Mauritania Human Capital Review M auritania Human Capital Review Building, Utilizing, and Protecting Human Capital for Inclusive and Resilient Economic Development © 2024 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Direc- tors, or the governments they represent. The World Bank does not guarantee the accuracy, completeness, or currency of the data included in this work and does not assume responsibility for any errors, omissions, or discrepancies in the information, or liability with respect to the use of or failure to use the information, methods, processes, or conclusions set forth. 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Cover photo: Dorte Verner/World Bank Cover and interior design: Nita Congress Contents Acknowledgments ...................................................v 5. Assessing the strengths and gaps Abbreviations...........................................................vi in protecting human capital............58 Executive summary................................................ vii Human capital risks and policy responses........58 Existing approaches to protect human capital in Mauritania..............................................63 1. Overview............................................... 1 Options to strengthen the protection of Building (early childhood) human capital ............ 5 human capital in Mauritania................................. 67 Utilizing human capital ........................................... 6 Protecting human capital ...................................... 8 6. Conclusions........................................74 2. Introduction.......................................11 Appendix A: Utilization-Adjusted Human Capital Index..............................77 3. Building early childhood human References.................................................78 capital..................................................18 Prenatal years and maternal health and nutrition ...................................................................18 Boxes Early childhood: 0–5 years...................................22 2.1 The Human Capital Index.....................................13 Within-country heterogeneity..............................26 2.2 Best practice examples of a whole-of- government approach to human capital............17 Evidence-based multisectoral programs focused on early childhood ................................. 27 4.1 Experiences with employment subsidies for vulnerable populations: lessons from Policy recommendations for building human Jordan ...................................................................55 capital in early childhood .....................................30 4.2 Approaches to estimate the potential of green jobs.............................................................. 57 4. Utilizing human capital ..................35 5.1 Coordinating the response to shocks............... 67 Measures of human capital utilization ...............35 Dimensions associated with low utilization of Figures human capital in Mauritania.................................39 1.1 Mauritania’s HCI is below its peers...................... 2 Gender disparities and human capital 1.2 Mauritania scores lower on the human utilization................................................................. 47 capital components than neighbors, Human capital utilization of older workers........50 structural peers, or aspirational peers................ 2 Policies to improve the utilization of human 1.3 Building early childhood human capital is a capital in Mauritania ..............................................51 multisectoral policy issue...................................... 6 iii iv Mauritania Human Capital Review 1.4 Mauritania became a lower-middle-income 5.1 Mauritian households, regardless country despite a reduction in human of location, are affected mostly by capital wealth ......................................................... 7 agropastoral and climate shocks.......................60 1.5 Mauritian households, regardless of location, are affected mostly by Tables agropastoral and climate shocks......................... 8 1.1 Mauritania’s HCI by sex......................................... 2 2.1 Human capital strongly correlates with GDP per capita...................................................... 11 1.2 Building, utilizing, and protecting human capital occurs across the life cycle...................... 3 2.2 Mauritania’s HCI is below its peers.....................13 1.3 Key constraints and policy actions for 2.3 Mauritania scores lower on the human building, utilizing, and protecting human capital components than neighbors, capital....................................................................... 4 structural peers, or aspirational peers...............14 2.1 Mauritania’s HCI by sex........................................14 2.4 Population pyramid in 2021 ................................14 3.1 Addressing key issues to building early 3.1 The return to a unit dollar invested in childhood human capital in Mauritania..............31 human capital is highest in the early years.......19 4.1 Mauritania’s per capita human capital 3.2 The Nurturing Care Framework..........................19 wealth growth rate is negative (1995–2018).... 37 3.3 Building early childhood human capital is a 4.2 Human capital held by males and females multisectoral policy issue....................................20 in Mauritania, 1995 and 2018 ............................ 37 3.4 Early childhood policy issues in Mauritania.....22 4.3 The employment rate is low, especially 4.1 Mauritania’s human capital wealth has among women.......................................................40 declined over the last 20 years (1998–2018).. 37 4.4 Public sector employment dominates, 2017.....41 4.2 Mauritania became a lower-middle-income 4.5 Many Mauritanians have low levels of country despite a reduction in human education, 2017.....................................................41 capital wealth .......................................................38 4.6 NEET rates are high across levels of 4.3 Mauritania is among countries with the education ..............................................................43 worst utilization of human capital......................38 4.7 Agriculture and services continue to drive 4.4 Penalty for underutilization of human employment...........................................................45 capital versus the level of HCI............................39 4.8 The potential gain from achieving gender 4.5 Employment peaks in middle age and equity in human capital is large.........................50 declines quickly thereafter..................................40 4.9 Suggested indicators to track outcomes 4.6 Youth struggle with the school-to-work along different dimensions of jobs ...................52 transition ...............................................................43 4.10 Addressing key issues of human capital 4.7 Mauritania has the second highest NEET utilization in Mauritania.......................................54 rate for youth 15–24 in Sub-Saharan Africa....43 5.1 Key risks for Mauritania’s human capital 4.8 Returns accrue only beyond primary accumulation and utilization...............................64 education...............................................................45 6.1 Operationalizing the policy recommendations.76 4.9 Poverty rate by employment/activity status of head of household...........................................46 4.10 Women’s better employment rate is correlated with income per capita.....................48 Acknowledgments This report was prepared by the Social Protection Thiane Dia (Executive Assistant), Yahya Ould Aly and Jobs Global Practice under the guidance of Jean (Program Assistant), Yacine Ndiaye (Program Keiko Miwa (Country Director), Christian Bodewig Assistant), and Hajalalaina Consuella Rabearivony (Practice Manager), and Cristina Panasco Santos Andrianjakanava (Program Assistant) provided (Country Manager). invaluable administrative and operational support. Oscar Parlback edited the report. Sariette Jippe The overall effort was led by Anne Hilger (Econ- (Senior Program Assistant) coordinated the review omist) and Ruslan Yemtsov (Lead Economist). of the report, provided editorial and quality control Nakawala Lufumpa (Consultant) provided substan- support, and facilitated its distribution. tial inputs to chapter 3. The Mauritania Human Capital Review has been The report strongly benefited from detailed conver- shaped by an ongoing dialogue with the Maurita- sations and inputs from the following sectoral nian authorities, including a feedback workshop colleagues: Amina Debissa Denboba and Djiby (July 2023) and a series of technical meetings. The Thiam (education); Mohamed Vadel Taleb El Hassen report also benefited from exchanges with devel- and Kazumi Inden (health); Friederike Rother, Mira opment partners. The peer reviewers were Heba Saidi, Matthieu Lefebvre, Margaux Vinez, Diey- Elgazzar (Program Leader), Mohamed El Aziz Ben naba Diallo, and Isselmou Boye (social protection Ghachem (Senior Social Protection Specialist), and and jobs); Oscar Anil Ishizawa Escudero (disaster Michael Weber (Senior Economist). risk management); Urbain Thierry Yogo (macroeco- nomics, trade and investment); and Djibril Ndoye (poverty). The report benefited from the overall guidance of Rebekka E. Grun (Practice Leader). v Abbreviations ANEPEJ National Youth Public Employment PBF performance-based financing Agency (Agence nationale pour la PEJ Youth Employability Project (Projet promotion de l’emploi des jeunes) d’employabilité des jeunes) ARC African Risk Capacity SCAPP Accelerated Growth and Shared BCC behavioral change communication Prosperity Strategy (Stratégie de la Croissance Accélérée et de la CCT conditional cash transfer Prospérité Partagée) FNRCAN National Fund to Respond to Food and SPJ Social Protection and Jobs Nutritional Insecurity (Fond National de Réponse aux Crises Alimentaires et SQ-LNS small-quantity lipid-based nutrient Nutritionnelles) supplement GDP gross domestic product UHCI Utilization-Adjusted Human Capital Index HCI Human Capital Index UNICEF United Nations Children’s Fund HIV/AIDS human immunodeficiency virus/ acquired immunodeficiency syndrome WASH water, sanitation and hygiene HNP Health, Nutrition and Population WHO World Health Organization LMIC lower-middle-income country NEET not in education, employment, or training All dollar amounts are U.S. dollars unless otherwise indicated. vi Executive summary This human capital review assesses human capital and improving the availability and quality of service outcomes in Mauritania and identifies actions to delivery while closing urban-rural health care gaps— strengthen, utilize, and protect human capital. performance-based financing mechanisms can be The government of Mauritania has demonstrated an effective tool to support this, as pilot experi- a strong commitment to placing human capital at ences in the country have shown. Implementation the forefront of its long-term vision, with dedicated of measures targeting malnutrition among children efforts focused on enhancing childhood health and under age five, including by adopting a package education outcomes. Despite Mauritania’s positive of interventions that includes cash transfers, are initiatives, the country’s human capital wealth per an important avenue to improve children’s nutri- capita has declined over the last 20 years; and it is tion status of children. Conditional cash transfers, imperative to look at ways to quickly reverse this which provided a top-up transfer to incentivize child- situation. Children born today in Mauritania will only hood vaccination among Tekavoul beneficiaries, be 38 percent as productive when they grow up as are an example of a successful, effective multisec- they could have been had they enjoyed complete toral intervention. The Tekavoul platform should education and full health. Increasing the produc- be leveraged further and could be coupled with tivity of Mauritanians—both men and women—and other interventions, such as the direct provision of thus allowing them to fully contribute to the develop- nutritional supplements to counter childhood malnu- ment of their society entails transforming the human trition. Its human capital accompanying measures capital challenge to a human capital opportunity. (the promotion sociale), including those focusing This report takes a comprehensive, cross-sectoral on early childhood nutrition and stimulation, could approach and proposes recommendations for be made available to an audience beyond safety building, protecting, and utilizing human capital in net beneficiaries. Mauritania. Mauritania has significant untapped human capital To better build human capital, it is essential to potential that can be harnessed and utilized for enhance maternal health and nutrition, encourage development. Challenges such as limited employ- the utilization of health services, and enhance early ment opportunities for young people can be childhood education through multisectoral solutions. addressed by creating pathways for smoother tran- Challenges such as high maternal mortality rates and