Arsenic contamination in shallow groundwater aquifers remains a major barrier to providing access to safe drinking water in Bangladesh. Chronic exposure to arsenic has been shown to cause serious health impacts, including various cancers, skin lesions, neurological damage, heart disease, and hypertension.
... See More + Numerous epidemiological studies have shown cognitive impacts on memory, linguistic-abstraction, attention, learning, and physical ability. The neurotoxic effects of arsenic could be particularly harmful for children during their critical growth periods and have impacts on early childhood development. This study uses cross-sectional data from the nationally representative 2012-13 Bangladesh Multiple Indicator Cluster Survey to investigate the effects of arsenic contamination in drinking water on early childhood development outcomes in a sample of around 7,500 children ages 3-5 years. Early childhood development is measured in four skills domains: literacy-numeracy, physical, social-emotional, and learning using the Early Childhood Development Index. Arsenic contamination is measured in source drinking water at the cluster-level. After controlling for a range of demographic, social, and economic characteristics of households, the results show that arsenic contamination is significantly and negatively associated with the overall Early Childhood Development Index, on outcomes within the physical, social-emotional, and learning skills domains. Further, there is a clear dose-response relationship, where those children with exposure to higher concentrations of arsenic have worse developmental outcomes.
See Less -
Policy Research Working Paper WPS8172 AUG 24, 2017
This report offers an overview of the state of WASH services in the country. It draws from a number of national data sources, desk reviews, and original research to analyze service delivery in the country and assess the sector's performance.
... See More + It offers an overview of poverty in Nigeria, considers the relationship between poverty and WASH, explores demographic patterns influencing access to WASH, and analyzes the relationship between WASH and child health outcomes. Further, it evaluates the performance of water agencies, examines and identifies institutional bottlenecks, offers insights on how to make the sector more efficient and sustainable, conducts a public expenditure review (PER) of the WASH sector, and explores the organization of the institutional landscape for urban water supply in Bauchi City. The report concludes with recommendations for tackling the current crisis of WASH services in Nigeria.
See Less -
The development objective of the Additional financing for the Health Governance and Nutrition Development Project for Lao People's Democratic Republic is to increase coverage of reproductive, maternal and child health, and nutrition services in target areas.
... See More + Some of the negative impacts are include : (i) Persons potentially at risk from exposure to hazardous HCW include medical staff, janitorial staff, patients and visitors, workers at waste treatment facilities, and scavengers at landfills; HCF wastewater discharge contains potentially hazardous constituents, including : microbiological pathogens introduced into wastewater streams by patients being treated for enteric diseases are of most concern; Some the mitigation measures are includes : (i) all medical waste before disposal needs to be reported to responsible disposable unit and disposed of according to each chemical, type and amount according to WHO standards; (ii) highly infectious waste (e.g., laboratory samples containing body fluids, tissues or fecal stools from isolation patients) will be autoclaves prior to disposal; (iii) adequate training will be provided to HCF personnel at all heighten awareness of risks and knowledge of safeguards procedures; (iv) mutilation, disinfection and encapsulation is the preferred method of sharps disposal; (v) high temperature incineration is recommended for larger waste quantities if adequate emissions cleaning equipment is installed; (vi) storage and disposal of wastes should be in strict accordance withspecific regulatory requirements applying to radioactive sources in hospitals; (vii) avoid use of materials hazardous to health and safety; (viii) ensure that handling and disposal of construction waste is in accordance with regulations and best practices; (ix) extending water supply to HCF from proven water sources such as municipal piped water supply or pumping from other safe wells.
See Less -
The report estimates the costs, impacts and financing scenarios to achieve the World Health Assembly global nutrition targets for stunting, anemia in women, exclusive breastfeeding and the scaling up of the treatment of severe wasting among young children.
... See More + To reach these four targets, the world needs $70 billion over 10 years to invest in high-impact nutrition-specific interventions. This investment would have enormous benefits: 65 million cases of stunting and 265 million cases of anemia in women would be prevented in 2025 as compared with the 2015 baseline. In addition, at least 91 million more children would be treated for severe wasting and 105 million additional babies would be exclusively breastfed during the first six months of life over 10 years. Altogether, achieving these targets would avert at least 3.7 million child deaths. Every dollar invested in this package of interventions would yield between $4 and $35 in economic returns, making investing in early nutrition one of the best value-for-money development actions. Although some of the targets—especially those for reducing stunting in children and anemia in women—are ambitious and will require concerted efforts in financing, scale-up, and sustained commitment, recent experience from several countries suggests that meeting these targets is feasible. These investments in the critical 1000 day window of early childhood are inalienable and portable and will pay lifelong dividends – not only for children directly affected but also for us all in the form of more robust societies – that will drive future economies.
