THE HUMAN CAPITAL PROJECT IN AFRICA STORIES OF PROGRESS CONTENTS 3 Foreword 5 The Human Capital Project In Africa, Investing In People For Equity And Growth STORIES OF PROGRESS 20 East Africa 22 Ethiopia 24 Lesotho 26 Madagascar 28 Mali 30 Mauritania 32 Mozambique 34 Tanzania 36 Zambia 39 Acknowledgements #36860 - October 2018 THE HUMAN CAPITAL PROJECT IN AFRICA STORIES OF PROGRESS FOREWORD Africa Can Reclaim the 21st Century I n this deeply interconnected digital world, the 21st century will be defined by rising generations of skilled young African men and women. Approximately 11 million young Africans are expected to enter the labor market each year for the next decade. Make no mistake: Africa’s greatest source of wealth, and its greatest contribution to the global economy, is its people. Enabling Africans from all walks of life reach their full potential— physically and intellectually—opens the door to a more prosperous world. Investing in human capital through education and health is proving to be the critical driver of a country’s growth and prosperity. These highly cost-effective investments can boost a country’s resilience and its capacity to adapt to rapid change, such as that happening now in technology. Africa has already shown through the spread of mobile phone technology that it’s possible to leapfrog development and deepen inclusion. The World Bank is at the forefront of helping the region strengthen its human capital by providing financial support and extensive knowledge. We are helping countries close gaps in child and maternal health, stunting and malnutrition, and access to quality education. The results are yielding healthier, higher-skilled societies. One could argue that the human capital indicators in Africa are bleak. However, we have seen several African countries make progress, and we share their stories, demonstrating that it’s possible to turn things around and provide a better future for coming generations. That is why the World Bank is launching the Human Capital Project, which will help countries scale up their efforts to boost human capital—the bedrock for propelling Africa into staking its claim on the 21st century. HAFEZ GHANEM Vice President for Africa World Bank 3 THE HUMAN CAPITAL PROJECT IN AFRICA H uman capital—the sum of a population’s health, skills, knowledge, and experience—accounts for the largest share of countries’ wealth globally. Human capital enables people to reach their full potential and is increasingly recognized as a primary driver of a nation’s economic growth. The World Bank’s Human Capital Project is a new global effort designed to accelerate human capital accumulation by identifying and encouraging more efficient and effective policies and investments. The project will support countries to strengthen their human capital, improve measurement and evidence, and promote knowledge exchange. The Human Capital Project places special emphasis on working with countries and partners across sub-Saharan Africa to help them meet their human capital goals. It recognizes that investing in Africa’s people is central to ensuring the continent’s future prosperity and full participation in global markets. This overview explains why investment in human capital in Africa is critical, how some countries in Africa have advanced the human capital agenda, and how the Human Capital Project will support countries to improve human capital outcomes. Investing in People for Equity and Growth 5 HUMAN CAPITAL MATTERS: FOR ECONOMIES, PEOPLE, AND SOCIETIES Human capital is a primary factor in propelling economic growth and enhancing competitiveness. Countries invest in the health and education of their populations because of the intrinsic value of these outcomes: they are core elements of well-being and human development. Human capital is also a critical driver of a country’s growth and prosperity. Studies show that 10 to 30 percent of the differences in per capita income between countries can be attributed to human capital.1 Looking forward, globalization and the digital economy will make human capital even more critical to strengthening countries’ competitiveness. Human capital affects people’s potential throughout life. Poor health, chronic malnutrition, and the lack of proper stimulation and security in infancy and childhood can have lifelong effects on both physical health and cognitive capacity. This can hamper school performance and productivity. Child deaths—still far too common in Africa—represent the ultimate and tragic loss of potential to a family and to a country. Inadequate schooling directly impacts students’ knowledge and skills, and hence their ability to compete and be productive in the labor market later in life. Health also matters, with illness or disability requiring costly medical care, reducing productivity and, potentially, resulting in an incapacity to work. Throughout life access to basic services, coupled with protection from extreme poverty and vulnerability, provides a foundation for building human capital. Deprivations that undermine human potential are not spread equally—inequalities in human capital investments are a key factor behind the deep inequalities in social and economic outcomes that are observed in many countries. Investments in human capital are among the most cost-effective investments governments can make. Scaling up priority nutrition interventions can generate sizeable returns—as high as $18 for every $1 invested in promoting exclusive breastfeeding, and $13 for every $1 invested in preventing anemia. 2 In turn, better nourished children earn between 5 to 50 percent higher incomes as adults. Investments in health have the potential of generating handsome economic benefits, both from the intrinsic value of lives saved and from higher income. Similarly, each additional year of schooling typically raises an individual’s earnings by 8 to 10 percent. 3 The quality of education also matters; increasing teacher quality can raise children’s lifetime income. Providing families and societies with adequate social protection can help manage risks and protect investments in human capital. Many countries are investing too little in human capital, are not achieving the results they should, and risk leaving the poor behind. Governments, households, and the private sector all invest in human capital. However, governments often underestimate the returns to investing in people and prioritize other sectors. In many cases, spending is plagued by inefficiency and governance challenges, and fails to reach those that need it most, thereby missing the broader societal benefits of strong human capital. 6 The Human Capital Project in Africa Households, notably poor households, also tend to under-invest in human capital, often because they are unable to mobilize the resources needed or are not certain of how behaviors impact long-term outcomes. Where the public capacity to deliver services is weak or absent, governments can play an important regulatory role, but often do not fully harness the capacity of non-state actors to reach those who are not receiving essential services. The consequence is that both countries and people fail to realize their potential to grow and thrive, or to address key questions of equity, and are too often poorly prepared for the future. MEASURING HUMAN CAPITAL: A FOCUS ON AFRICA The World Bank Group’s new Human Capital Index focuses on how human capital contributes to the productivity of the next generation of workers. One of the pillars of the Human Capital Project is the development of an index that measures the health and the quantity and quality of education that a child born today can expect to have had by the age of 18 (Box 1). Countries’ performance on the Human Capital Index (HCI) is expected to draw in the high- level political attention needed for transformative action at the country level. Despite strong progress in some countries in Africa, many are lagging behind in the three components of the index: survival, school, and health. Box 1. The Human Capital Index (HCI) The HCI measures countries’ performance on key building blocks of human capital of the next generation. It includes three components that are closely linked with the Sustainable Development Goal targets for health, education, and nutrition:  Survival: Will children born today survive to school age?  