sitions into the workforce. In 2019, the proportion limited access to family planning and quality health of youth not in employment, education, or training services have been identified; the country should was 44.8 percent—ranking high in Sub-Saharan therefore focus on working toward overcoming the Africa, second only to Niger. Efforts can focus on constraints in early childhood education, fostering a enhancing the relevance of skills provided by the more supportive and effective learning environment education system to expedite the transition to work, for young children, and doing so in a coordinated recognizing that less than a quarter of young adults and concerted manner. Enhancing maternal health are employed by age 34. requires addressing barriers to health care access, vii viii Mauritania Human Capital Review Empowering women in the workforce is a key Mauritania needs to protect and safeguard its human element for unlocking Mauritania’s human capital capital in the face of recurrent challenges. With potential. Early marriage, unequal family obligations, the growing exposure to shocks, ensuring inclu- employment segregation, and legal barriers are sive systems for protecting human capital will help contributors to only 23 percent of prime-age women strengthen resilience. From 2000 to 2021, Mauri- participating in the labor force. Moreover, women tania ranked third highest in Sub-Saharan Africa currently earn, on average, only 60 percent of men’s on the level of human impact from climate-related salaries for comparable jobs and equivalent levels of events, after Somalia and Eswatini. About half of human capital. Addressing these barriers and recti- Mauritania’s households report facing shocks; fying this imbalance can unleash a valuable source extreme climate events make close to a million of development and prosperity and contribute to a Mauritanians food insecure every year. Mauritania more inclusive and equitable workforce. has made impressive progress in building a compre- hensive shock response system. Its core safety To better utilize its human capital, Mauritania should net, Takavoul, and its shock response program, improve the relevance of its education system, Elmaouna, are at scale covering all the extreme improve the business climate for entrepreneurship, poor and vulnerable. These rely on an early warning and scale up labor market programs for vulner- system and innovative financing mechanisms, able youth. Improvements of business climate and providing a harmonized framework for government concerted efforts to diversify the economy, coupled and development partners. Robust evaluations with entrepreneurship support, are needed for of the first experiences in utilizing this system robust job creation. Mauritania is currently scaling are needed to ensure efficiency, timeliness, and up its youth employment programs. Further multi- adequacy. The vaccination campaign in response sectoral solutions—including improvements in the to COVID-19 has demonstrated strong commitment relevance of basic and technical education—are through a joint effort to better surveillance, preven- needed to have a greater impact on the job pros- tion, and response. pects for youth. Work on social norms around gender roles is also necessary to strengthen nondis- Mauritania’s sustainable growth depends on its crimination and empower women and girls. Finally, human capital wealth. Unlocking this opportunity demographic change will put aging on the agenda is one of the country’s biggest challenges—for in the medium to long term, requiring better access which, however, solutions are known. This growth to health care, changing strategies of urbanization, is in reach, and this report aims at contributing to and requiring a framework to extend working life. this process of change. 1 Overview   Human capital, which encompasses knowledge, inclusive and resilient economic development along skills, health, and nutrition, is a significant deter- the three pillars of the human capital framework— minant of long-term economic growth and social that is to build, use, and protect human capital. advancement. Human capital drives economic growth globally and represents two-thirds of global Mauritania’s human capital wealth per capita has wealth. The COVID-19 pandemic led to a sharp declined over the last 20 years. Human capital decline in human capital in the critical stages of life, accounts for an estimated 64 percent of global with children and young people most affected. Mauri- wealth (World Bank 2021a). While its contribution tania, a sparsely populated, arid, and resource-rich to overall wealth increased between 1995 and 2018 lower-middle-income country (LMIC), is facing globally, it decreased in Mauritania, where the stock frequent shocks, which limits progress in poverty of human capital per capita shrunk by an average reduction by depleting the assets of poor households of 1.6 percent per year, and its share in the nation’s and by increasing the risk faced by the nonpoor of wealth is just 50 percent. The accumulation of the falling into poverty. The COVID-19 pandemic reversed stock of human capital has been lagging population progress in poverty reduction with an increase of growth because of increasingly poor employment extreme poverty to 6.1 percent in 2020, and of the outcomes, especially for women, and a failure to overall poverty rate to 33.6 percent in 2021 (World diversify the economy. Bank 2022d). The country is particularly vulner- Mauritania’s Human Capital Index (HCI) was able to climate shocks, which disproportionately 38 percent in 2020, meaning that children born in affect the poorest, who depend on agriculture for Mauritania today are expected to only be 38 percent 45 percent of their total income, and for whom food as productive when they grow up as they could have products comprise 57 percent of their consumption. been had they enjoyed complete education and This human capital review assesses human capital full health. The country’s HCI is slightly above the outcomes in Mauritania and identifies actions average for Sub-Saharan Africa, but below that of to build, utilize, and protect human capital. The other LMICs (figure 1.1). Girls tend to fare slightly government of Mauritania has put human capital better than boys across all dimensions of the HCI: development at the center of its long-term vision, they are less likely to be stunted, more likely to and concerted efforts have been made to improve survive to age five and beyond, and their expected childhood health and education outcomes in Mauri- schooling is higher (table 1.1). However, women have tania. However, progress has been limited. This much lower potential to realize their human capital report takes a cross-sectoral approach toward than men in Mauritania. 1 2 Mauritania Human Capital Review Figure 1.1  Mauritania’s HCI is below its peers Mauritania scores lower on HCI components than 0.6 its peers. Figure 1.2 shows that Mauritania scores 0.5 below the values achieved by neighbors (bordering 0.4 countries; i.e., Morocco), structural peers (countries with similar economic characteristics as Mauritania HCI 0.3 in 2015–21; i.e., Senegal), and aspirational peers 0.2 (countries with structural characteristics similar to 0.1 Mauritania’s in 1990–2010 that have enjoyed faster 0.0 Mauritania Sub-Saharan Lower-middle per capita growth since 2010; i.e., Honduras and Lao Africa income countries People’s Democratic Republic) across most of the Source: World Bank 2022a. components of the HCI.1 Mauritania scores partic- ularly low on learning outcomes—learning-adjusted years of schooling and harmonized test scores— Table 1.1  Mauritania’s HCI by sex and could do better on early childhood outcomes Component Boys Girls such as childhood survival rates. These issues are HCI overall 0.37 0.39 of particular importance given the structure of the Survival to age 5 0.92 0.93 Mauritanian population: 29 percent of the current Expected years of school 7.5 7.9 population is below age 10. Proportionally, the Harmonized test scores 340 343 0–4-year-old age group is the country’s largest Learning-adjusted years of school 4.1 4.4 population group. Building the human capital of Adult survival rate 0.78 0.83 these young Mauritanians is therefore of utmost Not stunted rate 0.74 0.80 importance. Source: World Bank 2022a. See World Bank (2020a) for a fuller discussion of these 1  three peer groups. Figure 1.2  Mauritania scores lower on the human capital components than neighbors, structural peers, or aspirational peers 12 500 100 10 400 80 Rate or share (%) 8 300 60 Score Years 6 200 40 4 2 100 20 0 0 0 Expected years Learning-adjusted Harmonized Survival to Adult Not of school years of school test scores age 5 survival stunted Mauritania Senegal Lao PDR Honduras Morocco Source: World Bank, World Development Indicators. 1 Overview 3 This human capital review offers a cross-sectoral challenges in building, utilizing, and protecting approach toward greater and shared prosperity. human capital. In building human capital, the report Building, utilizing, and protecting human capital focuses on key constraints to accumulating early occurs across the life cycle (table 1.2). It is beyond childhood human capital. Early childhood is the the scope of this review to provide a thorough period that carries the highest return to investment. detailed analysis of human capital in Mauritania; It further lays the foundation for people’s ability to rather, the report highlights the most pressing keep building their human capital throughout their Table 1.2  Building, utilizing, and protecting human capital occurs across the life cycle Objective Early years School years Youth Working age Old age ■ Secondary ■ Nutrition ■ Quality of educa- education ■ Remedial educa- ■ Early child- tion tion ■ Tertiary hood ■ Social safety net education On-the-job Building ■ ■ Caregivers of stimulation with incentives learning human ■ Remedial young children capital ■ Social for schooling education ■ Lifelong learning ■ Need to be safety nets ■ Reduce early ■ Apprentice- ■ Improved quality engaged for with health marriages, ships of health service changing social incentives empower girls, delivery norms and (antenatal ensure schooling ■ On-the-job empowering visits, vaccina- progression, training ■ Adaptive social women tions) provide relevant providing rele- protection to ■ Quality child- skills, including vant skills, avoid food inse- care services life skills including life curity skills ■ Labor market ■ Reduce early intermediation ■ Retirement marriages and and reform of the schemes to Utilizing utilize human legal framework incentivize human capital in labor longer working ■ Competition, capital market life access to finance Avoid child labor ■ Youth labor and markets ■ Better work market environment for ■ Productive programs, older workers economic inclu- including subsi- sion ■ Better-quality/ dies, childcare services, green ■ Childcare affordable health jobs services, green care jobs Protecting human ■ Adaptive social protection, health capital insurance, etc., to avoid coping ■ Adaptive social protection, health insurance, index insur- strategies that affect nutrition and ance to avoid negative coping strategies and protect assets learning ■ Resilience of service delivery for continued access ■ Resilience of service delivery for ■ Social cohesion through community-based programs continued access 4 Mauritania Human Capital Review lives. In utilizing human capital, the report focuses shocks, which will get worse due to climate change. on the constraints that vulnerable groups such as Table  1.3 presents the framework for building, women and youth face in making productive use of utilizing, and protecting human capital, identifying the skills and knowledge acquired. This part of the the key constraints as well as main policy actions report focuses on Mauritania’s untapped resources, identified in the review. Because constraints to which need to be activated to reap the demographic human capital accumulation, utilization, and protec- dividend. In protecting human capital, the focus is tion are cross-sectoral, the recommended policy on protection against climate shocks. Mauritania actions require strong collaboration across sectors is already affected by frequent and severe climate and government. Table 1.3  Key constraints and policy actions for building, utilizing, and protecting human capital Objective Key constraints Key policy actions ■ Increase access to and use of family planning Building human capital ■ Increase the quality of health services pre- and post- ■ High maternal mortality partum rate and poor maternal ■ Support the adoption of recommended health/nutri- health outcomes tion practices ■ Poor child health and nutri- ■ Improve infant and young child feeding practices tion outcomes ■ Improve water, sanitation, and hygiene practices By promoting the ■ Lack of (early) childhood ■ Improve knowledge of responsive caregiving among demand for, use of, and education and stimulation caregivers access to quality health, ■ Non-enforcement of child ■ Strengthen teachers’ content knowledge and peda- nutrition, and education protection policies gogical skills