See Less -
Publication 114429 JUL 01, 2017
Shekar,Meera; Kakietek,Jakub Jan; Dayton,Julia M.; Walter,DylanEnglishDisclosed
In Nepal, researchers supported by the World Bank's Strategic Impact Evaluation Fund worked with the government to develop a program to inform pregnant women and mothers of young children on how to best care for themselves and their children, using already ongoing community meetings to deliver messages.
... See More + An impact evaluation was designed to measure the effectiveness of the information and to test whether combining this with a short-term cash transfer for mothers made it more effective. The evaluation found that mothers who received both information and cash reported a higher likelihood of breastfeeding their babies and reported that they took recommended vitamins and their households consumed more calories. Also, their children had better fine and gross motor skills as compared to the control group, which didn't receive this intervention. But there weren't any reductions in malnutrition. Two years later, after a devastating earthquake in 2015, researchers returned and found that while mothers still retained more knowledge on good nutrition practices, their children didn't show any continued development gains. The results are helping the Government of Nepal as it considers new steps for improving child development, and the materials used during the meetings to inform women about healthy nutrition have been adopted for wider use.
See Less -
The brief summarizes results from an analysis of the impacts of child marriage on two health outcomes - under-five mortality and stunting - for young children.
... See More + For the purposes of this brief, we focus on the impact of child marriage through early childbirths, as this is the mechanism through which child health and nutrition outcomes are most directly affected. There is a close correlation between child marriage and early childbirths in most countries - at a global level, six out of seven early childbirths take place within the context of child marriage. The brief does not include analyses for other aspects of child health that may also be affected by child marriage, nor does it consider costs that may be incurred by health systems as a result of poor child health.
See Less -
The brief summarizes results from an analysis of the impacts of child marriage on a few selected health outcomes, specifically early childbirths, maternal mortality and intimate partner violence.
... See More + It does not include analyses for other aspects of women's health that are likely to be affectedby child marriage to various extents, such as maternal morbidity, obstetric fistula, female genital mutilation/cutting, sexually-transmitted infections (including HIV and AIDS)and psychological well-being.
See Less -
Every six hours, the death of a woman from the complications of pregnancy serves as the most vexing reminder of Indonesia’s challenges with maternal health (MH).
... See More + This is incommensurate with Indonesia’s strong economic development and stature compared with regional peers, especially as MH is a marker of overall health system performance and affects economic opportunities especially for the poor. The maternal mortality ratio (MMR) is high and progress on improving MH outcomes has been slow, such that the MH Millennium Development Goal (MDG) has already been missed. This policy paper analyzes new data on the ‘missing link’ of primary MH service provision, i.e., private providers, which is critical given that 54 percent of all deliveries in Indonesia occurred in the private sector, compared with 22 percent in the public sector, although overall rates of institutional deliveries remain below target. Key findings from the analysis elucidate the potential value of the private sector in expanding access to MH services covered by the financial purchasing and strategic purchasing umbrella of JKN, the effectiveness of these private MH services, and patient satisfaction. The remainder of the policy paper is structured as follows: The next section provides some background on Indonesia, including general health-related outcomes and an overview of the country’s health system and financing. Section III focuses on MH outcomes and context, including comparisons with global peers, and provides an overview of provision, utilization, and financing of MH services in the country, underscoring the importance of private providers. Section IV summarizes the distributional context and service readiness of private MH providers across the 64 high-priority districts, including a comparison with public providers for context. Section V concludes with a summary of key findings and their policy implications.
See Less -
The objective of the Social Investment and Local Development Project for Armenia is to improve the quality and use of and access to community and intercommunity infrastructure.
... See More + Some of the negative impacts and mitigation measures include: the local construction and environment inspectorates and communities have been notified of upcoming activities; the public has been notified of the works through appropriate notification in the media and/or at publicly accessible sites (including the site of the works); waste collection and disposal pathways and sites will be identified for all major waste types expected from demolition and construction activities; mineral construction and demolition wastes will be separated from general refuse, organic, liquid and chemical wastes by on-site sorting and stored in appropriate containers; the approach to handling sanitary wastes and wastewater from building sites must be approved by the local authorities; before being discharged into receiving waters, effluents from individual wastewater systems must be treated in order to meet the minimal quality criteria set out by national guidelines on effluent quality and wastewater treatment; monitoring of new wastewater systems (before/after) will be carried out; construction vehicles and machinery will be washed only in designated areas where runoff will not pollute natural surface water bodies; and if the building is a designated historic structure, very close to such a structure, or located in a designated historic district, notification shall be made and approvals/permits be obtained from local authorities and all construction activities planned and carried out in line with local and national legislation.
