Publication: The Complementarity of MDG Achievements : The Case of Child Mortality in Sub-Saharan Africa
Loading...
Published
2009-09-09
ISSN
Date
2012-03-19
Author(s)
Editor(s)
Abstract
This paper analyzes complementarities between different Millennium Development Goals, focusing on child mortality and how it is influenced by progress in the other goals, in particular two goals related to the expansion of female education: universal primary education and gender equality in education. The authors provide evidence from eight Sub-Saharan African countries using two rounds of Demographic and Health Surveys per country and applying a consistent micro-econometric methodology. In contrast to the mixed findings of previous studies, for most countries the findings reveal strong complementarities between mothers educational achievement and child mortality. Mothers schooling lifts important demand-side constraints impeding the use of health services. Children of mothers with primary education are much more likely to receive vaccines, a crucial proximate determinant of child survival. In addition, better educated mothers tend to have longer birth intervals, which again increase the chances of child survival. For the variables related to the other goals, for example wealth proxies and access to safe drinking water, the analysis fails to detect significant effects on child mortality, a finding that may be related to data limitations. Finally, the study carries out a set of illustrative simulations to assess the prospects of achieving a reduction by two-thirds in the under-five mortality rate. The findings indicate that some countries, which have been successful in the past, seem to have used their policy space for fast progress in child mortality, for example by extending vaccination coverage. This is the main reason why future achievements will be more difficult and explains why the authors have a fairly pessimistic outlook.
Link to Data Set
Citation
“Lay, Jann; Robilliard, Anne-Sophie. 2009. The Complementarity of MDG Achievements : The Case of Child Mortality in Sub-Saharan Africa. Paper is funded by the Knowledge for Change
Program (KCP),Policy Research working paper ; no. WPS 5062. © World Bank. http://hdl.handle.net/10986/4253 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication The Economic Value of Weather Forecasts: A Quantitative Systematic Literature Review(Washington, DC: World Bank, 2025-09-10)This study systematically reviews the literature that quantifies the economic benefits of weather observations and forecasts in four weather-dependent economic sectors: agriculture, energy, transport, and disaster-risk management. The review covers 175 peer-reviewed journal articles and 15 policy reports. Findings show that the literature is concentrated in high-income countries and most studies use theoretical models, followed by observational and then experimental research designs. Forecast horizons studied, meteorological variables and services, and monetization techniques vary markedly by sector. Estimated benefits even within specific subsectors span several orders of magnitude and broad uncertainty ranges. An econometric meta-analysis suggests that theoretical studies and studies in richer countries tend to report significantly larger values. Barriers that hinder value realization are identified on both the provider and user sides, with inadequate relevance, weak dissemination, and limited ability to act recurring across sectors. Policy reports rely heavily on back-of-the-envelope or recursive benefit-transfer estimates, rather than on the methods and results of the peer-reviewed literature, revealing a science-to-policy gap. These findings suggest substantial socioeconomic potential of hydrometeorological services around the world, but also knowledge gaps that require more valuation studies focusing on low- and middle-income countries, addressing provider- and user-side barriers and employing rigorous empirical valuation methods to complement and validate theoretical models.Publication It’s Not (Just) the Tariffs: Rethinking Non-Tariff Measures in a Fragmented Global Economy(Washington, DC: World Bank, 2025-10-22)As tariffs have declined, non-tariff measures (NTMs) have become central to trade policy, especially in high-income countries and regulated sectors like food and green technologies. Although NTMs may serve legitimate goals, they could also sort countries and firms into or out of markets based on compliance capacity and differences in product mix. Documenting recent advances in the estimation of ad valorem equivalents (AVEs), this paper uncovers new patterns of use and exposure of NTMs. High-income countries rely more heavily on NTMs relative to tariffs, while low- and middle-income countries face steeper AVEs on their exports. Firm-level evidence shows that NTMs disproportionately affect smaller firms, leading to market exit and concentration. Poorly designed NTMs can harm productivity and welfare, while coordinated, capacity-aware use can deliver inclusive outcomes. Policy design, transparency, and diagnostics must evolve to reflect the growing role—and risks—of NTMs in a fragmented global trade landscape.Publication Monitoring Global Aid Flows: A Novel Approach Using Large Language Models(Washington, DC: World Bank, 2025-11-04)Effective monitoring of development aid is the foundation for assessing the alignment of flows with their intended development objectives. Existing reporting systems, such as the Organisation for Economic Co-operation and Development’s Creditor Reporting System, provide standardized classification of aid activities but have limitations when it comes to capturing new areas like climate change, digitalization, and other cross-cutting themes. This paper proposes a bottom-up, unsupervised machine learning framework that leverages textual descriptions of aid