services ■ Ease the birth registration process and eliminate penalties for late registration Utilizing human capital ■ Challenging transition from education to work ■ Improve the quality of education and implement reme- dial education programs ■ Underutilization of the human capital of prime-age ■ Diversify the economy and private sector development workers ■ Improve labor market information and intermediation ■ Gender disparities in terms ■ Consider wage subsidies for vulnerable groups such By helping people maxi- of access to opportuni- as youth and women mize their productive ties and distribution of care ■ Establish a system for lifelong learning in partnership potential and access responsibilities with the private sector high-quality jobs and ■ Underutilization of older ■ Scale up apprenticeship programs and social pensions livelihood opportunities workers’ skills ■ Expand the universal health coverage scheme and Protecting human capital increase coverage to reduce out-of-pocket spending ■ Low coverage of insurance ■ Improve early warning systems and ensure they are from health-related idio- integrated with emergency response protocols and syncratic shocks financing instruments to respond effectively to emer- ■ Increased frequency and gencies severity of climatic shocks ■ Increase the adequacy of social protection coverage By developing resilience ■ Prevalence of negative and gradually expand social insurance to the informal to shocks and protecting coping strategies sector people from welfare and ■ Weakening of traditional ■ Improve labor market prospects for poor and vulner- human capital erosion informal safety nets able groups and increase social cohesion at the due to shocks community level through behavioral change interven- tions 1 Overview 5 Building (early childhood) Similarly, although school enrollment has increased, learning poverty remains high. Fourth grade students human capital score, on average, 21.0 percent, 38.6 percent, and 31.6 percent on tests evaluating French, Arabic, Maternal health and nutrition—even before and mathematics skills, respectively (Gauthier et conception and the prenatal years—are of critical al. 2023). Childhood immunization rates in Mauri- importance for building human capital. The health tania are notably low, and air pollution is a significant and nutritional status of women of reproductive contributor to child morbidity and mortality, affecting age significantly affects early childhood outcomes, both fetal health and childhood development. Early including intrauterine growth, birthweight, neonatal childhood education faces various constraints, and maternal mortality, and early childhood devel- including limited caregiver knowledge and resources opment. Mauritania faces challenges such as high for early learning, along with low enrollment rates maternal mortality rates and limited access to family in preprimary education. Child protection and rights planning and quality health services, leading to are also of concern, with a notable decline in birth inadequate adoption of recommended health and registrations and persistent issues related to child nutrition practices. Child marriage, teen pregnancy, marriage, child labor, and female genital mutilation. and female genital mutilation are prevalent, contrib- Mauritania’s academic performance is significantly uting to maternal morbidity and mortality and poor worse than the average of other African coun- birth outcomes. Maternal malnutrition, including tries where comparable assessments have been overnutrition and micronutrient deficiency, also conducted: 45.4 percent and 45.2 percent on tests poses risks to maternal and child health. Insuffi- evaluating French/English and mathematics skills, cient health infrastructure, especially in rural areas, respectively. further exacerbates these challenges. Maternal health, education, and socioeconomic status play To better build early childhood human capital, it crucial roles in shaping childhood health outcomes. is essential to enhance maternal health and nutri- tion, encourage the utilization of health services, Childhood health and education outcomes, as well as and enhance early childhood education (figure 1.3). the protection of children’s rights, have far-reaching Enhancing maternal health will require addressing implications for future productivity and well-being. barriers to accessing health services, improving The prevalence of stunting (low height for age) service availability and quality, and bridging remains high at 25.1 percent of children under five urban-rural health service disparities. Investments years old (UNICEF, WHO, and World Bank 2021; in the health sector are also needed to ensure MoH and ANSADE 2022). If present trends continue, remote populations have access to quality primary Mauritania will be unable to reach the global target health services. Performance-based financing for childhood stunting by 2030.2 Worryingly, Mauri- mechanisms adopted by the Ministry of Health can tania’s 2022 SMART (Standardized Monitoring and incentivize health workers to serve in rural areas, Assessment of Relief and Transitions) survey results potentially supported by financial incentives like suggest an almost 8 percentage point increase in hardship allowances. To improve child health and wasting in the last year, likely due to COVID-19.3 nutrition, Mauritania should urgently implement measures targeting undernutrition among children 2  The global target for childhood stunting is a 50 percent under age five, including by adopting a package of reduction in the number of children under five years old who are stunted by 2030. interventions that include cash transfers and nutri- Wasting refers to acute malnutrition. Stunting refers to 3  tional supplements. School feeding programs and chronic malnutrition. 6 Mauritania Human Capital Review Figure 1.3  Building early childhood human capital is a multisectoral policy issue Nutrition Health Education Protection ■ Infant and young child feeding ■ Immunization ■ Caregiver knowledge ■ Birth registration ■ Water, sanitation and hygiene ■ Quality of care ■ Caregiver resources ■ Legal/institutional ■ Integrated management of ■ Community health framework moderate acute malnutrition ■ Noncommunicable disease prevention Equity and gender-related policy issues Childhood human capital health-related social and behavioral change commu- country despite a reduction in human capital wealth nication can contribute to improved child nutrition. (figure 1.4). The Utilization-Adjusted Human Capital To enhance child education and development, care- Index (UHCI) reveals very low human capital utili- givers need to be empowered to stimulate children’s zation in Mauritania, especially among women. cognitive and behavioral development. Lessons Children born in Mauritania today are expected to from the Tekavoul program, which has success- utilize only 15 percent of their human capital poten- fully induced behavior change and increased tial by the time they enter the labor market. parent-child interaction, could inform other national programs. Given that most Mauritanian children are The country faces significant challenges in effec- cared for by immediate family members, information tively utilizing its human capital, primarily because campaigns should utilize various tools and engage of low employment, poor quality of jobs, and low traditional figures of authority like village or religious educational attainment. Mauritania’s labor market leaders to reach potential caregivers effectively. struggles with low participation rates, especially among women, and employment rates are low for the country’s population, with even fewer opportu- nities for women. The labor force participation rate Utilizing human capital among the working-age population (age 15–64) was low at 47 percent in 2019 (29 percent among Mauritania is not yet fully utilizing the country’s women, compared to 64 percent among men),4 accumulated human capital. According to the much lower than the Sub-Saharan African average Wealth of Nations approach, which separates of 68.4 percent. However, the country’s labor force national wealth into natural, physical, and human participation and overall unemployment rate of capital, the country’s human capital wealth per 20.19 percent in 2017 mask even higher rates of capita has decreased over the last two decades, nonparticipation, unemployment, and underemploy- representing only 50 percent of total wealth in ment among youth (age 15–24). When employed, 2018. This decline, particularly pronounced among women face severe penalties in terms of wages, women, has hindered the country from fully capi- earning on average only 60 percent of men’s sala- talizing on its demographic dividend. The transition ries for comparable human capital and type of job. to LMIC status was attributed largely to the growth of mineral wealth: Mauritania is one of only three countries that became a lower-middle income 4  Source: International Labour Organization, ILOSTAT. 1 Overview 7 Figure 1.4  Mauritania became a lower-middle-income country despite a reduction in human capital wealth 30,000 Armenia Albania Per capita human capital, 2018 (2018 $) 25,000 Bosnia Lao PDR and Herzegovina 20,000 Nigeria Ghana Congo, Rep. 15,000 Zimbabwe Cambodia Low-income, 1995; lower-middle-income, 2018 10,000 Low-income, 1995–2018 Ethiopia MAURITANIA Low-income, 1995; upper-middle-income, 2018 Rwanda 5,000 Mozambique 0 5,000 10,000 15,000 20,000 25,000 30,000 Per capita human capital, 1995 (2018 $) Source: World Bank 2021a. Note: Countries above the line have seen an increase in their human capital wealth over the 1995–2018 period. This gender disparity in the labor force contributes market. The transition from school to work is partic- to a significant portion of women dropping out of ularly challenging for Mauritanian youth, who often the job market. The quality of jobs is also a major face unrealistic expectations about job prospects. concern, as most employment occurs in the informal On the other hand, older workers tend to withdraw sector with low productivity, offering little or no from the labor force relatively early, reflecting their protection for workers’ rights and no social secu- deteriorating health and the prevalence of jobs not rity. A substantial proportion of jobs are precarious, suitable for them. affecting both men and women, with higher prev- alence in rural areas compared to urban centers. Mauritania can significantly improve utilization of its human capital. Bridging the gender gap in A large proportion of youth fails to transition labor force participation and earnings, combating successfully into employment, remaining unem- early marriages and pregnancies, and promoting ployed or largely inactive in the labor market. In equal opportunities for women are vital steps to 2019, 44.08 percent of young people between harness the full potential of the country’s human the ages of 15 and 24 (and 54.8 percent of young capital. Reform of labor market regulations, such women) were not in employment, education, or as ensuring equal remuneration for equal work training—the second highest level in Sub-Saharan and adopting legislation against workplace harass- Africa after Niger. Over 60 percent of the popula- ment, could enhance gender equality in the tion in Mauritania is below age 25, which means workforce and encourage women’s participation in that many young people are soon entering the labor higher-quality jobs and leadership roles. Regulatory 8 Mauritania Human Capital Review issues, corruption, and skill mismatches hamper job Protecting human capital creation across sectors. To increase employment opportunities, Mauritania is currently working on Mauritania is frequently affected by a variety of initiatives such as tax and land reforms, but the shocks, including both slow and rapid onset shocks authorities must also focus on accelerating private as well as predictable and unpredictable events, sector growth, promoting entrepreneurship, and leading to protracted crises. Climate-related disas- expanding access to finance. ters, such as desertification, rising temperatures, soil erosion, and extreme weather, pose signif- Mauritania can optimize labor market programs, icant threats to livelihoods and food security. improve vocational training, and promote green jobs Over 2000–21, Mauritania ranked third highest in for youth and women. Wage subsidies and better Sub-Saharan Africa on the level of human impact labor market information systems could enhance from climate-related events, after Somalia and Eswa- the experience of Mauritanian workers. Increasing tini. The country’s vulnerability to climate change is women’s labor market participation requires high, with potential gross domestic product (GDP) addressing their education, health, and entrepre- losses of 2.8 percent by 2030 in the absence of neurial empowerment as well as issues related to urgent climate adaptation investments. Shocks child marriage. Older workers’ productivity could affecting households include health crises, loss of be maintained by increasing their access to health cattle, and weather-related events, with poverty services and developing a retirement scheme with rates rising significantly during droughts (figure 1.5). activation incentives. Multisectoral policies are Trade costs, price shocks, high transport costs, and crucial to unlock the potential of Mauritania’s human an overvalued real exchange rate further challenge capital. food security. Additionally, the country’s reliance on livestock exposes it to contagious zoonotic diseases, Figure 1.5  Mauritian households, regardless of location, are affected mostly by agropastoral and climate shocks a. By agroecological zone b. Urban/rural Livestock death Livestock death Serious illness Serious illness Price shock Price shock Drought Drought Flood Flood Coastal Valley Rural Loss of harvest Loss of harvest Pastoral Urban Loss of employment Loss of employment 0 10 20 30 40 50 0 10 20 30 40 50 Percent Percent Source: Based on data from the 2017/18 Resilience Index Measurement and Analysis. 