School: How much school will they complete and how much will they learn?  Health: Will they leave school in good health, ready for further learning and/or work? Child Survival In the past 25 years, countries in Sub-Saharan Africa have seen major reductions in under-five mortality, but the region is lagging behind other parts of the world. The expansion of critical interventions, such as vaccinations, the treatment of fever and diarrhea, and the use of bed nets have contributed to the reduction of mortality. Yet, 2.9  million children under the age of five still die in Sub- Investing in People for Equity and Growth 7 In spite of important improvements, under-five mortality in Sub- Figure 1.  1990 180 160 140 120 100 2015 80 60 40 20 0 Low-income Source: World Development Indicators, 2017. Saharan Africa every year, mostly from avoidable causes, such as complications related to respiratory infections, diarrhea, or malaria. In many countries, reductions in child mortality fell short of the Millennium Development Goals (MDG) targets, and achieving the Sustainable Development Goals (SDG) targets represents a daunting challenge. Some countries in the region—Somalia, Chad, Central African Republic, Sierra Leone, Mali, and Nigeria—struggle to reduce child mortality rates that are still above 100 deaths per 1,000  live births, some of the highest in the world (Figure 1). The persistently high levels of child mortality in the region reflect the widespread lack of access to essential goods and services, such as water and sanitation, basic health care, and adequate shelter. Despite improvements in access to services, wide disparities remain within countries, especially for access to more complex interventions, such as skilled birth attendance and treatment for severe illnesses. Even for more routine services such as immunizations, very few 8 The Human Capital Project in Africa Saharan Africa remains high Upper-middle Low-middle income & High-income countries are achieving universal coverage. This often compounded by the poor quality of care, reflected in deficits of essential drugs and the availability of medical equipment, and in the training and practices of frontline health workers. School Africa has the largest return on education of any continent, with each additional year of schooling raising earnings by 11 percent for males and 14 percent for females. But issues of access and quality loom large: about 50 million children remain out of school. Africa is also the only region of the world where the number of out-of- school adolescents has risen in recent years, partly because of rapid population growth among the poorest, who also have the lowest access to education. Investing in People for Equity and Growth 9 Levels of Learning are low in many Sub-Saharan countries Figure 2.  Percentage of primary school students who pass a minimum proficiency threshold 100 90 80 70 60 50 40 30 20 10 0 Sub-Sarahan Latin America Europe Africa & Caribbean & Central Asia Middle East East Asia & North Africa & Pacific Mathematics Reading Source: World Development Report, 2018. Completing the unfinished agenda of universal basic education is essential, but schooling on its own is not enough: learning levels across the region are very low (Figure 2). In some African countries, over 85 percent of primary (elementary) school students are unable to read proficiently. The most disadvantaged fare worst both in access to education and success in learning. Ensuring that all children learn will require bold efforts to eliminate gaps in access to quality education. There is plenty of proof that Africa can do better. Many countries have done so already through the reorientation of their education systems, largely by adopting new initiatives, such as measuring and tracking student learning outcomes, acting on the substantial evidence available on what works for all learners, using cash transfers to promote access for the poor, and developing a sense of urgency among key actors to address the changes needed. Health Good health is essential for children to be able to prosper in school and in the labor market. One proxy for chronic malnutrition and childhood development that forms part of the Human Capital Index is childhood stunting, usually assessed through a measure of 10 The Human Capital Project in Africa Competency level in mathematics from 2007, Southern and Eastern Africa Consortium for Monitoring Educational Quality 100 50 0 Zambia Malawi Mozambique Lesotho Namibia Uganda South Africa Botswana Zimbabwe Kenya Seychelles Tanzania Mauritius High Competency Low Competency Not Competent a child’s trajectory in height relative to his or her age. Stunting is a strong determinant of cognitive capacity and adult health, as well as future productivity. Sub-Saharan Africa reports the world’s highest rates of stunting among children (Figure 3). This means children fall sick more often, miss opportunities to learn, perform less well in school, and grow up economically disadvantaged and more likely to suffer from chronic diseases in adulthood. As a result of high levels of fertility and only modest reductions in stunting, the actual number of stunted children in the region increased by 12 million between 1990 and 2015 and is likely to keep rising unless these issues are addressed. The good news is that a few countries — including low income countries — have managed to reduce the rate of stunting substantially. Although progress on reducing stunting in Africa has been slow, some countries, such as Senegal, Lesotho, and Malawi, have made notable progress. These improvements have been achieved by creating awareness of the problem and implementing evidence-based programs for pregnant women and infants that provide key interventions, including the provision of folic acid and other micronutrients, the promotion of breastfeeding and appropriate infant stimulation and feeding practices, access to essential health services, and improvements in water and sanitation. Concerted action of this kind is needed; evidence from Africa shows that growth in income and a reduction in poverty on their own have only modest impacts on the level of chronic malnutrition. Investing in People for Equity and Growth 11 Figure 3. Stunting in Sub-Saharan Africa remains high 60 50 1990 40 2015 30 20 10 0 Low-income Source: UNICEF/WHO/World Bank joint child malnutrition estimates: stunting. May 2018. The Human Capital Index also focuses on adult survival as a proxy for the overall health environment and the range of fatal and non- fatal health outcomes that a child born today would experience as an adult. Adult survival rates in Africa are very low relative to other regions, with substantial variation across countries. Communicable diseases and pregnancy-related complications are still the continent’s biggest killers, but the burden of non-communicable disease is increasing rapidly. More than 700,000  people died from HIV/AIDS related causes in 2016, and as many from tuberculosis. Malaria remains an important cause of death, in particular for children. Africa is the region with the highest level of maternal mortality, with 500 mothers dying per 100,000 live births. This translates into 200,000 deaths annually. At the same time, non- communicable diseases are on the rise, primarily due to lifestyle factors: smoking rates are high and, in some cases, increasing. More sedentary lives and poor diets also contribute. As a result, high blood pressure, diabetes, and other conditions are rapidly becoming more prevalent, but often go undiagnosed and untreated. 