See Less -
This paper presents findings from a large scale multi-arm randomized control trial implemented in 2014-2015 across 236 poor settlements across Bulgaria with the aim to improve full-day kindergarten participation of poor children, especially Roma and Turkish.
... See More + It finds that removing the costs of kindergarten reduced the share of children aged 3-6 not registered in kindergarten by half – while also significantly increasing attendance by about 20 percent. Additional financial incentives of either BGN7 or BGN20 monthly conditional on attendance had no clear impact on registration and attendance. Organizing community meetings to provide information about the importance of kindergarten also did not impact participation in kindergarten, although it slightly improved parental perceptions of the benefit of kindergarten and raised parental aspirations for their children – especially girls. Overall, removing kindergarten costs was thus the most cost-effective strategy to increase kindergarten participation. However, the effect on short-term child development – emergent literacy, numeracy, motor and socio-emotional skills – is mixed: slightly positive for Bulgarian children, while negative for Roma and Turkish children. These results suggest that all children may not immediately benefit from kindergarten, especially minority children who may need additional support to successfully transition to, and benefit from, kindergarten.
See Less -
Amid recurrent natural disasters and severe financial hardship Haitians face formidable challenges to their health. Maternal and infant mortality rates are 5 and 3 times higher than the regional average.
... See More + Access to health care is low compared to low-income countries and particularly among the poorest households. Delivery of preventive health services like immunizations is below minimum standards. Patients often bypass the public health system for lack of trust, and rely on consultations from traditional healers or simply purchase medication directly from unregulated providers for their medical needs. Haiti faces the challenge of meeting the United Nations' Sustainable Development Goals on health and improving outcomes for the poor despite declines in external financing for health and relatively low government contributions compared to other low-income countries to finance the health sector. In light of this, Haiti's healthcare system must operate more efficiently, and access to services must become more equitable and reach vulnerable populations.
See Less -
Amid recurrent natural disasters and severe financial hardship Haitians face formidable challenges to their health. Maternal and infant mortality rates are 5 and 3 times higher than the regional average.
... See More + Access to health care is low compared to low-income countries and particularly among the poorest households. Delivery of preventive health services like immunizations is below minimum standards. Patients often bypass the public health system for lack of trust, and rely on consultations from traditional healers or simply purchase medication directly from unregulated providers for their medical needs. Haiti faces the challenge of meeting the United Nations' Sustainable Development Goals on health and improving outcomes for the poor despite declines in external financing for health and relatively low government contributions compared to other low-income countries to finance the health sector. In light of this, Haiti's healthcare system must operate more efficiently, and access to services must become more equitable and reach vulnerable populations.
See Less -
Amid recurrent natural disasters and severe financial hardship Haitians face formidable challenges to their health. Maternal and infant mortality rates are 5 and 3 times higher than the regional average.
... See More + Access to health care is low compared to low-income countries and particularly among the poorest households. Delivery of preventive health services like immunizations is below minimum standards. Patients often bypass the public health system for lack of trust, and rely on consultations from traditional healers or simply purchase medication directly from unregulated providers for their medical needs. Haiti faces the challenge of meeting the United Nations' Sustainable Development Goals on health and improving outcomes for the poor despite declines in external financing for health and relatively low government contributions compared to other low-income countries to finance the health sector. In light of this, Haiti's healthcare system must operate more efficiently, and access to services must become more equitable and reach vulnerable populations.
See Less -
At the beginning of the 1990s, Romania inherited a disastrous child protection system from the communist regime. As a result of pro-birth policies and of the economic depression in the 1980s, the traditional models of child care in the family, especially for children in need (in particular those with disabilities) were undermined.