projects to generate highly granular activity clusters. Using the 2021 Creditor Reporting System data set of nearly 400,000 records, the model produces 841 clusters, which are then grouped into 80 subsectors. These clusters reveal 36 emerging aid areas not tracked in the current Creditor Reporting System taxonomy, allow unpacking of “multi-sectoral” and “sector not specified” classifications, and enable estimation of flows to new themes, including World Bank Global Challenge Programs, International Development Association–20 Special Themes, and Cross-Cutting Issues. Validation against both Creditor Reporting System benchmarks and International Development Association commitment data demonstrates robustness. This approach illustrates how machine learning and the new advances in large language models can enhance the monitoring of global aid flows and inform future improvements in aid classification and reporting. It offers a useful tool that can support more responsive and evidence-based decision-making, helping to better align resources with evolving development priorities.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication The State of Global Services Trade Policies: Evidence from Recent Data(Washington, DC: World Bank, 2025-10-28)The economic environment for services trade has changed dramatically over the past 15 years, driven by rapid technological progress that has expanded the possibilities for exchanging services. How has trade policy responded to these changes? How do policy stances in a wide range of service sectors compare across economies? With its unprecedented global coverage, the Services Trade Policy Database and the associated Services Trade Restrictions Index, developed jointly by the World Bank and the World Trade Organization, help address these questions. This paper makes three principal contributions. First, it offers an in-depth discussion of the current state of services trade policies and their differences across 134 economies and 34 services subsectors. Second, the paper reveals how recent (2016–22) changes in policy stances have seen progressive liberalization by lower-income economies but stabilization or even slight policy reversals in high-income economies. This dynamic differs fundamentally from the trend that unfolded after the Great Recession over 2008–16. Third, the paper shows the implications of policy changes over the past six years on services trade costs, and it showcases how the Services Trade Policy Database’s regulatory information can inform trade negotiations, regulatory analysis, and policy making. Alongside these contributions, the paper documents updates to the Services Trade Policy Database’s economy and sector coverage and explains the latest methodological improvements made to the World Bank–World Trade Organization Services Trade Restrictions Index.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Maternal and Child Survival : Findings from Five Countries Experience in Addressing Maternal and Child Health Challenges(World Bank, Washington, DC, 2014-05)Considerable progress has been made towards the achievement of the Millennium Development Goals (MDGs) since 1990. Although advances in improving MDG 4 and MDG 5a (reducing child and maternal mortality, respectively) have been made, progress is some countries have been insufficient. While some countries have made substantial gains, others have not. This paper is part of a larger study that aims to address this gap in knowledge. The paper discusses the findings from qualitative case studies of five countries that are either on track to meet MDGs 4 and 5a by 2015 or have made significant progress to this end (Bolivia, China, Egypt, Malawi and Nepal). Although they have different socio-economic characteristics, all have made significant advancements due to a strong commitment to improving maternal and child health. To do this, strong political commitment, through policies backed by financial and programmatic support, was critical. In addition, focusing on the most vulnerable populations helped increase access to and use of services. Empowering women and families through education, employment, and poverty reduction programs have led to better health outcomes. These countries still face challenges, however, in terms of the evolving health system, and changes at the economic, social and political levels. Future qualitative and quantitative analyses on the returns of health investments, the political context and institutional arrangements at the country level could help deepen the understanding of the ways in which various countries, with their unique conditions, can improve MCH.Publication Health, Nutrition, and Population in Madagascar 2000-09(World Bank, 2011-07-05)With an income per capita US$400 in 2008, Madagascar is one of the poorest countries in the world. Poverty is widespread but with significant urban-rural differences (52 percent versus 74 percent). Health, nutrition, and the fight against communicable diseases and HIV/AIDS are key goals of the country's poverty reduction strategy, the Madagascar Action Plan 2007-2012. The National Health Sector and Social Protection Development Plan 2007-2011 was developed to strengthen the health system and improve service delivery to reduce neonatal, child and maternal mortality, address malnutrition and control communicable illnesses. The health sector has benefited from increasing investment over the last years, and a number of studies and surveys have been carried out, providing a wealth of information that is yet to be analyzed in a complementary way. This Country Status Report (CSR) seeks to capitalize on all of the existing data in the health sector, compare Madagascar to countries of similar income levels and assess the results achieved by the health system. The CSR provides an analysis of the population's health and nutrition status