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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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In this brief, the authors explore whether lack of access to childcare is a constraint to female labor force participation (LFP) in Indonesia, a country where female LFP lags far below the regional average.
... See More + Using household and labor force survey data, we find that low female LFP is linked to unsatisfied childcare needs - after childbirth, lack of access to informal childcare is associated with a longer absence from the workforce for women and a switch into less lucrative occupations or unpaid family work.
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In this brief, the authors explore whether lack of access to childcare is a constraint to female labor force participation (LFP) in Indonesia, a country where female LFP lags far below the regional average.
... See More + Using household and labor force survey data, we find that low female LFP is linked to unsatisfied childcare needs - after childbirth, lack of access to informal childcare is associated with a longer absence from the workforce for women and a switch into less lucrative occupations or unpaid family work.
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This policy note examines the status of Early Childhood Development (ECD) efforts in Bangladesh and presents the results of a rigorous impact evaluation of an ECD program.
... See More + While Bangladeshi policymakers and their development partners are increasingly aware of the importance of ECD to the country's economic and social development objectives, empirical evidence of the effectiveness of individual ECD efforts remains limited. The impact evaluation, which focused on a set of ECD interventions implemented as part of Save the Children's Early Childhood Stimulation (ECS) program, was conducted between 2013 and 2015. The program was designed to improve parental knowledge of good childrearing practices through the distribution of informational materials combined with parental counseling sessions. The ECS program was implemented in three rural districts located in Sylhet, Barisal and Chittagong divisions, and it built on an existing community-clinic project implemented by the Ministry of Health and Family Welfare.
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Longitudinal patterns of child development and socioeconomic status are described for a cohort of children in Madagascar who were surveyed when they were 3–6 and 7-10 years old.
... See More + Substantial wealth gradients were found across multiple domains: receptive vocabulary, cognition, sustained attention, and working memory. The results are robust to the inclusion of lagged outcomes, maternal endowments, measures of child health, and home stimulation. Wealth gradients are significant at ages 3–4, widen with age, and flatten out by ages 9-10. For vocabulary and sustained attention, the gradient grows steadily between ages three and six; for cognitive composite and memory of phrases, the gradient widens later (ages 7-8) before flattening out. These gaps in cognitive outcomes translate into equally sizeable gaps in learning outcomes. Between 12 and 18 percent of the predicted gap in early outcomes is accounted for by differences in home stimulation, even after controlling for maternal education and endowments.
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Policy Research Working Paper WPS7973 FEB 15, 2017
Galasso,Emanuela; Weber,Ann; Fernald,Lia C. H.Disclosed
Stunting is a widespread and persistent condition in Indonesia with more than one-third of young children being stunted. The national stunting rate for under five-year-olds increased slightly from 3.8 percent in 2007 to 37.2 percent in 2013, based on official stunting rates reported by the Ministry of Health of the Government of Indonesia.
... See More + During the same time period, the percentage of population in poverty reduced from 16. Percent to 11.4 percent (World Bank), suggesting that the increased purchasing power did not translate to better nutritional outcomes for children.
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