... See More + The government of Romania has made significant progress in the past 25 years in terms of reducing the number of children in public care. Despite the large number of children placed in public care, the government of Romania has acknowledged the fact that the residential type of care has negative effects, especially on the development of young children, and has managed to improve child protection services substantially by developing family-type care alternatives. However, following the global crisis, which affected the situation of children in the entire Central and Eastern Europe/Commonwealth of Independent States region, the process of reducing the number of institutionalized children slowed down significantly, both in Romania and in other countries in the region. This book presents the results of this research on more than 52,000 children placed in public care in Romania (in special protection) who receive family or residential-type protection services, as well as on the children at risk of separation from their families from the source communities. The whole analysis in this volume is child-centered, encompassing both children in the special protection system and children at risk of separation from their family. The results presented in this book have been and would be discussed with the central and local authorities in Romania in order to identify the priority steps required to advance the reform of and increase investments to the child protection system reform.
See Less -
This paper presents the results of a randomized controlled trial set to evaluate the effects of a pay-for-performance scheme that rewarded community health worker cooperatives for the utilization of five targeted maternal and child health services by their communities.
... See More + The experiment took place in 19 districts in Rwanda between 2010 and 2014. The analysis finds no impact of the performance payments on coverage of the targeted services, attitudes and behaviors of community health workers, or outcomes at the cooperative level. No synergies are found between the scheme and a demand-side, in-kind transfer intervention that was independently effective in increasing coverage rates of targeted services.
See Less -
Policy Research Working Paper WPS8059 MAY 16, 2017
Lesotho is a small, mountainous kingdom, surrounded by the Republic of South Africa. The country is divided into ten administrative districts and further divided into four ecological zones: Lowlands, Foothills, Mountains, and Senqu River Valley (Ministry of Health, Lesotho and ICF International, 2016).
... See More + This report presents results from the baseline survey for the Maternal and Newborn Health Performance Based Financing (PBF) Project in Lesotho. The baseline survey covers four districts: Mafeteng, Mohale’s Hoek, Mokhotlong and Thaba-Tseka. The PBF is implemented in health centers managed by the Ministry of Health (MOH) and Christian Health Association of Lesotho (CHAL). In the catchment area of each health center, a sample of households was selected. Households were eligible to be included in the sample if they had a female member who was either recently pregnant or was an adolescent. The fieldwork was implemented by a local firm, Leads Services, from March to June 2015. The final sample included 53 health centers and 2120 households.
See Less -
Working Paper 114373 APR 01, 2017
Walldorf,Jeanette; De Walque,Damien B. C. M.; Shapira,Gil; Yamashita-Allen,KanakoDisclosed
India suffers from a high maternal and infant mortality rate, especially in rural areas, where poor women do not receive effective care and one in every 22 infants die within one year of life.
... See More + In 2010, Dimagi, in partnership with Catholic Relief Services (CRS), IntraHealth International, Real Medicine Foundation, and Save the Children, deployed CommCare mobile technology to help Accredited Social Health Activists (ASHAs) improve their care for pregnant women and their newborns at the last mile in rural India. CommCare uses audio, video, imagery, short message service (SMS) texting, data and tracking forms, multiple languages, and other features to standardize ASHAs’ service delivery, improve counseling techniques and patient coordination, and collect real-time data for performance monitoring. The multimedia aids enhance client engagement and assist low-literate ASHAs and their clients. Through a partnership with the Government of India and the Bill and Melinda Gates Foundation, a CommCare-based application is being scaled across eight Indian states to strengthen the monitoring of the service delivery of anganwadi center’s in the country. The CommCare mobile application is intended to replace the extensive paper registers anganwadi workers are required to maintain. The app is designed to improve the care anganwadi workers provide their communities, tracking distribution of immunizations and supplementary food, attendance of children at preschool, and the nutrition status of children up to age five.
See Less -
Sustaining in recent years expenditure on early childhood education (ECE) at over a fifth of its education budget, Mongolia is a relatively high spender on pre-primary education.
... See More + This report examines structural and process aspects of quality in Mongolian kindergartens, along with early development outcomes among children enrolled in these kindergartens, to assess the effectiveness and equity of the country's public investments in ECE. The analysis shows that while the last decade saw tremendous progress in improving access to preschool overall, the most disadvantaged and vulnerable are still excluded from the system. Further, an assessment of child development outcomes shows that even after significant exposure to formal preschool services in the public sector, socioeconomic gaps in outcomes remain large. At the same time, potential areas where relatively low-cost investments could reap significant gains remain unexploited. Key among these is use of home- or community-based ECE interventions that could improve school preparedness among children in rural areas not enrolled in preschools. Another is the potential for an expanded role for the private sector in urban areas.
See Less -