by linking health outcomes, household/individual behaviors, community factors, government interventions, and service provision. Although Madagascar is performing beer than the SSA average of 645 per 100,000 live births, the maternal mortality rate has stagnated over the last decade and in 2008/09 was estimated at 498. Health care seeking behavior for preventive child health services at the health facility level is improving. Complete immunization coverage stands at 62 percent in 2008 (for children 12 to 23 months), but there are still large differences in coverage across regions, place of residence, and income groups.Publication On Gender and Growth : The Role of Intergenerational Health Externalities and Women’s Occupational Constraints(2010-12-01)This paper studies the growth effects of externalities associated with intergenerational health transmission, health persistence, and women's occupational constraints-- with particular emphasis on the role of access to infrastructure. The first part provides a review of the evidence on these issues. The second and third parts present an overlapping generations model of endogenous growth that captures these interactions, and characterize its properties. The model is then used to perform several gender-based or gender-related experiments -- a reduction in the cost of child rearing, improved wage equality in the market place, and better access to infrastructure. The last part draws together the implications of the analysis for promoting the role of women in growth strategies.Publication A Closer Look at Child Mortality among Adivasis in India(2010-03-01)The authors use data from the National Family Health Survey 2005 to present age-specific patterns of child mortality among India's tribal (Adivasi) population. The analysis shows three clear findings. First, a disproportionately high number of child deaths are concentrated among Adivasis, especially in the 1-5 age group and in those states and districts where there is a high concentration of Adivasis. Any effort to reduce child morality in the aggregate will have to focus more squarely on lowering mortality among the Adivasis. Second, the gap in mortality between Adivasi children and the rest really appears after the age of one. In fact, before the age of one, tribal children face more or less similar odds of dying as other children. However, these odds significantly reverse later. This calls for a shift in attention from infant mortality or in general under-five mortality to factors that cause a wedge between tribal children and the rest between the ages of one and five. Third, the analysis goes contrary to the conventional narrative of poverty being the primary factor driving differences between mortality outcomes. Instead, the authors find that breaking down child mortality by age leads to a much more refined picture. Tribal status is significant even after controlling for wealth.Publication Timor-Leste Health Sector Review : Meeting Challenges and Improving Health Outcomes(Washington, DC, 2006-10-06)The Timor-Leste health sector review describes the accomplishments made by the government of Timore-Leste in the health sector since it separated from Indonesia, and analyzes the challenges still facing the government moving forward. Infant and maternal mortality, and malnutrition, are still important battles. Underutilization of services, and poor quality of services when available, are also reasons for the poor health quality indicators. Improving the quality or effectiveness of health services is difficult. However, now that most of the basic health care infrastructure is in place, the time is right for the Ministry of Health (MOH) to develop a system to monitor and upgrade the quality of health care services, starting with public sector services. One initiative put forth is health education delivered through various channels, which would make households better aware of the risks associated with certain health conditions or symptoms and the importance of using the available health services from government and NGO facilities. A second type of potential intervention is the introduction of conditional cash transfers, whereby the Government pays a subsidy to households in exchange for certain behaviors beneficial to society, such as having their children immunized. Carrying out the various interventions described above would require that the Government increased its spending on health services further.
Users also downloaded
Showing related downloaded files
Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication Lebanon Economic Monitor, Fall 2022(Washington, DC, 2022-11)The economy continues to contract, albeit at a somewhat slower pace. Public finances improved in 2021, but only because spending collapsed faster than revenue generation. Testament to the continued atrophy of Lebanon’s economy, the Lebanese Pound continues to depreciate sharply. The sharp deterioration in the currency continues to drive surging inflation, in triple digits since July 2020, impacting the poor and vulnerable the most. An unprecedented institutional vacuum will likely further delay any agreement on crisis resolution and much needed reforms; this includes prior actions as part of the April 2022 International Monetary Fund (IMF) staff-level agreement (SLA). Divergent views among key stakeholders on how to distribute the financial losses remains the main bottleneck for reaching an agreement on a comprehensive reform agenda. Lebanon needs to urgently adopt a domestic, equitable, and comprehensive solution that is predicated on: (i) addressing upfront the balance sheet impairments, (ii) restoring liquidity, and (iii) adhering to sound global practices of bail-in solutions based on a hierarchy of creditors (starting with banks’ shareholders) that protects small depositors.Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.