12 The Human Capital Project in Africa Upper-middle Low-middle income & High-income Although health outcomes in Africa are concerning, success stories from the region and a growing momentum towards Universal Health Coverage provide cause for optimism. The region has seen massive increases in the coverage of antiretroviral therapy over the last 15 years. Coverage of other interventions have also increased, albeit less dramatically, and some countries have seen impressive progress. Eight countries achieved more than a 60  percent reduction in maternal mortality between 1990 and 2015—Cabo Verde, Ethiopia, Eritrea, Equatorial Guinea, Mozambique, Rwanda, Tanzania, and Zambia. Equally important, several countries are starting to implement policies and programs aimed at improving access to health care and addressing health risks, such as outbreaks of disease and chronic diseases, including the rising epidemic of obesity in Africa. Investing in People for Equity and Growth 13 HUMAN CAPITAL FOR INCLUSIVE GROWTH AND SHARED PROSPERITY: WHAT WILL IT TAKE? How can African governments realize the gains from improving human capital outcomes? Countries must find their own path to advance the human capital agenda. A key aim of the Human Capital Project is to support the development and implementation of country-owned action plans, as well as to facilitate cross-country learning. Business as usual and incremental reforms are unlikely to deliver the results that are needed in the region, however. Progress will require political leadership and concerted action on several fronts:  xpand government investment in social services. Human  E capital does not materialize on its own: it requires collective action by households, governments, members of the private sector, and non-governmental actors. The state has a more central role in providing public goods, addressing externalities, ensuring equity, and regulating service provision. Leaving this entirely to individuals is a missed opportunity for realizing the broader gains that human capital can foster. Yet, many countries in Africa are underinvesting in health, nutrition, education, social protection systems, and other drivers of strong human capital outcomes. Mobilizing domestic resources for human capital investment calls for work on improving tax systems, finding better approaches to managing natural resource wealth, and improving financial administration.  ntroduce reforms and innovation to improve service delivery.  I Allocating more resources to human capital is only one piece of the puzzle. Governments must also focus on increasing returns to those investments, including improving the efficiency of current spending and the quality of services delivered to their populations. In many contexts, this will require the fundamental reform of systems for delivering key services, with a focus on enhancing governance and transparency, and strengthening accountability for results. The promise of technology and the marketplace of ideas gives African countries the opportunity to do things differently. Many are already leading the way. In Rwanda, RapidSMS, a cellphone- based technology, has saved the lives of pregnant women through the routine surveillance of their health by community health workers. Sierra Leone and Tanzania are using spatial statistical modeling to generate poverty maps to inform the expansion and harmonization of social safety net programs.4 In Nigeria’s commercial capital of Lagos, even short exposure to eReaders with curriculum content, significantly increased the learning of students without paper textbooks. Commit to equity and inclusiveness. Gaps in levels of health,   education, and nutrition mirror poverty gaps, with the poorest people usually having the lowest levels of human development. Poor families often struggle to allocate the time and resources 14 The Human Capital Project in Africa needed to build the human capital of their children, to access health and nutrition services, and to invest in their own skills to enhance productivity. Pregnant women and young children are often voiceless in national and global debates, and hence likely to be excluded. Health and education systems can be designed with this in mind, making sure that quality services are available for disadvantaged groups. A large body of evidence drawn from social protection programs shows that providing poor and vulnerable households with income support can improve their access to services that enhance human capital, as well as a wide range of human development outcomes. 5 Households living in contexts affected by fragility and conflict are particularly vulnerable.6 The basic systems for building and sustaining human capital are likely to have been disrupted; deprivation is compounded by the impact of the socio- emotional stress borne by families and children. Working closely with stakeholders to provide essential services and strengthen resilience can prevent conflicts from spilling over and help bridge the humanitarian–development divide.  ddress fertility and gender issues to harness a demographic  A dividend. Africa has by far the highest level of fertility in the world—nearly 5 births per woman, compared to between 1.8 and 2.8 in other regions. At present, close to half of the population in Sub-Saharan Africa is under 15 years old; by 2050, the region will be home to all ten of the world’s countries with the youngest populations.7 Harnessing the demographic dividend requires an acceleration of the fertility transition, which would reduce dependency ratios and free up resources to invest in the human capital of today’s workforce and that of the next generation’s. This calls for expanding access to comprehensive family planning, improving maternal and child health and nutrition, and investing in girls’ education. Accelerated progress in building human capital is possible but will require strong political leadership and coordinated action across sectors. A whole-of-government approach can help coordination across sectoral programs, sustain momentum across political cycles, and promote evidence-based policy making. Engaging partners, private sector actors, and civil society can support accountability and advocacy, as well as open channels for effective service delivery. THE HUMAN CAPITAL PROJECT: MOVING FORWARD IN AFRICA The Human Capital Project seeks to build commitment for effective reforms and investments that will transform human capital outcomes for the greater good of people, societies, and economies. In Africa, the Human Capital Project will provide dedicated support to countries in the region to prioritize more and Investing in People for Equity and Growth 15 better human capital investments. The project will highlight the importance of human capital, help identify gaps in potential human capital, track service delivery and human capital outcomes, and adopt evidence-based policy reforms to improve services and outcomes. This work is multi-sectoral and will count on the support of many partners, spanning government ministries, the private sector, and civil society. The Human Capital Project involves three pillars:  he Human Capital Index is an entry point into an important  T conversation about the economic payoffs of investing in human capital. It quantifies countries’ distance to the frontier— the gap between their people’s wellbeing today and a future in which everyone is equipped to reach his or her full potential. It helps countries assess how much income they are foregoing because of gaps in human capital, compare their rates of progress, and gauge how much faster they can reach the frontier by strengthening human capital outcomes. Through this, the Human Capital Index aims to draw the high-level attention needed for transformative action at the country level.  