1 Overview 9 necessitating health system improvements and The implementation of adaptive social protection disease surveillance. Gaps in health insurance programs is crucial in Mauritania to prevent the coverage leave many vulnerable to catastrophic use of negative coping strategies during shocks. health spending, further exacerbating the impact of These programs complement informal risk-sharing health shocks. According to data from the 2017/18 networks, especially in vulnerable communities. Resilience Index Measurement and Analysis Survey, Adaptive social protection systems use tools such almost half of all households and two-thirds of rural as social registries, disbursement protocols, and households reported having experienced shocks payment systems to respond effectively to shocks, over the previous year. Usually, between 300,000 helping households prepare, cope, and recover and 800,000 individuals are food insecure during while building resilience. Adaptive social protection the lean agricultural period; the number of food inse- improves preparedness by diversifying livelihoods, cure reached 660,000 in 2022. Acute malnutrition, 5 building asset bases, and enabling access to private which is highly correlated with seasonal food inse- and public instruments to mitigate the impact of curity, affects about 12 percent of children under severe shocks. Tekavoul and Elmaouna form the 5 years old during the lean season; and one in five backbone of Mauritania’s integrated adaptive social children is chronically malnourished. 6 protection system. Tekavoul provides regular cash transfers and social promotion activities to practi- Traditional reliance on informal community and cally all the country’s extreme poor. Elmaouna, a family networks as coping strategies is eroding. shock-responsive program, assists poor households Although these networks remain common, the affected by various shocks. Both programs have increasing frequency and severity of covariate grown in recent years, and their integration ensures shocks often make them inadequate to weather efficient coverage during crises. Mauritania’s social an emergency. Moreover, they do not guarantee registry—a vital component of an effective shock protection for everyone in need. Sudden shocks response—is becoming a critical coordination tool push vulnerable households toward adopting nega- for social and humanitarian programs during the tive coping strategies, which have an adverse effect lean season. The social registry includes complete on human capital investment. Only 27 percent of data for 225,855 households, of which 43 percent school-age children in vulnerable households have up-to-date records (less than three years old). attend formal school. This cycle of underinvest- ment in human capital leads to issues like acute Efforts are also under way to protect human capital and chronic malnutrition. To address these chal- from health-related shocks. Initiatives like the equity lenges, improving social risk management is crucial; bonus for health facilities and universal health insur- this involves providing social insurance to protect ance coverage aim to provide health protection to a against income loss due to various shocks, including larger portion of the population—particularly those illness and job loss, as well as insurance mecha- not covered by existing state-subsidized health nisms for productive assets like crops and livestock. insurance systems—contributing to Mauritania’s Additionally, adaptive social protection and resilient social protection goals. The social registry’s linkage delivery systems are needed to shield households with the country’s health insurance scheme has from covariate shocks effectively. resulted in 100,000 additional beneficiaries being included in the subsidized health insurance system. Mauritania’s integrated adaptive social protection 5  Source: Integrated Food Security Phase Classification (IPC), Cadre Harmonisé, 2022. system needs more agile response mechanisms 6  Source: World Food Programme, Mauritania webpage. and better integration with early warning systems 10 Mauritania Human Capital Review and disaster risk management. Updating the social emergency response, and reconstruction, ensuring registry is crucial, as records become outdated, facilities can support contingency measures such which could hinder its reliability in coordinating as shelter and classroom relocation. Reconstruc- a disaster response. Additionally, the authorities tion planning should be evidence based, leveraging need to improve the monitoring and evaluation of lessons from infrastructure failures to accelerate the productive elements in safety nets, clarify multi- implementation, maximize efficiency, and reduce year financing frameworks, and promote insurance vulnerability. instruments. The expansion and enhancement of the Taazour payment platform is essential, and it Financial instruments to increase resilience, is necessary to expand its use across the govern- including contingency borrowing and sovereign ment and to nongovernment users. Index-based wealth funds, need to be prepared to ensure rapid insurance could be explored to enhance finan- deployment during crises. This involves improving cial resilience against climate shocks, focusing on fiscal management, creating medium-term expen- both crop and livestock farmers. While the universal diture frameworks, regulatory adjustments, health insurance scheme is expanding, its coverage and international cooperation. The government remains low, necessitating investments in resilient has started implementing innovative financing health systems. approaches, such as the Shock Response Frame- work (Dispositif National de Prévention et de Education systems and infrastructure need to be Réponse aux Crises Alimentaires et Nutrition- more resilient to shocks. On the service delivery nelles—DCAN) and the National Fund to Respond side, this includes expanding digital learning plat- to Food and Nutritional Insecurity (Fond National de forms and enhancing teacher training for distance Réponse aux Crises Alimentaires et Nutritionnelles— learning. Building agile, resilient, and adaptive FNRCAN), which will provide important technical human development systems is essential, empha- lessons for future expansion and coordination with sizing the ability to respond quickly to shocks, climate-related insurance mechanisms such as the promote interoperability, and utilize data and African Risk Capacity (ARC) initiative. technology effectively while ensuring resilience through integration and dynamic targeting based on up-to-date information. The authorities need to ensure plans are in place for business continuity, 2 Introduction   Human capital is a key determinant of long-term (World Bank 2021a). There are also high rates of economic growth and social advancement in the returns and multiplier effects from human capital modern world economy. It consists of the knowl- investments (World Bank 2021b). Human capital is edge, skills, nutrition, and health that people therefore indispensable for unlocking and protecting accumulate over their lives, enabling them to realize human, economic, and social rights by providing their potential as productive members of society. the framework necessary to secure good health, Human capital has been shown to be a driver of security, and economic well-being as well as social economic growth across the world (figure 2.1) and and political participation—all of which is crucial to accounts for two-thirds of global wealth, making it accelerate inclusive socioeconomic development. the most important component of wealth globally Figure 2.1  Human capital strongly correlates with GDP per capita Mauritania East Asia & Pacific Latin American & Caribbean North America Sub-Saharan Africa Europe & Central Asia Middle East & North Africa South Asia Source: Based on data from World Bank 2021a. 11 12 Mauritania Human Capital Review The COVID-19 pandemic led to a sharp decline in a pre-COVID path of 5 percent growth in 2022 and human capital across countries, especially among an estimated 4.4 percent growth in 2023 (Yogo children and youth, who are at a critical stage of 2023). Mauritania recorded a fiscal surplus of about human capital development. Across the world, 2 percent of GDP in 2019–21. However, the country people age 25 and younger have been the most has been affected by the fallout from the Russian affected by the erosion of human capital due to the Federation’s invasion of Ukraine, which has been pandemic, and this cohort will make up 90 percent weathered only at the cost of a significant increase in of the prime-age workforce by 2050 (Schady et al. subsidies and transfers. As a result, the fiscal balance 2023). The pandemic led to a sharp reduction in entered negative territory in 2022 for the first time critical inputs for child development and resulted in since 2017, posting a deficit of 3.5 percent of GDP. school closures: nearly 1 billion children in low- and middle-income countries missed at least one year of Frequent shocks limit progress in poverty reduc- in-person schooling during the crisis. The learning tion by depleting the assets of poor households and losses observed today could reduce future earn- increasing the risk faced by the nonpoor of falling into ings around the world by $21 trillion. The pandemic poverty. Recurrent droughts, climate change impacts, reduced youth employment rates dramatically and and land degradation and desertification jeopardize delayed the transition for young people into the food security and threaten livelihoods. The most crit- labor market. The number of young people neither ical shocks are environmental, with climate change employed nor enrolled in education or training creating a new source of risk by increasing the increased substantially during the pandemic. frequency and intensity of shocks. Household strat- egies of coping with shocks involve measures that Mauritania is a sparsely populated, arid, and directly negatively affect the accumulation of human resource-rich country. The country’s population capital: reducing the intake of nutrition, pulling children of over 4.8 million is spread across 15 regions out of school, selling assets, and depleting savings. (wilayas). At a density of 4 inhabitants per square kilometer, it is one of the least densely populated Mauritania’s Human Capital Index (HCI) of 0.38 countries in the world. Mauritania is classified as a means that children born in the country today will lower-middle-income country (LMIC), with a gross only be 38 percent as productive when they grow up national income per capita of $1,730 in 2021, higher as they could have been had they enjoyed complete than the Sub-Sahara African average of $1,578.1 education and full health. The country’s HCI (box 2.1) Since 2002, the country’s gross domestic product is low both in absolute terms and relative to regional (GDP) per capita has almost tripled due to discov- and economic peers: it is lower than the average eries of mineral resources. of Sub-Saharan Africa (0.40) and LMICs (0.48) (figure 2.2) (World Bank 2022a). Mauritania has recovered strongly from the COVID-19 pandemic and has maintained a relatively strong Mauritania scores lower on the human capital compo- fiscal position until very recently. Following real nents than its peers. Figure 2.3 shows that Mauritania GDP contraction of 0.9 percent in 2020 due to scores below the values achieved by neighbors the pandemic, the recovery started in 2021, with (bordering countries; i.e., Morocco), structural economic activity growing by 2.4 percent in 2021 peers (countries with similar economic character- (slightly above the population growth rate) to resume istics as Mauritania in 2015–21; i.e., Senegal), and aspirational peers (countries with structural char- acteristics similar to Mauritania’s in 1990–2010 that have enjoyed faster per capita growth since 1  World Bank, World Development Indicators. 