, Ramesh ; Herbst, Christopher H. ; Ajumobi, Oluwayemisi ; Rockmore, Christophe ; Zine Eddine El Idrissi, Moulay Driss ; Workie, Netsanet ; Clark, John Paul ; Govindaraj, Ramesh ; Herbst, Christopher H. ; Ajumobi, Oluwayemisi ; Rockmore, Christophe ; Zine Eddine El Idrissi, Moulay Driss ; Workie, Netsanet ; Clark, John PaulStrengthening Post-Ebola Health Systems addresses the challenge of enabling the development of viable, resilient, and fiscally sustainable health system in Guinea, Liberia, and Sierra Leone. Initiated while Ebola was still raging in all of the three most-affected countries in West Africa, it identifies the requirements for strengthening the health systems in these countries to go beyond just getting the number of Ebola cases to zero. The overall goal of this study is thus twofold: To assess the capacity of the health systems of the three most-affected countries in terms of their ability to deliver quality health services to their populations, perform core public health functions on a routine basis, and to respond to public health emergencies; and To identify the highest impact strategies to help these countries to strengthen their health systems to be more effective and resilient, drilling down into three key aspects of the health system--that is, fiscal space for universal health coverage (UHC), development and deployment of an effective health workforce, and continuous disease surveillance. -
Publication
The Africa Competitiveness Report 2017: Addressing Africa’s Demographic Dividend
(Geneva: World Economic Forum, 2017-05-01) World Economic Forum ; World Bank ; African Development BankWithout urgent action to address low levels of competitiveness, Africa’s economies will not create enough jobs for the young people entering the job market. If current policies remain unchanged, fewer than one-quarter of the 450 million new jobs needed in Africa in the next 20 years will be created. These are among the key findings of the Africa Competitiveness Report 2017, a biennial publication jointly produced by the World Economic Forum, the African Development Bank, and the World Bank Group. Priorities to meet the changing demographics include policy reform to improve the quality of institutions, infrastructure, skills and adoption of new technology. House construction and better urban planning present opportunities for short-term competitiveness gains. The report finds that the ability of Africa’s economies to generate enough jobs for its young and growing population rests on the successful implementation of urgent structural reforms to boost productivity. Competitiveness is defined as the set of institutions, policies and factors that determine the level of productivity, and hence future prosperity, of a country. The report, which covers North Africa and Sub-Saharan Africa, comes at a time when growth in most of the region’s economies has been slowing after a decade of sustained growth. Further stagnation is likely in the absence of improvements in the core conditions for competitiveness. Compounding the challenge to Africa’s leaders is a rapidly expanding population. -
Publication
The Economic Impact of the 2014 Ebola Epidemic : Short- and Medium-Term Estimates for West Africa
(Washington, DC: World Bank, 2014-11-20) World Bank GroupBeyond the terrible toll in human lives and suffering, the Ebola epidemic currently afflicting West Africa is already having a measurable economic impact in terms of forgone output; higher fiscal deficits; rising prices; lower real household incomes and greater poverty. These economic impacts include the costs of healthcare and forgone productivity of those directly affected but, more importantly, they arise from choices by others to avoid exposure to the disease, called 'aversion behavior'. This report provides a systematic analysis of the channels of economic impact and the likely magnitude of that impact for Guinea, Liberia, and Sierra Leone, as well as West Africa as a whole. The short-term (2014) impact of Ebola on economic output is on the order of US$359 million in foregone output in 2013 prices. Two alternative scenarios are used to estimate the medium-term (2015) impact of the epidemic. A 'Low Ebola' scenario corresponds to rapid containment within the three most severely affected countries, while 'High Ebola' corresponds to slower containment in the core three countries, with some broader regional contagion. The estimates of the GDP lost as a result of the epidemic in the core three countries for 2015 alone sum to US$97 million under Low Ebola (implying some recovery from 2014), and US$809 million under High Ebola (in 2013 dollars). Over the medium term, however, both epidemiological and economic contagion in the broader sub-region of West Africa is likely. This report uses a multi-country general equilibrium model to estimate the medium-term impact on output for West Africa as a whole. Under Low Ebola, the loss in GDP for the sub-region is estimated to be US$2.2 billion in 2014 and US$1.6 billion in 2015. Under High Ebola, the estimates are US$7.4 billion in 2014, and US$25.2 billion in 2015. This analysis shows that the economic impacts are already very serious in the core three countries - particularly Liberia and Sierra Leone - and could become catastrophic under a slow-containment, High Ebola scenario. In broader regional terms, the economic impacts could be limited if immediate national and international responses succeed in containing the epidemic and mitigating aversion behavior. If, on the other hand, the epidemic spreads into neighboring countries, some of which have much larger economies, the cumulative two-year impact could reach US$32.6 billion by the end of 2015 - almost 2.5 times the combined 2013 GDP of the core three countries. -