focus on research and measurement of human capital will  A create public goods to understand how to improve outcomes most effectively. To complement the Human Capital Index and improve the quality of data for its future calculations, country participation in international assessments (for example, of student learning) and national surveys (such as, the quality of service delivery) will better track its progress on human capital investments and their outcomes. This will help identify relevant policy levers to address the constraints critical to improving human capital, including the need for reforms, innovative programs, and for strengthening existing systems. Building this evidence base can also inform resource allocation, especially for domestic resources, to achieve greater efficiency and effectiveness in spending.  ell-coordinated, long-term, evidence-driven country engage-  W ment will help tackle the greatest challenges that constrain people’s health, education, and resiliency. Many countries have already become early adopters of the Human Capital Project and are prioritizing human capital investments and reforms. The World Bank is working with early adopter countries to help them define their vision to accelerate human capital development for current and future generations and plan their strategy on how that vision will be achieved. The World Bank Group will support the achieve- ment of these visions and plans through an integrated menu of indicators and interventions that are evidenced-based, feasible, and cost-effective to implement. The World Bank Group will also emphasize peer learning. Knowledge sharing will be prioritized to exchange ideas and build communities of practice, not only across Africa, but also by leveraging the World Bank Group’s global engagement. Through broadening initia- tives, the project can ensure that future generations in Africa are well placed to learn, earn, innovate, and compete. 16 The Human Capital Project in Africa Endnotes 1  Hsieh, Chang-Tai, and Peter J. Klenow. 2010. ‘Development Accounting.’ American Economic Journal: Macroeconomics 2 (1): 207–23. 2  Eozenou, Patrick Hoang-Vu; Shekar, Meera. 2017. Stunting Reduction in Sub-Saharan Africa. 2017 (English). Washington, D.C, World Bank Group. 3  World Bank, 2018. World Development Report. 2018. Learning to Realize Education’s Promise. Washington, D.C. 4  Beegle, Kathleen G.; Coudouel, Aline; Monsalve Montiel, Emma Mercedes. 2018. Realizing the Full Potential of Social Safety Nets in Africa. Washington, D.C.: World Bank Group. 5 B  astagli, F., Hagen-Zanker, J., Harman, L., Barca, V., Sturge, G., & Schmidt, T. (2016). “Cash transfers: What does the evidence say? A rigorous review of programme impact and the role of design and implementation features.” London: Overseas Development Institute. 6  Manor. James. 2007. “Aid That Works: Successful Development in Fragile States.” Directions in Development—World Bank Group. 7  anning, D; Raja, S; Yazbeck, A. S. 2015. Africa’s Demographic Transition: Dividend C or Disaster? Africa Development Forum;. Washington, D.C.: World Bank; and Agence française de développement. World Bank Group. Investing in People for Equity and Growth 17 STORIES OF PROGRESS EAST AFRICA CURBING THE SPREAD OF COMMUNICABLE DISEASE Sharing resources and know-how, East African nations are working together to prevent the spread of communicable disease. Public health officials network through 41 upgraded laboratories in Burundi, Kenya, Rwanda, Tanzania, and Uganda. I n 2010, officials in East Africa improvement scheme toward accred- recognized their health systems were itation, and four laboratories were ill-prepared to deal with multidrug- awarded the gold standard ISO 15189 resistant tuberculosis (TB) and outbreaks level of accreditation. of diseases such as Ebola, Marburg, and yellow fever. Underinvestment in State-of-the-art GeneXpert machines their laboratories had contributed to in locations such as Mbale Regional misdiagnosis and prevented health Referral Hospital close to Uganda’s officials from detecting public health border with Kenya, have facilitated threats quickly and accurately. It was the faster, more accurate, cross-border compromising patients’ care and diagnosis of multidrug-resistant TB. resulting in the greater transmission of GeneXpert tests have been conducted disease and higher health care costs. network-wide, providing results within hours rather than the months taken To tackle this, a network of 41 laboratories for culture results. in five countries received $128 million in IDA financing. Each serves as a center “Before I visited Mbale Hospital, I had of excellence in a specialized area, been receiving treatment for fever and piloting innovations, fostering efficiency flu at a clinic near my home without any in preparedness and response, and sign of recovery. I thought it was HIV,” says sharing good practice. Aliyi Mwanika, a  motorbike taxi driver. The GeneXpert machine correctly For example, performance-based diagnosed his illness as multidrug-re- financing in Rwanda has served as sistant TB, and he was put on the right a model for other countries. In 2013, treatment. “After six months I was able the Uganda TB Reference Laboratory to go back to work,” he says. qualified as a Supranational Reference Laboratory of the World Health There has been an Organization (WHO), only the second of 80 percent increase its kind in Africa. It now supports over in the confirmation of 20 countries on the continent. pathogens, and more regional collaboration, with cross-border By 2017, 96 percent of the facilities committees, joint investigations, reached two-star rating in a regionally tabletop simulations for diseases like recognized, WHO-endorsed quality Ebola, and a mobile phone reporting 20 The Human Capital Project in Africa system for the timely sharing of surveillance officers, and operational information on outbreaks of disease. researchers has expanded to 13,000, generating new evidence and Through training, the pool of qualified knowledge to help inform public assessors, lab managers,  disease policy and shape it. Stories of Progress | East Africa 21 ETHIOPIA MANAGING THE IMPACT OF DROUGHT Ethiopia routinely supports members of its population during droughts, with the World Bank helping fund programs that focus on long-term practical measures to prevent famine. A cross the vast, flat plains of government, it pools money from 11 