2 Introduction 13 Box 2.1  The Human Capital Index The HCI is designed to capture the amount of human capital a child born today could expect to attain by age 18. It measures the human capital of the next generation, defined as the amount of human capital that children born today can expect to achieve in view of the risks of poor health and education prevailing in the country where they live. The HCI is based on three components: survival, expected years of learning-adjusted school, and health: ● Survival refers to the need of children to survive until they can start accumulating human capital through formal education. Survival is measured using the under age five mortality rate. ● Expected years of learning-adjusted school refers to the level of education a child can expect to obtain by age 18, which is combined with a measure of quality. This measure captures how much children learn in school based on a country’s relative performance on international student achievement tests. ● Health is measured through two indicators of a country’s overall health environment: (1) the rate of stunting of children under age 5; and (2) the adult survival rate, defined as the proportion of 15-year-olds who will survive until age 60. The first indicator reflects the health environment experienced during prenatal, infant, and early childhood development; the second reflects the range of health outcomes a child born today may experience as an adult. The HCI is constructed by transforming its components into contributions to productivity, anchored in micro- econometric evidence on the effects of education and health on worker productivity, consistent with the broader literature on development accounting (e.g., Caselli 2005). The resulting index ranges from 0 to 1. A country where a child born today can expect to achieve both full health (no stunting and 100 percent adult survival) and full education (complete 14 years of high-quality school by age 18) will score a value of 1 on the HCI. From a productivity point of view, an index of 1 implies that the future productivity of the next generation would not be reduced due to health and education constraints; thus, a score of 0.70 signals that productivity as a future worker for a child born today is 30 percent below what could have been achieved with complete education and health. Figure 2.2  Mauritania’s HCI is below its peers 2010; i.e., Honduras and Lao People’s Democratic 0.6 Republic) across most of the components of the 0.5 HCI.2 Mauritania scores particularly low on learning 0.4 outcomes—learning-adjusted years of schooling and harmonized test scores—and could do better on early HCI 0.3 childhood outcomes such as childhood survival rates. 0.2 These issues are of particular importance given the 0.1 structure of the Mauritanian population: 29 percent 0.0 Mauritania Sub-Saharan Lower-middle of the current population is below age 10. Propor- Africa income countries tionally, the 0–4-year-old age group is the country’s Source: World Bank 2022a. largest population group (figure 2.4). Building the human capital of these young Mauritanians is there- fore of utmost importance. 2  See World Bank (2020a) for a fuller discussion of these three peer groups. 14 Mauritania Human Capital Review Figure 2.3  Mauritania scores lower on the human capital components than neighbors, structural peers, or aspirational peers 12 500 100 10 400 80 Rate or share (%) 8 300 60 Score Years 6 200 40 4 2 100 20 0 0 0 Expected years Learning-adjusted Harmonized Survival to Adult Not of school years of school test scores age 5 survival stunted Mauritania Senegal Lao PDR Honduras Morocco Source: World Bank, World Development Indicators. Figure 2.4  Population pyramid in 2021 100+ 90–94 80–84 70–74 60–64 Age group 50–54 Males Females 40–44 30–34 20–24 10–14 0–4 400 300 200 100 0 100 200 300 400 Population (thousands) Source: United Nations Department of Economic and Social Affairs Population Division. Table 2.1  Mauritania’s HCI by sex While human capital outcomes during the formative years differ little by sex in Mauritania, women face Component Boys Girls Overall distinct barriers in later years. Perhaps surprisingly, HCI 0.37 0.39 0.38 girls tend to fare slightly better than boys across Survival to age 5 0.92 0.93 0.92 all dimensions of the HCI: they are less likely to Expected years of school 7.5 7.9 7.7 be stunted, more likely to survive to age five and Harmonized test scores 340 343 342 beyond, and their expected schooling is higher Learning-adjusted years of school 4.1 4.4 4.2 (table 2.1). However, Mauritanian women are much Adult survival rate 0.78 0.83 0.80 less likely than their male counterparts to realize Not stunted rate 0.74 0.80 0.77 their human capital. Based on the latest Gender Source: World Bank 2022a. 2 Introduction 15 Inequality Index, Mauritania is ranked 157th out of care such as hospitals (MoH and World Bank 2021). 189 countries.3 Nutritional action is an essential component of the health strategy; however, its financing relies heavily The government of Mauritania has put human capital on external sources. A multisectoral action plan has development at the center of its long-term vision. been drawn up for 2016–25 (MEF 2015), but plan- Human capital development is part of the govern- ning, coordination, and implementation difficulties ment’s Accelerated Growth and Shared Prosperity persist—especially at the subnational level. Strategy 2018–2030 (Stratégie de Croissance accélérée et de Prospérité partagée—SCAPP), The country’s preprimary education expenditure adopted in October 2017. SCAPP’s objectives are was an estimated 0.03 percent of GDP in 2019. This to (1) promote strong, inclusive, and sustainable represented a slight increase from 0.02 percent of growth, (2) develop human capital and increase GDP in 2010.5 Mauritania’s most recent education access to basic social services, and (3) strengthen policy—Programme National de Développement overall governance. Improving access to and the du Secteur de l’Éducation (PNDSE II) 2011–2020— quality of education, expanding access to health includes a three-part strategy to strengthen early services, creating job opportunities for youth, and childhood education. This includes increasing building resilience for the most vulnerable constitute access to preprimary education, particularly among a central pillar of the strategy (Government of Mauri- lower-income and rural populations; strengthening tania 2020). Although concerted efforts have been parenting education for children under three years made to improve childhood health and education old; and improving the quality of available preprimary outcomes in Mauritania, progress has been limited. education. Mauritania’s current health expenditure (current Spending on poverty-targeted social assistance health expenditure) was 3 percent of GDP in 2020.4 remains only a small part of total social protec- Although current health expenditure as a share tion spending. While Mauritania’s total spending of GDP has remained relatively constant over the on social protection (3 percent of GDP) is higher last decade, current health expenditure per capita than that of regional peers, its spending on increased from $43 in 2010 to $59 in 2020. The poverty-targeted social assistance constituted a health budget showcases allocative and technical mere 0.17 percent of GDP in 2018 (World Bank inefficiencies, particularly at the primary health care 2021c), which is projected to increase to 0.8 percent level. Two-thirds of the health budget is dedicated to of GDP by 2024. Coverage of the country’s regular noncommunicable disease treatment, while alloca- social safety net program (Tekavoul) is significant,6 tions for maternal health and nutrition are alarmingly and the program is predominantly financed by the low at 12.2 percent and 0.2 percent, respectively. government. Tekavoul includes social and behavioral Mauritania still lacks a focus on preventive and change communication (dialogue familiale), which, primary health care, as opposed to higher levels of among other things, introduces beneficiary families to the Nurturing Care Framework (e.g., nutritional 3  The index is measured using three gender-based inequality dimensions: reproductive health, empowerment, and economic activity; source: United Nations Devel- opment Programme’s Mauritania Human Development 5  Source: World Bank, Education Statistics (EdStats). Report Profile. The program currently supports 97,886 households, 6  Source for the current health expenditure data in this 4  covering 47 percent of the poorest quintile. The national paragraph: World Health Organization, Global Health coverage target is all extreme poor households (100,000 Expenditure Database. households). 16 Mauritania Human Capital Review needs and suggestions for early childhood stimu- protect Mauritania’s human capital. Building lation). human capital involves investing in education, health, and other essential services that help indi- Meanwhile, regressive spending on pensions,7 viduals develop the knowledge, skills, and abilities and in-kind programs continue to dominate public needed to contribute to their societies. It begins finances. Explicit food subsidies are high but provide with improving maternal health before a child is only meager support, and they do not guarantee born. Since the early years lay the foundation for food security for poor households (including young lifelong health and learning outcomes, this report children). The total volume of subsidies is estimated focuses on building early childhood human capital. at 1.9 percent of GDP in 2019 (World Bank 2021c). Ensuring the utilization of human capital involves They have risen since because of COVID-19-related creating an environment that enables people to measures (during which electricity and fuel prices fully participate both in the economy and society. were effectively frozen) and a series of disasters Protecting human capital involves ensuring that indi- (floods and droughts of 2022). In 2022, the total viduals are safe, healthy, and able to reach their cost of energy subsidies alone (UM 13.2 billion) was full potential, free from violence, discrimination, or comparable to all public spending on education other forms of harm. Protecting human capital is (UM 13.8 billion), and much higher than spending particularly important in the Mauritanian context, on social protection (UM  8.1 billion) or health given that the frequent and severe climate-related (UM 4.5 billion). Refocusing energy subsidies and shocks affecting the country have the potential of providing targeted social programs instead would quickly eroding any human capital gains. Accel- lead to a greater impact on poverty reduction. erating human capital development in Mauritania will require a whole-of-government (box 2.2) and a This human capital review offers analyses and whole-of-World-Bank approach, with strong collab- policy recommendations to build, utilize, and oration between ministries and global practices outside the human development sectors. Current schemes cover civil servants and some formal 7  sector workers, a mere 5 percent of the population. 2 Introduction 17 Box 2.2  Best practice examples of a whole-of-government approach to human capital This box presents examples of three countries—the Philippines, Morocco, and Ghana—which vary consider- ably in their levels of development, their choice of policies and programs to develop human capital, and the outcomes they achieved. Yet all followed a whole-of-government approach to strengthen human capital. The Philippine government’s commitment to education in the 1970s jumpstarted an expansion in school enroll- ment, with primary gross enrollment rates well over 100 percent and nearing 90 percent at the secondary level in 2017. While access has increased, quality remains an issue, with 15-year-old Philippine students scoring lower in the latest round (2018) of the Programme for International Student Assessment (PISA) than students in most participating countries. Morocco’s commitment to human capital development has led to remarkable gains in the health of its citizens. The government has launched efforts to combat child and maternal mortality while controlling fertility rates through intensive family planning programs. Ghana’s commitment to improving human capital and innovative policies have led to marked human capital improvements. Primary enrollment rates have increased substantially to 95 percent in 2017, without harmonized test scores declining; stunting rates have fallen to 17.5 percent in 2017. The Philippines has adopted multisectoral policies, promoted integrated approaches, and encouraged greater participation by stakeholders in service delivery. Many policies reflect the understanding that factors beyond the social sectors affect human capital development, such as clean air, a safe water supply, and the provision of sanitation services. An example of a multisectoral program is the Pantawid Pamilya Pilipino Program (4Ps), which provides cash transfers to chronically poor households with children age 0–14 years. In return, these households are required to take their children to health centers, send them to school, and attend prenatal checkups in the case of pregnant women. The 4Ps actively involved local service providers (such as school principals and midwives) in implementation. Ghana’s progress in decreasing stunting rates and improving test scores has in large part been due to a multi- sectoral approach. For example, the Ghana School Feeding Program spans three different sectors—agriculture, education, and health. It links school feeding programs with agricultural development, especially smallholder production, thus helping to create new markets for locally grown food. In addition, initiatives aimed at improving water, sanitation, and hygiene in schools have helped increase access to water and sanitation, which is a proven factor in improving health and education outcomes. A consistent approach to building human capital has been harder to achieve in Morocco, where political commitment to education across successive governments did not extend to other policies critical to improving human capital outcomes. However, the conditional cash transfer program (Taissyr) and universal health insur- ance coverage have achieved a degree of coordination between health, education, and social protection sectors, based on targeting and monitoring of outcomes. The experiences of these countries highlight the importance of sustained effort across political cycles, suffi- cient resource mobilization and effective allocation across programs, good data and measurement to inform and design programs, and multisectoral strategies that address the complex underlying determinants of human capital outcomes. Sources: Blunch 2020 (Ghana); Benkassmi and Abdelkhalek (Morocco); King (the Philippines). 