Publication
The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda
(World Bank, 2012) Lule, Elizabeth ; Haacker, MarkusHIV/AIDS imposes enormous economic, social, health, and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub-Saharan Africa, home to two-thirds (22.5 million) of the people living with HIV/AIDS globally, and where HIV/AIDS has become the leading cause of premature death. But now, after decades of misery and frustration with the disease, there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV/AIDS in Southern Africa, the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV/AIDS programs. Importantly, it highlights the long-term nature of the fiscal commitments implied by HIV/AIDS programs, and explicitly discusses the link between HIV infections and the resulting commitments of fiscal resources. The analysis shows that, absent adjustments to policies, treatment is not sustainable. But it also shows that, by accompanying treatment with prevention, and making existing programs more cost-effective, these countries can manage both treatment and fiscal sustainability. Even in countries where HIV/AIDS-related spending is high or increasing (as past infections translate into an increasing demand for treatment), the fiscal space absorbed by the costs of HIV/AIDS-related services will decline if progress in containing and rolling back the number of new infections can be sustained. The purpose of this study is to refine the analysis of the fiscal burden of HIV/AIDS on national governments and assess the fiscal risks associated with scaling-up national HIV/AIDS responses. The study complements and contributes to the agenda on identifying and creating fiscal space for HIV/AIDS and other development expenditures. The findings from this study, and the analytical tools developed in it, could help governments in defining policy objectives, improving fiscal planning, and conducting their dialogue with donor agencies. -
Publication
Diaspora for Development in Africa
(World Bank, 2011-04-26) Ratha, Dilip ; Plaza, SoniaThe diaspora of developing countries can be a potent force for development for their countries of origin, through remittances, but also, importantly, through promotion of trade, investments, research, innovation, and knowledge and technology transfers. This book brings relevant experience from both developed and developing countries to bear on issues confronting today's governments in linking with their diaspora. The chapters present different approaches used by countries that have tried to maximize the possible gains from migration by engaging more comprehensively with different diaspora groups and individuals. Some African countries are pursuing policies to develop links with Africans abroad, either to encourage them to return or to use their skills, knowledge, or financial capital to foster African development. The book discusses concrete examples of diaspora initiatives that are being implemented in Africa. There are comprehensive reviews on how the diaspora can promote trade and investment linkages. Some developing countries are using dual citizenship to deepen ties with their diaspora. The book directly addresses the issues of remittances-linked financial instruments, investments by the diaspora, diaspora bonds, contributions of skilled and unskilled diaspora in transferring knowledge, analytical research on return migration, and concrete circular migration experiences. There is a need to have a better understanding of these initiatives and to see whether they can be scaled up or replicated in other countries worldwide. -
Publication
Accelerating the Education Sector Response to HIV : Five Years of Experience from Sub-Saharan Africa
(World Bank, 2010) Bundy, Donald ; Patrikios, Anthi ; Mannathoko, Changu ; Tembon, Andy ; Manda, Stella ; Sarr, Bachir ; Drake, LesleyThe work described in this review shows the commitment of education teams throughout Africa to contribute to the multisectoral response to HIV/AIDS. It is also a testament to the leadership shown by ministries of education, in helping the new generation of children and youth grow up better able to challenge HIV, and in providing care and support for the educators who often represent more than half the public sector workforce. The work described in this review does not suggest any single solution. Instead, the approach is based on the recognition that Africa is a diverse continent, and countries need to find their own local approaches to the epidemic. The Regional Economic Communities (RECs) of the African Union have been instrumental in encouraging locally specific responses, and recognizing that HIV knows no frontiers, in coordinating responses among neighbors. The countries of East, Central, and West Africa, working through the RECs, have created sub-regional networks of ministry of education HIV/AIDS focal points; these networks have been key to sharing information and developing capacity, and so to accelerating and strengthening responses at the national level. The review shows how, over the last five years, the leadership in ministries of education has been crucial in mobilizing these activities, and also emphasizes that effective implementation depends on the full participation of all stakeholders. Education staff, educators, and learners all have a role to play, as do parent-teacher associations, teachers' unions and the many civil society organizations, including faith-based organizations that are so important in the non-formal sector. The review also demonstrates the commitment of the development partners, and their efforts to harmonize their contribution toward strengthening the education agenda. -