southeastern Ethiopia, plumes donors, including the World Bank of dust whirl like mini tornados. Group’s International Development Local people say they signal the onset Association (IDA). of rain but, from 2015 to 2017, rain failed to come in many places. The The PSNP provides regular cash Government of Ethiopia is no stranger or food transfers and its food-for- to drought. Since 2003, it has faced five work component supports public serious droughts affecting millions of works that are usually related to people. This has forced it to think how landscape restoration, irrigation, and it can anticipate, plan, and respond. agroforestry. The government runs two approaches in parallel: the safety Each year, the drought is given a net program and the distribution of name by the people most affected humanitarian aid. by it. Some called this one “Sima,” the “great leveler” in the Somali language Halimo and Mariama Ali are neighbors spoken by many in southeastern in Kabribayah woreda (district). Unlike Ethiopia, suggesting everyone will Mariama, in 2016, Halimo had only suffer, rich or poor. Studies have just been included on the list of shown, however, that droughts make beneficiaries for humanitarian aid. “I had the poor even poorer. In this drought, to depend on  the generosity of my people’s livestock holdings fell by neighbors to tide me over,” says Halimo, nearly 50 percent. Often it takes as the bread-winner for eight children. many as four years for households to She had a small plot, but nothing recover. had grown on it. On paper there is very little to distinguish between who In 2016, the Ethiopian government’s becomes a beneficiary response was its largest-ever, and who does not, but the providing 18.2 million people—about PSNP does not have 20 percent of the country’s total enough funds to include population—with food or the cash everyone. The best it can do to buy it. On the frontline of this was is to coordinate better so that the Productive Safety Net Program food and water reaches not just its (PSNP), one of the world’s largest beneficiaries but the “transitory food safety net programs. Run by the insecure,” such as Halimo’s household. 22 The Human Capital Project in Africa The safety net program is about a We are exploring the options with decade old but has an entire system at innovative financial products, as well its disposal from kebele (the smallest as by bolstering the PSNP.” administrative unit) to district and national level. The government has Evaluations built into the PSNP full-time staff working on it and, over suggest it is now generally well the years, has been able to improve targeted and has a significant impact its targeting of beneficiaries. When on food security. The percentage asked, most beneficiaries prefer PSNP of beneficiaries achieving full food over emergency humanitarian aid security rose from 17 to 32 percent because it is dependable, predictable, between 2006 and 2012. The impact and regular. The government is on female-headed households now putting in place a framework has been particularly large. It has that brings together the PSNP and increased household spending emergency aid. This framework sets on food and non-food items, and out the operational procedures they improved educational attainment, will use, extending and adopting particularly for girls. each other’s procedures. Ethiopia is now pioneering the “Droughts are a regular occurrence in first urban safety net program of Ethiopia,” says Carolyn Turk, the World its kind in Sub-Saharan Africa to Bank’s Country Director for Ethiopia. cover 11 cities and reach 55 percent “We and other donors are working of the poor living in them (604,000 with the government to build the beneficiaries) by 2021, through a mix capacity to respond from within to of public works, direct support, and its regular development programs. livelihood interventions. Stories of Progress | Ethiopia 23 LESOTHO UPGRADING LOW PERFORMING SCHOOLS The Kingdom of Lesotho has made substantial gains in education service delivery since the introduction of free primary education in 2000. Lesotho spends 8.4 percent of its GDP on education, but inefficiency and uneven quality remain a challenge, contributing to an unemployment rate of 25 percent. K eeping children in school is a The project aims to improve teaching challenge in Lesotho. High rates of in math, science, and the national cur- absenteeism, dropping out, and riculum. It also aims to strengthen how repeating grades are caused by factors, schools account for student retention including gender issues (boys staying and improve their learning environ- home to herd cattle), early marriage ment by introducing grants for schools or early pregnancy for girls, economic to implement improvement plans. status, the high cost of education, and long walking distances. It means that So far, 60 junior secondary education many Basotho youth are not acquiring teachers have been trained in the basic skills that lay the foundations progressive mathematics and science for future learning. and 424 in the national curriculum. Some 17 schools have been given Lesotho still lags behind the regional interactive, electronic equipment average in both reading and for teaching, and 14 of the country’s mathematics in primary education, lowest performing schools have and less than quarter of students who been awarded grants to improve the sit the junior certificate exams pass learning environment and increase mathematics and science. Raising the student retention. quality of basic education is crucial to giving Basotho youth a strong “Although we still face challenges foundation for developing further with the supply of qualified math and skills and improving their ability to science teachers, with the equipment participate more productively in provided under the LEQEP, we have the economy. seen an improvement in the mindsets of both teachers and students. In 2016, the Government of Lesotho, Both are increasingly with support from the World Bank, enjoying teaching and launched the Lesotho Education learning these subjects,” Quality for Equality Project (LEQEP) and, says Bertha Mabakubung a year later, the Lesotho Basic Education Seutloali, Chief Education Improvement Project  (LBEIP). The Officer at Lesotho’s Ministry $27.1  million project is supported of Education. by IDA and the Global Partnership for Education. 24 The Human Capital Project in Africa The project is expected to have resource teachers, subject advisors, 85,600 beneficiaries by 2021. They school inspectors, and the members will include students, primary and of school boards. secondary school teachers, district Stories of Progress | Lesotho 25 MADAGASCAR STRONG PARTNERSHIP FOR IMPROVING NUTRITION Stunting, which is caused by chronic malnutrition, is the biggest obstacle to developing the full potential of Madagascar’s human capital. Close to 50 percent of children under five are affected by it—the fourth highest rate in the world—with its annual cost to the economy estimated at 7 to 12 percent of GDP. M adagascar’s prolonged political for their mothers. “Every month, I crisis (2009–14) deepened pov- show them how to feed their children erty and put its social services to properly with the little resources the test. The World Bank approved the they have,” she says. “With simple, $65 million, IDA-financed, Emergency improved practices, we can help them Support to Critical Education, Health, avoid deficiencies in their diet—a few and Nutrition Services Project—com- beans, some rice, a little iodized