3 Building early childhood human capital   al. 2006). Given the complexity and interrelated Key messages relationship of the components of nurturing care, ● Building human capital begins before concep- applying the Nurturing Care Framework for investing tion—maternal health is a strong determinant in childhood human capital—which involves multi- of early childhood human capital outcomes. sectoral policy actions—is critical in building human ● Mauritania’s maternal mortality rate is high: capital. Figure  3.2 includes more details on the almost one-third of all deaths of women of framework. reproductive age are due to pregnancy-related complications. Recent estimates suggest that there has an Prenatal years and ● increase in childhood stunting, making malnu- trition and stunting a multisectoral priority. maternal health and ● Lack of cognitive and behavioral develop- nutrition ment in early childhood leads to low learning outcomes. Building human capital begins before conception. The health and nutritional status of women of repro- ductive age can significantly affect early childhood The importance of the first five years of life in outcomes (Abu-Saad and Fraser 2010). During preg- building human capital cannot be overstated. nancy, women’s poor health and lack of nutrition Early childhood is a critical period for growth and increase the risk of intrauterine growth restriction, development, and, consequently, for ensuring that low birthweight, postpartum health complications, children develop the knowledge, skills, and physical neonatal mortality, and maternal mortality. Addition- well-being that encourage future productivity and ally, disruptions to maternal health and nutritional economic growth (Victora et al. 2008). Economic status postpartum can disrupt childcare and feeding growth is a product of capital, labor productivity, practices—and consequently, early childhood devel- and advances in technology. Importantly, present opment (figure 3.3). levels of human capital and productivity largely reflect investments in human capital in early child- Mauritania’s maternal mortality ratio surpasses hood. Investments in human capital have the highest the lower-middle-income country (LMIC) average. rate of return when focused on children under five Mauritania’s mortality rate is 424 per 100,000 years old, including the period in utero (figure 3.1) live births, compared to the LMIC average of 253 (Alderman, Hoddinott, and Kinsey 2006; Cunha et per 100,000 live births (ONS, MS, and ICF 2021). 18 3  Building early childhood human capital 19 Figure 3.1  The return to a unit dollar invested in human capital is highest in the early years Programs targeted towards the Rate of return to investment in human capital earliest years Preschool programs Schooling Job training Prenatal 0–3 years 4–5 years School Postschool Source: Adapted from Heckman 2008. Figure 3.2  The Nurturing Care Framework in Sub-Saharan Africa are attributable to medical complications that occur during pregnancy, labor, and/or the puerperium period (largely hemorrhaging and hypertension);1 one in four maternal deaths are attributable to non-obstetric medical conditions that develop or are worsened during pregnancy (largely preexisting medical conditions) (Say et al. 2014). Only 69 percent of health facilities offer assisted deliveries, and only 70.4 percent of births are attended by skilled health professionals (which drops to 53.3 percent in rural areas) (ONS, MS, and ICF 2021). Cultural norms and limited accessibility result in nearly 50 percent of all births occurring in the home. Mauritania’s high maternal mortality, along with poor maternal health, reflects inadequate access to and Source: WHO and UNICEF 2022. use of family planning and quality health services in pre- and postpartum periods as well as limited adop- Additionally, the country has the world’s third tion of recommended health/nutrition practices. highest proportion of deaths of reproductive-age Conservative estimates, calculated using a sample women due to pregnancy-related complications— of married women, suggest that only 28 percent of representing almost one-third of all deaths in this group (WHO 2016). Three in four maternal deaths The puerperium period is the period postpartum up until 1  six weeks after giving birth. 20 Mauritania Human Capital Review Figure 3.3  Building early childhood human capital is a multisectoral policy issue Prenatal period: Women 15–49 years old Maternal health and nutrition ■ Malnutrition ■ Morbidity ■ Mortality Early childhood 0–5 years old Child health and nutrition Early childhood education Child protection ■ Infant & young child feeding ■ Quality childcare ■ Birth registration ■ Water, sanitation, and health ■ Early learning ■ Child marriage ■ Immunization ■ Female genital mutilation ■ Air pollution Cross-sectoral concerns Within-country heterogeneity ■ Socioeconomic disparities ■ Gender inequality reproductive-age women believe that their demand less likely to have adopted clinically recommended for family planning is being met. Moreover, only health/nutrition practices. According to recent survey 67 percent of the country’s health facilities offer estimates, almost 56 percent and 41 percent of family planning, and only two in five women with reproductive-age women cite finances and distance children attend all four antenatal care visits recom- to a health facility, respectively, as a barrier to mended by the World Health Organization (WHO). accessing health services (ONS, MS, and ICF 2021). Finally, more than half of all women of reproductive Perceived gender norms are a further barrier for age suffer from anemia—most commonly attributable women’s access to health services. This is especially to nutrient deficiencies (ONS, MS, and ICF 2021). true for poor women, as 44 percent of women from the poorest wealth quintile consider “getting permis- Mauritanian women highlight finances and distance to sion to go to the hospital” to be an important problem, a health facility as key barriers preventing them from while 49 percent say “not wanting to go alone” is an accessing health services. Women in low-income important barrier to accessing health services. households and/or with limited formal education exhibit lower demand for health services,2 have Child marriage, teenage pregnancies, inadequate limited physical access to health facilities, and are spacing between births, and female genital muti- lation are common in Mauritania and associated with an increased risk of maternal morbidity and Relevant health services during pregnancy and post- 2  partum include family planning; services to identify, treat, mortality as well as poor birth outcomes (Nour and monitor medical conditions in women of reproductive 2006; Sylla, Moreau, and Andro 2020). Almost age; antenatal care; and labor, delivery, and postpartum services. 58 percent of Mauritanian women age 15–49 are 3  Building early childhood human capital 21 married before the age of 18, and 17 percent of them decade suggest an insufficient number of health are married before the age of 15 (ONS, MS, and professionals and facilities. There was an average ICF 2021). Statistics are similar among older and of 4 hospital beds per 10,000 people in 2006;5 younger age groups, signaling limited progress over there were 1.03 tertiary-level hospitals and 11.65 the last decades. In addition, 17.6 percent of women primary-level health facilities per 100,000 people age 15–19 are pregnant or have given birth to one in 2013;6 and there were an estimated 1.92 doctors or more children; contrary to clinical recommenda- and 9.54 nurses/midwives per 10,000 people in tions, one in four births occur within 23 months of 2018 (WHO 2016). The country’s health facilities a previous birth. Moreover, almost two in three of are in poor condition and suffer from limited use of the women in this age cohort have been the victim clinical guidelines and lack people-centered care.7 of female genital mutilation, despite its ban in 2015. Mauritania’s health challenges are compounded by The high prevalence of maternal malnutrition in a high concentration of health professionals and Mauritania—specifically overnutrition and micro- facilities in high-density or urban areas relative nutrient deficiency—is an important determinant of to rural areas. More than 20 percent of the rural maternal health and child outcomes both in-utero population lacks access to a health facility within a and postpartum. More than half of reproductive-age five-kilometer radius.8 Mothers-to-be therefore have women in the country are overweight or obese, limited physical access to health facilities for clinical and 56 percent of them are anemic (ONS, MS, and care, such as antenatal care.9 Primary health facil- ICF 2021). During pregnancy, being overweight or ities are typically staffed by nurses who are unable obese increases the risk of obstetric complications to provide emergency obstetrics care in the case and fetal morbidity (Galtier-Dereure, Boegner, and of complications. The community health program Bringer 2000), and anemia increases the risk of is insufficient, with limited capacity to deliver basic pregnancy complications, intrauterine growth care and public health interventions (e.g., family restriction, preterm birth, and low birthweight planning, malaria testing and treatment). Moreover, (Abu-Ouf and Jan 2015). Maternal nutrition is typi- the retention and competency of health workers cally worse for women who do not adopt clinically is problematic, especially in remote areas. Health recommended diets; are not regularly attending personnel are highly concentrated in urban areas, antenatal care to identify, treat, and monitor malnu- and high absenteeism and reluctance of health trition; and live in households experiencing food workers to serve in rural regions, along with under- insecurity. Half of Mauritanian women experience representation of women and youth in high-skilled moderate/severe food insecurity. 3 The country’s health system affects the types of 5  Source: WHO, Global Health Observatory. services available to mothers and children and 6  Source: WHO, Global Health Observatory. the quality of care afforded to them.4 Data about 7  For example, only one-third of health facilities have the current state of the health system in Mauri- electricity, and two-thirds have access to improved water tania are limited. However, estimates from the last sources. Perceived poor reception and low-quality care deter individuals from seeking timely health and nutrition services (UNICEF 2015). Source: Food and Agriculture Organization of the United 3  The Ministry of Health is working to enhance the 8  Nations, FAOSTAT, Suite of Food Security Indicators. coverage of community health workers and extend their outreach with mobile teams. 4  WHO-defined components of a health system include service delivery, health workforce, health information 9  Only 39 percent of women had four or more antenatal systems, access to essential medicines, financing, and care visits for their most recent live birth (ONS, MS, and leadership/governance. ICF 2021). 