Publication
Intensifying the Fight Against Malaria : The World Bank's Booster Program for Malaria Control in Africa
(Washington, DC : World Bank, 2009) World BankThis document describes the purpose and context of the Booster Program, its first three years of operation and the proposed design of phase two of the program. Phase two seeks to build on the successes of and lessons learned from phase one and to enable the World Bank to play its expected role in scaling up and sustaining malaria control interventions to reach the new ambitious but achievable global goal set by the Roll Back Malaria (RBM) Partnership, of eliminating malaria as a major public health problem in Africa by 2015. The Bank has subscribed fully to this agenda, as illustrated by statements made by senior management in several public forums. -
Publication
Namibia: Country Brief
(World Bank, 2009) World BankNamibia is a large country in Southern Africa that borders the South Atlantic Ocean, between Angola to the north and South Africa to the south. With a surface area of 824,290 square kilometers, it is similar in size to Mozambique and about half the size of the U.S. state of Alaska. Namibia has a small population of approximately 2.1 million people. It is also one of the least densely populated countries in Sub-Saharan Africa, with an average density of approximately 2.5 people per square kilometer, compared to 34 people per square kilometer for the region as a whole. Namibia was the last colonized country in Sub-Saharan Africa to become independent. After nearly 70 years of South African rule, Namibia gained its independence on March 21, 1990. Until 1990, Namibia's official languages were German, Afrikaans, and English. Following independence, English became the official language, although it is the first language of only a very small percentage of Namibians. Oshiwambo dialects are the mother tongue of approximately half of the population. Namibia, a lower-middle-income country, has one of the highest levels of per capita income in Sub-Saharan Africa. Namibia is one of very few countries in Sub-Saharan Africa that maintains a social safety net for the elderly, the disabled, orphans and vulnerable children, and war veterans. It also has a social security act that provides for maternity leave, sick leave, and medical benefits. Namibia has one of the most productive fishing grounds in the world. The fishing industry is an important source of foreign exchange and a significant employer. The tourism industry in Namibia is similar in size to that in Botswana and is the country's third-largest foreign exchange earner. Namibia is one of the largest producers of gem quality diamonds in the world. It is estimated that 98 percent of its mined diamonds are gem quality. In 2006, almost half of total production was recovered from offshore sources. Namibia is the driest country in Sub-Saharan Africa, with deserts occupying much of the country. It has no perennial rivers or any other permanent water bodies. Due to the low and erratic rainfall and scarce ground and surface water, less than five percent of the country is arable, including through irrigation. Namibia was the first country in the world to incorporate environmental protection into its constitution. Nearly six percent of its land is nationally protected, including large portions of coastal areas within the Namib Desert. -
Publication
Tanzania: Country Brief
(World Bank, 2009) World BankThe name Tanzania is a portmanteau of Tanganyika, the mainland, and Zanzibar, the nearby archipelago in the Indian Ocean. The two united to become the United Republic of Tanzania in 1964. With a surface area of 947,300 square kilometers, Tanzania is comparable in size to Nigeria and is slightly more than twice the size of the U.S. state of California. Tanzania's population of approximately 40.4 million (as of 2007) is the second largest in East Africa, after Ethiopia's. Dar es Salaam, the most populous city, contains approximately 2.7 million people and accounts for most commercial activity. Swahili (or Kiswahili) and English are the two official languages of Tanzania. A large number of local languages are also spoken. In Zanzibar, Arabic is commonly used. Agriculture remains the mainstay of Tanzania's economy, accounting for one-quarter of gross domestic product (GDP) and approximately 80 percent of employment. Tanzania is endowed with mineral and natural resources, including gold, diamonds, and several other precious and semiprecious stones. The blue gemstone tanzanite is found only in Tanzania. Tanzania accounted for almost two percent of world gold production as of 2006. Tanzania has a long history of hosting refugee's fleeing civil wars in nearby countries. As of January 2008, there were more than 380,000 refugees living in Tanzania, predominantly from Burundi and the Democratic Republic of Congo. Tanzania is an up-market tourism destination. The country is endowed with a variety of tourism assets, including seven United Nations Educational, Scientific, and Cultural Organization (UNESCO) world heritage sites and numerous wildlife parks, beach resorts, coral reefs, and spectacular scenic mountain views.
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