salt, monly known as PAUSENS—in 2012, to oil, vegetables.” help the government maintain critical services in five of its poorest regions. A key feature of PAUSENS was About 500,000 pregnant women and removing geographic and financial 1.7 million children received free health barriers. The project ensured that and nutrition services as a result. frontline health clinics could provide maternal and child health services at PAUSENS helped the government’s no cost using a voucher scheme and long-running National Community other targeted interventions. Prenatal Nutrition Program, which until 2017, visits increased by 10 percent a year, focused on reducing acute malnutrition skilled deliveries went up six-fold in by providing free support to primary many areas, and routine vaccination caregivers through a network of over rates significantly improved. rural 6,500 community nutrition sites. “When there was a cost related to This program was crucial for families these services, pregnant women like Jocelyne Rasoanantenaina, whose would only come to the health center baby weighed barely 7 kilograms at a as their due date approached. Now year old. “We didn’t have much to eat,” many of them come by their third Jocelyne explains. “The harvest wasn’t month,” says Voahangy enough to feed our children.” Rahantamalala, the head physician in the nearby Other children in their village  in town of Ambohimanjaka. Ambositra district in central Mada- gascar were also acutely malnourished. Evidence emerging in 2012 A community nutrition worker, Noëline showed the National Community Razafindraibe, visited them all in their Nutrition Program was having a positive homes and ran counseling sessions impact on reducing the number of 26 The Human Capital Project in Africa children who were underweight, but with the highest rates of stunting, no significant impact on increasing before being gradually expanded to their height-for-age (thus reducing 15 regions. stunting). This was troubling and spurred the government to rethink its “Stand-alone operations work fine in strategy. In 2017, it prioritized reducing many contexts, but if you are grappling chronic malnutrition. The World with an issue as complex as stunting Bank supported it with up to $200 in a country like Madagascar, the million in IDA financing to develop a multiphase programmatic approach new 10-year program. The Improving is ideal because it allows you to take Nutrition Outcomes Program is the a long-term perspective and mitigate first of its kind to use a new multiphase the risks associated with a stop-and- programmatic approach that allows go approach, which have resulted clients to structure long, large, or in stalled or reversed progress,” said complex engagements. Jumana Qamruddin, Senior Health Specialist in the Health, Nutrition “The government has prioritized and Population Global Practice at reducing stunting from 47 to the World Bank, and the program’s 33  percent,” says Coralie Gevers, the team leader. World Bank’s Country Manager for Madagascar. “This requires long-term The first phase of the program has investment. We are very pleased already begun to scale up high-impact the country is striving to give all interventions, such as promoting Malagasy children a better chance of a micronutrient supplementation and prosperous future.” breastfeeding. It will prioritize the first 1,000 days of life from conception Targeting close to 75 percent of to two years, a critical window for children under-five, the program reducing stunting and maximizing will be rolled out in eight regions cognitive development. Stories of Progress | Madagascar 27 MALI EDUCATING GIRLS, WITH BIKES TO HELP THEM GET TO SCHOOL Many girls drop out of school at puberty in Mali’s rural areas, due to long walking distances, the high poverty rate, and the influence of social norms. Giving girls bicycles helps them continue their education. O n a morning unlike any other, Like Déboura, 27 other young girls Déboura Goita gets off her have gone back to school after being brand-new, blue bicycle and given bicycles in Kimparana. After heads toward the big shade tree in school, she usually helps her mother the Waki school yard in Kimparana, with the housework—preparing meals, Ségou region, about 490 kilometers fetching water, doing the dishes, and (305 miles) from Bamako. Several other sweeping the yard. She does farm bicycles are propped up against the work when she is on vacation. tree already. Wearing her backpack, she goes to her classroom. “Déboura diligently attends classes, arrives on time every day, and Sixteen-year old Déboura is a seventh- even sat the exams right after the grade student. Her mother has been bike donation,” says her principal, the sole provider for her, her three Mamadou Konaté. sisters, and two brothers since their father died. Before getting this bicycle, Secondary (middle and high) school she walked the six kilometers every attendance in Mali is 53 percent for day to school. “In the evenings, I was boys and 43 percent for girls. “Some very tired with neither the time nor villages are more than 15 kilometers the energy to study,” says Déboura. As away from the school”, says Birama a result, she dropped out. Kassogué, director of Kimparana’s educational outreach center. “We She started school again when she hope the bikes will lead to a lower got her bicycle, which she handles dropout rate.” skillfully and with great care. Déboura is now deepening her knowledge of About 900 girls in all from 75 schools in French, math, history, and geography. Ségou and other regions of Mali “My favorite subjects are physics, have been given bicycles. chemistry, biology, geography, and Keeping them in school civics and ethics,” she says, sitting next not only educates them to her friends while copying down but puts them at less risk of sentences written on the blackboard their parents placing them in by the teacher in her notebook. arranged marriages. “My  dream is to become a teacher,” she continues. 28 The Human Capital Project in Africa Free bicycles was one of the initiatives Religious and community leaders have funded by the World Bank through been mobilized to become champions the Sahel Women’s Empowerment of the rights of young girls. and Demographic Dividend (SWEDD) project. The slogan of the campaign Through the SWEDD, girls’ empow- was “My challenge: the DEF!” (Diplôme erment interventions should reach d’études fondamentales). The DEF is more than 100,000 vulnerable girls in the certificate marking the completion Burkina Faso, Chad, Côte d’Ivoire, Mali, of ninth grade. Mauritania, and Niger. Several interven- tions are led by ministries of Education These initiatives may help as many to keep girls in school, others by minis- as 22,000 girls in Mali continue their tries of Social Affairs, Women’s Affairs, studies and take charge of their Health, Population, Planning and lives. SWEDD also trained teachers Youth. Ministers of Finance and human and school counselors, raising the development ministers in at least four awareness of practices that damage a of the six countries have revised their girl’s individual contribution to society national development plans, putting a and the workplace, such as teenage stronger focus socio-economic policies pregnancy and gender-based violence. and gender equity measures. Stories of Progress | Mali 29 MAURITANIA INVESTING IN EARLY CHILDHOOD By 2020, about 100,000 of Mauritania’s poorest households will be receiving quarterly cash transfers. The program is tackling intergenerational poverty