22 Mauritania Human Capital Review positions, further strain health services in deprived Childhood health and education outcomes and the areas (MoH 2021). For these reasons, many Mauri- protection of children’s rights are associated with tanian women likely have limited physical access to health and education outcomes in adolescence and primary-level health services such as family plan- adulthood as well as future productivity (figure 3.4). ning, antenatal care, and postnatal care. Beyond the impact of maternal health on fetal health Nutrition and birth outcomes, maternal health, education, and One in four children under five years of age in Mauri- socioeconomic status are important determinants of tania is currently stunted (low height for age). This child health outcomes. Maternal malnutrition while increases the risk of poor health outcomes in child- breastfeeding can affect the quantity and/or compo- hood and adulthood, low school performance, and sition of breast milk, which directly affects the child’s lower future productivity and wages. Although the nutritional status (Allen 1994). This is particularly prevalence of stunting in Mauritania (25.1 percent) important in low-income settings where access to is lower than among peers in Sub-Saharan improved water sources and baby formula/milk are Africa (32.3 percent) and the average of LMICs limited. Moreover, maternal socioeconomic status (28.7 percent), it remains high (MoH and ANSADE is associated with health, nutrition, and education 2022). The high stunting rate is compounded by outcomes in early childhood (Jeong, McCoy, and limited progress over the last 10 years and signifi- Fink 2017; Ngandu et al. 2020). Lower socioeco- cant inequality by age group, income quintile, and nomic status among mothers is associated with area of residence. Over the last decade, the prev- limited parental knowledge or implementation of alence of stunting in Mauritania decreased by only recommended childcare and infant and young child 0.4–0.6 percentage points annually—much lower feeding practices, affecting childhood outcomes. than the average annual decrease of 1.19 and 1.56 percentage points in Sub-Saharan Africa and LMICs, respectively. Early childhood: 0–5 years Estimates suggest a recent increase in wasting, Following birth, and in addition to maternal health, making malnutrition a multisectoral priority. building human capital is dependent on the child’s Worryingly, Mauritania’s 2022 SMART (Standard- nutrition, health, education, and protection. ized Monitoring and Assessment of Relief and Figure 3.4  Early childhood policy issues in Mauritania Nutrition Health Education Protection ■ Infant and young child feeding ■ Immunization ■ Caregiver knowledge ■ Birth registration ■ Water, sanitation and hygiene ■ Quality of care ■ Caregiver resources ■ Legal/institutional ■ Integrated management of ■ Community health framework moderate acute malnutrition ■ Noncommunicable disease prevention Equity and gender-related policy issues Childhood human capital 3  Building early childhood human capital 23 Transitions) survey results suggest an almost A significant share of young children in Mauritania 8 percentage point increase in wasting in the live in households with unimproved water and/or last year, likely due to the COVID-19 pandemic, 10 inadequate sanitation infrastructure facilities and climate shocks, and a growing refugee population poor water, sanitation, and hygiene (WASH) prac- (MoH and ANSADE 2022). Importantly, childhood tices, increasing the risk of contracting infectious undernutrition carries an economic cost: the annual diseases and becoming malnourished. In 2020, economic loss associated with chronic malnutrition 15 percent (32 percent in rural areas) of Maurita- in Mauritania is estimated at $759 million, which is nians only had access to unimproved drinking water approximately 7.6 percent of the country’s GDP. 11 sources, 31 percent (58 percent in rural areas) had Severe climate shocks are likely to become more no access to sanitation facilities, and 19 percent frequent due to climate change, which will have (33 percent in rural areas) had no hygiene facili- further detrimental impacts on food insecurity and ties.12 The share of households with access to subsequently childhood nutrition. improved water/sanitation facilities and adopting safe WASH practices is also lower among house- Nutritional status is contingent on health and holds in the lower wealth quintiles relative to their feeding practices. First, children who are ill are at an more well-off counterparts. Poor WASH practices increased risk of becoming undernourished because are compounded by inadequate treatment of diar- of higher nutritional demand, decreased appetite, rheal diseases: 53.2 percent of mothers provide no and/or difficulty absorbing nutrients. Second, chil- treatment to their children with a diarrheal disease. dren who do not consume an adequate diverse diet are more likely to be undernourished. Finally, malnourished children usually have an impaired Health immune system, increasing their risk of contracting Less than 16 percent of children aged 12–35 months infectious diseases. receive all age-appropriate vaccinations in Mauri- Infant and young child feeding practices in Mauritania tania. Age-appropriate immunizations are important are largely inadequate to support optimal growth to prevent the incidence of disease and/or mini- and development. On average, Mauritanian children mize the risk of severe illness. Children who are are exclusively breastfed for 3.8 months (compared malnourished and unvaccinated are more likely to to the WHO recommendation of 6 months); only suffer from severe illness. In Mauritania, 7 percent 55 percent of children age 6–8 months have been of children were never vaccinated (ONS, MS, and introduced to complementary foods; and less than ICF 2021). These “zero-dose children” are at greater 1 in 10 children age 6–23 months have a diet that risk of diseases like polio and measles, which strain meets the minimum acceptable level according to health resources. Twenty-three percent of under the WHO. Determinants of infant and young child age five deaths are linked to households with a feeding practices include sociocultural feeding prac- zero-dose child (GAVI 2023). Childhood immuniza- tices, levels of household food security, and parental tion practices are influenced by parents’ awareness knowledge about clinically recommended feeding of the importance of immunization, cultural beliefs practices. about vaccines, and the accessibility of vaccina- tion services (Ali et al. 2022; Bangura et al. 2020). Wasting refers to acute malnutrition. Stunting refers to 10  chronic malnutrition. Source: WHO/UNICEF Joint Monitoring Programme for 12  11  Source: World Food Programme, Mauritania webpage. Water Supply, Sanitation and Hygiene. 24 Mauritania Human Capital Review Children do not receive the needed care after birth, Early childhood education and many remain untreated due to insufficient community health services. High neonatal mortality The latest data (2015) show that 40 percent of can be attributed to poor quality of newborn care children age 36–59 months are developmentally (for those delivering at a facility) and the absence off track in three or more of the following areas: of seeking care (among those delivering at home). literacy/numeracy, social-emotional, learning, and Postnatal care for newborns remains poor, thereby physical development.16 This is an important deter- failing to initiate childhood health care. Given minant of future academic performance, school insufficient community health services, many chil- completion, and educational attainment. Optimal dren remain untreated for diseases that could development in the first three domains requires be addressed through basic clinical care, such quality childcare and learning. Caregiving is consid- as malaria, pneumonia, or diarrhea, and do not 13 ered good quality when it is responsive,17 and early receive preventative and promotive care. learning involves early stimulation through play/ reading. In Mauritania, fewer than half of all chil- Air pollution is the third leading risk factor for child dren age 24–59 months are engaging with adult mortality and morbidity in Mauritania, respon- household members in activities that provide early sible for 13.64 percent of all disability-adjusted stimulation and responsive care.18 Lack of aware- life years (UNICEF, WHO, and World Bank 2021). 14 ness about responsive caregiving and its value Natural sources of air pollution include dust storms; as well as time constraints hinder the provision of human-made sources include waste disposal, responsive care to young children (Naveed 2020). cooking, heating, lighting, transport, agroforestry practices, and energy production. Exposure to air There are various constraints on early learning in pollution during pregnancy can affect fetal health, Mauritania. These include limited caregiver knowl- fetal growth, and birth outcomes (WHO 2018). Child- edge/awareness of early learning practices, limited hood exposure to air pollution is further associated access to tools/resources to strengthen early with an increased risk of mortality and morbidity learning at home, and limited access to high-quality (respiratory infections and childhood stunting). early childhood education centers outside the home From 2010 to 2017, there was a nearly 20 percent once children turn three years old. Only one in three increase in average annual exposure to air pollu- children under the age of five years has two or more tion in Mauritania. Furthermore, access to clean 15 play items in his or her home, and 1 percent has fuel and technologies has remained largely constant three or more books (World Bank 2021c). Enroll- at only 43 percent of the population over the last ment in preprimary education facilities is estimated 10 years. at 10.5 percent; 67 percent of that enrollment is in private facilities (GPE 2018), but data about the quality of services provided at these facilities are Only 46 percent of children sought care for pneumonia 13  limited. In this context, empowering caregivers with from a health facility or a provider—this is the lowest Demo- graphic and Health Survey estimate in West Africa in the the skills and tools to strengthen early learning in past five years (ONS, MS, and ICF 2021). Only 20 percent the home is important to improve children’s cognitive of children with diarrhea received oral rehydration salts (World Bank, forthcoming). The WHO defines disability-adjusted life years (DALYs) 14  16  Source: UNICEF, Early Childhood Education data. as the sum of the years of life lost due to premature mortality (YLLs) and the years of healthy life lost due to Responsive caregiving is defined by the WHO as the 17  disability (YLDs) due to a particular cause. “ability of [a] caregiver to notice, understand, and respond to the child’s signals in a timely and appropriate manner.” Source: Institute for Health Metrics and Evaluation, 15  Global Burden of Disease Study 2017. 18  Source: UNICEF, Early Childhood Education data. 3  Building early childhood human capital 25 and behavioral development and future educational although learning outcomes remain low. At the outcomes. primary level, over 54 percent of pupils do not have the requisite skills in addition and almost 64 percent in subtraction. At the secondary level, Childhood education only 2 percent of students achieved the desired threshold of 60 percent of the overall mark (MEN/ Children reach school age without being school CNE 2021b). ready and are faced with an educational system that is not set up to foster their learning. Lack of Teachers are a key determinant of the learning cognitive and behavioral development in early child- process, but do not receive the needed support. hood leads to low learning outcomes. Policies that Teachers in Mauritania are struggling to fulfill their improve health and nutrition are an integral part of duty, partly due to the challenges of bilingual instruc- interventions that address skill and learning deficits. tion. The latest SDI showed that no teacher scored A significant portion of children age 6–11 years old 80 percent in French—the minimum level of knowl- do not attend school (33.9 percent in rural areas, edge required for a teacher to perform his or her compared to 19.8 percent in urban areas); this duties. Teaches scored better in Arabic and mathe- share is higher among boys than girls (ANSADE matics, where 6.6 percent and 11.2 percent reached 2021). Mauritania faces a lack of public provision the minimum threshold. A 2021 small-scale teacher of education: at the primary level, only 42 percent evaluation conducted by the government confirmed of schools offer the necessary educational facili- this low teacher competency in both French and ties.19 According to the Service Delivery Indicators Arabic instruction (MEN/CNE 2021a). The reform surveys 2022, only 18.6 percent of schools have agenda will further complicate this issue with the the minimum infrastructure,20 defined as the avail- introduction of national languages in the education ability of functional toilets for pupils and sufficient system. light in the classroom. Not addressing the chronic quality gap is costly for The low quality of education offered translates to the budget: high repetition (more than half of all low learning outcomes. In Mauritania, 95 percent primary-level students repeat grades) and dropout of children age 10 do not read (World Bank 2019d), rates cost 0.2 percent of GDP, while compensating either because they are not at school or because teacher absences and learning time lost cost another they have not acquired the necessary skills at 0.2 percent of GDP. A recent public expenditure school. Bilingual instruction is not yet yielding fruit. review for Mauritania estimated that 30 percent of Environments where most pupils have a mother spending at the school level does not achieve results tongue other than Arabic have the worst scores, and can be cut without any impact on the quality of with two-thirds of pupils in those areas not being service delivery (World Bank 2021c). able to identify letters, and four out of five pupils being unable to write more than a single word.21 Students are performing better in mathematics, Child protection/rights In 2021, 55 percent of children under five years old Source: Ministry of Education, Système d’Information 19  et de Gestion de l’Éducation (SIGE), 2023. in Mauritania were not registered. A birth certificate 20  Source: World Bank, Service Delivery Indicators surveys. Among pupils in the first years of primary and secondary 21  school, on average, 25 percent have difficulty identifying short sentence, and 40 percent are unable to write more letters in Arabic, two out of three are unable to read a than a single word (MEN/CNE 2021b). 