by incentivising parents to invest in their children’s development. T oday’s mood is festive in the the UK’s Department for International village of Bachatt Ould Boughrou Development, and funding from the in southern Mauritania. Mous- French Agency for Development, tapha and Hawa, two social outreach which has invested $2.5 million. The workers, are here to give a course purpose of the program is to improve on the benefits of a balanced diet. the everyday lives of members of the Women of all ages have gathered — country’s most vulnerable households their toddlers on their knees — to listen by investing in human capital and attentively to the young people’s giving people an incentive to alter recommendations for feeding their their habits. children a healthy mixture of protein from milk and meat, carbohydrates Every three months, over from grains and tubers, and nutrients 22,000  households in six of the from vegetables. poorest departments in the country receive the sum of 1,500 ouguiya “What do you want your children to be (about $42) each. To qualify, members when they grow up?” asks Moustapha. of each household must attend “Teacher,” shouts one woman. “Doctor,” social improvement courses (like answers another. “Soldier,” says a third. those given by Moustapha and Hawa) Moustapha and Hawa hope that covering a range of topics such as asking this classic question will get nutrition, hygiene, and early childhood these mothers thinking about the development. future. “When you feed your children well, play with them, and teach them “By 2020, the program will have the rules of hygiene, you guarantee targeted no fewer than 100,000 them a better future,” they assure their households, and will cover the audience. entire country,” says Mohamedou M’Haimid, Bachatt Ould Boughrou is one of the coordinator of the villages targeted by the Mauritanian national Tekavoul program. government for the five-year Tekavoul (solidarity in Arabic) social transfer “One of the program’s objectives is program. Mauritania has invested to invest in the next generation and $10 million in it and received $15 million break the poverty cycle by tackling from the World Bank, $4 million from intergenerational poverty,” explains 30 The Human Capital Project in Africa Matthieu Lefebvre, Senior Social hands and I sweep the house, and you Protection Specialist at the World can already see the difference in the Bank, and the program’s team leader. village because there’s less illnesses “So, there is both a short-term impact like diarrhea or skin complaints. I’ve as the households can use the money also learned what to give my children for their immediate needs, generally for to eat to improve their diet.” food and basic services, and a longer- term impact, whereby households Penda Sow, deputy mayor of the can put aside a little money from neighboring village, believes the these cash transfers to invest in their program has a dual impact: it gives livelihoods and well-being.” women (the program’s main recipients since they are the ones looking after “Cash transfers to the poor also have the children) a certain amount of a proven knock-on effect on local financial independence to support economies, so they benefit the entire their children’s needs, and it allows community,” he adds. them to grow. Mariam Samba Sow, a 42-year-old The Tadamoun agency in charge of mother of five, has been receiving managing the Tekavoul program this type of help for over a year makes sure that the transfers are now, and conscientiously attends efficient and secure, with a network the improvement classes. “I used to of agents using portable terminals to neglect hygiene,” she explains. “Now, make the payments. Each recipient I encourage my family to wash their has a smart payment card. Stories of Progress | Mauritania 31 MOZAMBIQUE RESULTS FRONT AND CENTER IN HEALTH AND EDUCATION Mozambique’s results-based financing for public health and education disbursed money as targets were met on the ground. Incentives created to drive behavior change at sub-national level led to tangible improvements in primary school management and the medical supply chain. M edicines only have value made it difficult for schools to run when they reach the right themselves properly. patient at the right time,” says João Grachane, a Senior Officer About 1,300 primary schools reaped at Mozambique’s Ministry of Health. the benefit of improvements in When his country launched a Public the timing of grant allocations. The Financial Management for Results schools received grants to purchase Program in 2014, the IDA financing basic learning materials and to instrument was then untested support the most vulnerable children in Mozambique. It made phased attending them. By 2017, 100 percent disbursements of funding to the of the primary schools in the program health and education sectors based had received their grants by the start on agreed targets. of the school year in February. Significant improvements in the Teams of coaches and facilitators health sector were documented were assigned to government minis- during the program, such as an tries and provinces to support coor- increase from 79 percent in 2013 to dination. “The project adopted an 83 percent in 2017 in the availability innovative, problem-driven, and iter- of medicine for maternal health at ative approach towards implementa- public health facilities, as well as a tion,” says Humberto Cossa, a Senior sharp decrease — from 27 percent Health Specialist at the World Bank. in 2013 to 5 percent in 2017— in the number of treatment sites running The Government of Mozambique out of antiretroviral drugs. improved the transparency and effi- ciency of its spending The system also had an impact on on the distribution, public education. “We now receive our storage, and availability grant allocations at the beginning of of medicine, as well as the school year,” notes Matilde Xilume, the management of school director of the 3 de Fevereiro primary councils and school districts, school. “This is a major improvement and their budgets. Follow-on as it allows us to plan better at the financing will focus on primary beginning of the year.” Before, grants health care in underserved areas of had rarely been issued on time, which the country. 32 The Human Capital Project in Africa Stories of Progress | Mozambique 33 TANZANIA INVESTING IN GIRLS TO REAP THE DEMOGRAPHIC DIVIDEND From 1990 to 2015, life expectancy in Tanzania increased by 16 years and mortality rates for under-fives halved, but fertility rates fell by just one child per woman, compared to 2 to 3 children per woman in neighboring Rwanda and Kenya. A t its current population growth rose from less than 20 percent in 2001 rate (3 percent a year) in 2064 to nearly 55 percent in 2015. But their Tanzania’s population could be dropout rates are high because all over 150 million, making it one of the students must pass a seventh-grade most populous nations on earth. The exam to continue, and a government reasons for this are twofold: more than directive makes it difficult for girls a third of Tanzanian women still marry who get pregnant to continue their very young—36 percent by the age of studies. 18—and the high fertility rates that come from many years of childbearing “Data show that fertility rates among prevent the country from reaping urban adolescents have been in a demographic dividend, or the decline since 1990,” says Miriam economic benefit that occurs when Schneidman, the World Bank’s rapid falls in mortality and fertility Lead Specialist for Health. “But result in smaller, healthier families. fertility among rural adolescents has increased slightly. Adolescent Tanzania’s government has taken mothers drop out of school. There is measures to curb early marriage: in no pathway out of poverty for them July 2016, its High Court ruled against and their children.” a 1971 Marriage Act allowing girls to marry at 15 with parental consent, and An economic simulation carried out at 14 with the permission of a court. by the World Bank suggests a drop of (The legal minimum for boys is 18.) one more child per woman could lead to increases in real GDP in Tanzania, Rebeca Gyumi is a young activist who from $610 per capita in 2015 to $1,192 in pushed for the 2016 ruling. As a child 2030, and to $2,709 per capita by 2050. in school she had noticed the silent Lowering the fertility disappearance from the classroom of rate would lift six million girls she knew. “This ruling offers an people out of poverty in opportunity for us to focus on investing the country by 2050. in developing our daughters instead of marrying them off young,” she says. The World Bank is doing in-depth analytical work to better understand The proportion of girls in secondary the determinants of adolescent fertility (middle and high) school in Tanzania in Mainland Tanzania and Zanzibar, 34 The Human Capital Project in Africa and to find culturally-sensitive ways to “Research in Tanzania shows that address them. 74 percent of the children with mothers who have secondary education or “A mother’s education has a strong higher are able to do primary school- correlation with their children’s learning level work equivalent to Standard Two outcome,” says Bella Bird, the World (second-grade), compared to only Bank Country Director for Tanzania, 46  percent of students with mothers Malawi, Somalia, and Burundi. with no formal education.” Stories of Progress | Tanzania 35 ZAMBIA PROJECT EMPOWERS WOMEN AND HELPS GIRLS STAY IN SCHOOL GEWEL, a girl’s education and women’s empowerment project, offers direct support to as many as 89,000 vulnerable girls and women in rural Zambia. The project involves three government ministries, creating a more comprehensive approach. M ary Maliti lives in Nkana working-age women, it offers training, Chiefdom, more than 100 km start-up capital, and mentoring (62 miles) from Kitwe, the through the Supporting Women’s urban center nearest it in Zambia’s Livelihood program. Copperbelt. Maliti is a peasant farmer; she grows peanuts, maize (corn), and At the age of 50, and with five children, vegetables on one hectare of land. She Maliti has made enough money to buy had struggled to grow enough food seeds, pay for labor to till her land, and for her family’s survival. but, following buy a bicycle to deliver vegetables to a business and life-skills course and her customers. She has also bought cash grant, now she is able to grow a pesticide sprayer to help her grow enough to feed her family and market healthy crops. “In past years, I made her produce locally. losses in my vegetable business because pests invaded my garden,” Maliti is one of thousands of she says. “And (without a bicycle) Zambians who has benefitted from some vegetables wilted before they the Girls Education and Women’s could reach my customers.” Empowerment and Livelihood Project (GEWEL). Funded by the International Maliti budgets and saves money. Every Development Association (IDA), the Friday, she and 41 other members of World Bank’s fund for the poorest her savings club contribute roughly countries, GEWEL supports the $1.25 each to their shared plan. This Zambian government in its goals to money is used to lend to members empower women. Three government of the club and later paid back with ministries are directly involved in the interest. project: Gender, General Education, and Community Development and The project’s other focus Social Services. on helping adolescent girls made it possible for The project focuses on two key points 14-year-old Eunice Sichone in a women’s life: adolescence and to go back to school; her working age. It helps expand access father had not been able to afford to secondary school for adolescent the secondary school fees. Most girls from poor households through Zambian girls attribute dropping out the Keep Girls in School bursary. For of school to a lack of financial support. 36 The Human Capital Project in Africa The bursary aims to remove this About 60 percent of Zambia’s barrier. population is rural. “In 2017, nearly 20,000 women and girls were “These programs are designed to reached through the GEWEL project,” alleviate the challenges faced by says Emily Weedon, Senior Social vulnerable women and girls in Protection Specialist at the World rural areas, by promoting longer- Bank and the program’s team term investment and enhancing leader. “In 2018, the government government capacity to manage plans to reach over 50,000 through interventions,” says Ina-Marlene both programs.” Ruthenberg, the World Bank’s Country Manager for Zambia. Stories of Progress | Zambia 37 38 The Human Capital Project in Africa ACKNOWLEDGEMENTS This publication was a collective effort of teams from the World Bank Africa Region’s Front Office (AFRVP), the Human Capital Project (HCP), the Human Development Vice Presidency (HDVP), and the Africa Region’s External Communications and Partnerships (AFREC). Our special thanks to Tom O’Brien, Diariétou Gaye, Magnus Lindelow, Laura Rawlings, Muna Salih Meky, Katelyn Jison Yoo, Martín De Simone, Julieta Trias, Dena Ringold, Amer Hasan, Zelalem Debebe, Emily Weedon, Kavita Watsa, Amit Dar, and Pia Schneider. The publication would not have been possible without the efforts of World Bank Directors, Managers, and Task Team Leaders who support the implementation of projects and programs in Africa. Thanks to Jumana Qamruddin, Margareta Norris, Humberto Cossa, Lucian Pop, Miriam Schneidman, Matthieu Lefebvre, Lynne Sherburne-Benz, Meera Shekar, Michele Gragnolati, Jeremy Veillard, Luis Benveniste, and Olusoji Adeyi. Communications Officers and consultants in the World Bank’s Country Offices make sure that stories of these programs demonstrate impact and are widely shared: among them, thanks to Elita Banda, Carlyn Hambuba, Habibatou Gologo, Sonu Jain, Loy Nabeta, Rafael Saute, and Diana Styvanley. A great deal of thought, planning, and skill went into this publication. Special thanks to Catherine Bond and Leslie Ashby for their commitment and execution of the project, and to Alex Hery, Daniella Leggelo, and Anne Senges for their input. Thanks also to Ahmad Omar, Marisa Simone, Bernadette Poaty, and Justine Bilong of Global Corporate Solutions, Translation and Interpretation (GCSTI), and Elena Queyranne (AFREC). Finally, many thanks to Sarah Farhat, Mohamad Al- Arief, Elita Banda, Andrea Borgarello, Bachir Diallo, Arne Hoel, Gustavo Mahoque, Tintseh Mukundi, Vincent Tremeau, Dorte Verner, and Daniel Silva Yoshisato for photographs, and to Manuella Lea Palmioli and Gregory Wlosinski of Global Corporate Solutions, Creative Services (GCSSV) for design. Acknowledgements 39 40 The Human Capital Project in Africa PHOTOGRAPHY CREDITS Front Cover - Vincent Tremeau Page 4 - Tintseh Mukundi Page 21 - Sarah Farhat Page 23 - Andrea Borgarello Page 25 - Elita Banda Page 27 - Mohamad Al-Arief Page 29 - Bachir Diallo Page 31 - Dorte Verner Page 33 - Gustavo Mahoque Page 35 - Arne Hoel Page 37 - Daniel Silva Yoshisato Page 42 - Vincent Tremeau Inside Covers - Arne Hoel Investing in People for Equity and Growth 41