26 Mauritania Human Capital Review is a legal document that allows access to social encouraging people to enroll. Initially, the goal was services, and it is meant to protect against prac- to have caught up with enrollments by January tices such as child marriage and labor. However, 2024. From this date onwards, all newborns born in birth registration has decreased in Mauritania hospitals or clinics would be registered at birth, with over the last decade, following the introduction solutions to be defined for those not born at estab- of a new legal framework for civil registration and lishments. However, as the enrollment campaign compounded by the COVID-19 pandemic. In 2015, was delayed, it is currently set to continue beyond 66 percent of children under five years old were December 2023. registered. 22 Since then, birth registrations have fallen by 21 percentage points. Obstacles to regis- tering births in Mauritania include travel distance and costs (direct and indirect), lack of supporting Within-country documents (e.g., marriage certificate, national ID for heterogeneity each parent, and a copy from the health facility birth A comprehensive understanding of childhood registry), formal and informal payments for birth human capital will require insights into existing registration, network issues at registration centers, disparities in childhood development. There are and lack of understanding about the registration significant disparities in child health, education, process. This situation is made worse by fines or and rights by socioeconomic status and gender in legal repercussions for late registration.23 Mauritania. Building human capital will therefore Over the years, Mauritania has established legal require additional policy actions that target vulner- and institutional frameworks to protect children’s able populations and regions. rights. Specifically, there have been efforts to increase birth registration and reduce the occur- Socioeconomic status rence of practices such as child labor, child marriage, and female genital mutilation. These Child health, education, and protection outcomes efforts have been combined with mass media and are, on average, significantly worse in lower-income education campaigns to encourage changes in households and rural regions. For instance, the prev- sociocultural norms and practices. Following the alence of child stunting in Mauritania ranges from introduction of the 2011 civil registration law, the 34.8 percent in households in the lowest wealth authorities employed a mass enrollment campaign quintile to 14.5 percent in households in the richest that included the deployment of mobile registration wealth quintile.24 The prevalence of stunting is much centers, resulting in a 90 percent registration rate in higher in rural areas (29.8 percent) than in urban 2015. Similarly, a commission was created in 2017 to areas (19.6 percent). A similar trend is observed address community-specific barriers to registration. in terms of birth registrations, which range from 16 percent in the lowest household wealth quintiles Mauritania has made concerted efforts recently to 81 percent in the highest, and the birth regis- to close the enrollment gap. The mass enrollment tration rate in urban areas is more than double campaign sped up in 2023 through the deployment that in urban areas: 68.0 percent compared to of fixed and mobile missions throughout the country, 29.7 percent. Source: UNICEF, Multiple Indicator Cluster Surveys 22  2015. 23  Source: UNICEF data, Mauritania. 24  Source: UNICEF data, Mauritania. 3  Building early childhood human capital 27 The utilization of health services is lowest among the have undergone female genital mutilation (ONS, MS, poor due to limited access and high out-of-pocket and ICF 2021).25 These practices are associated expenditures. Low utilization of health services with an increased risk of poor maternal and birth among poor communities reflects an inequitable outcomes, child health, and educational attainment. allocation of resources across wilayas as well as challenges reaching poor and rural populations. In 2019–21, an average of 61 percent of women from the lowest wealth quintile reported the long distance Evidence-based to the closest health facility as an important barrier multisectoral programs to accessing health services; this was almost three focused on early childhood times the number of women in the highest wealth quintile (22 percent) (ONS, MS, and ICF 2021). Over Multisectoral policy action is needed to improve half of total health expenditure is out of pocket in human capital in early childhood. Not only are Mauritania, presenting a barrier for especially poor risk factors and determinants of childhood health households. Around 71 percent of women from and education outcomes multisectoral, childhood the poorest wealth quintile consider out-of-pocket outcomes in each sector are also interrelated with expenses for treatment an important barrier to one or more outcomes across other sectors. In health services, compared to 37 percent of women addition to information on a successful multisec- from the wealthiest households (ONS, MS, and ICF toral program in Mauritania, this section details case 2021). From the demand side, gender norms and the studies of multisectoral World Bank programs in low household decision-making power of women, other countries that can offer lessons for the Mauri- opportunity costs of seeking care, limited health tanian context. literacy (underestimating the severity of illnesses), and perceived poor quality of care at accessible Rwanda Stunting Prevention health facilities further limit utilization. and Reduction Project The World Bank Rwanda Stunting Prevention and Gender inequality Reduction Project aimed to reduce the prevalence Childhood human capital outcomes vary by sex, of stunting in children under five years old (as well with girls being more susceptible to practices as children under two years old) in 13 districts in that increase the risk of poor health and educa- Rwanda. It consisted of the design and implemen- tion. Women have limited decision-making power tation of several operations by the World Bank’s in Mauritania, both legally and within households. Agriculture and Food Global Practice; Health, Nutri- More than one in five women of reproductive age tion, and Population (HNP) Global Practice; and are not involved in making major decisions in their Social Protection and Jobs (SPJ) Global Practice. households (ONS, MS, and ICF 2021). Male heads This multisectoral project was designed based on of household make decisions about investments a similar successful program in Peru (Marini, Rokx, in children, which is associated with poorer child- and Gallagher 2017). hood outcomes. In addition, women are more likely than men to have been subjected to child marriage (37 percent of women age 20–24 were married of as children) and to experience gender-based violence In rural areas, 81 percent of women (ages 15–49) have 25  (9 percent); 58 percent of women in Mauritania undergone female genital mutilation (ONS, MS, and ICF 2021); this figure is also high—54 percent—in urban areas. 28 Mauritania Human Capital Review Each operation had a complementary focus on The project was introduced in selected regions with early childhood development. The Agriculture high rates of poverty and poor maternal and child and Food operation sought to increase house- health outcomes. It included two main components: hold food security and improve the accessibility/ a performance-based financing (PBF) scheme quality of nutritious food; while the HNP-led oper- and conditional cash transfers (CCTs). PBF was ation included behavioral change communication provided to health facilities based on the quantity (BCC), home-based early childhood development and quality of health services related to maternal centers, 26 and caregiver education/support. The and child health, nutrition, family planning, HIV/ SPJ-led operation included caregiver education/ AIDS, malaria; and tuberculosis. Financing could support, childcare centers for participants of a be used to provide bonuses to health workers or public works program, cash transfers conditional cover facility-related operational costs and improve on the use of maternal and child health services the working environment according to an approved and attendance at parenting sessions, and BCC. business plan. The BCC included messages about child health, nutrition, WASH, and early childhood stimulation. The CCTs complemented a national cash transfer Importantly, BCC messages were harmonized and program, Tekavoul, that imposed soft conditions. disseminated across different sectors. Tekavoul beneficiary households with children under four years old were offered a top-up transfer (the Over the four years that this project has been imple- CCT) in addition to their regular Tekavoul transfer. mented, the prevalence of stunting in children under The cash transfer was conditional on children under five years old has decreased by 10 percentage four years old receiving their vaccinations until they points. Similar findings were observed for children reached age two and attending growth monitoring under two years old. Improvements have also been visits regularly until age three. Cash transfers were observed in maternal and child health and nutrition distributed quarterly alongside BCC sessions that practices and in the use of health care services. covered the use of relevant health care services; gender equality as it relates to the use of health care; and cultural practices such as female genital M a u r i t a n i a I N AYA-H e a l t h mutilation, child marriage, and teenage pregnancy. System Support Project In 2021 and 2022, a total of 29,416 households The Mauritania INAYA-Health System Support received these CCTs. Project aimed to improve the utilization and quality This project has resulted in improvements in the of reproductive, maternal, neonatal, and child health quality and utilization of reproductive, maternal, and services. The first iteration of the project was a child health services in Mauritania. Between 2017 collaboration between HNP and SPJ (World Bank and 2022, 126,650 children age 12–23 months were 2017a). The second iteration included additional fully immunized; 76,497 births were attended by a collaboration and sought to increase the reach skilled health professional; 51,700 women accepted of the project to support the country’s large and modern family planning; and 222,729 women and growing refugee population. The social registry was children accessed basic nutrition services. Addi- central in strengthening the provision of various tionally, 87 percent of the households eligible for social services among the target population. CCTs met the conditions, and the average grading of quality of health care services increased by Home-based early childhood development centers, 26  38 percentage points to 52 percent (World Bank based in communities, encouraged early learning and provided caregiver education/support. 2022b). 3  Building early childhood human capital 29 Early Childhood Education separate projects were simultaneously designed Innovation Project and implemented. In Mauritania, there was a joint health–social protection project, but the complex The Early Childhood Education Innovation Project implementation arrangements likely slowed project sought to improve multiple areas of both formal implementation. and informal early childhood education in China. The project, led by the World Bank’s Education Effectiveness can be strengthened by incorporating Global Practice, focused on addressing care- the use of modern mass media and local events. giving in a holistic way, reaching young children Using mass media and integrating messages into through different models, from building and equip- local community events/activities can increase the ping kindergartens (and training teachers) and speed and reach of information dissemination. In supporting community-based kindergartens run Rwanda, Umuganda, a monthly holiday requiring by nongovernmental organizations in rural areas people to engage in community work, was used to directly reaching parents through information as an avenue to disseminate BCC messaging. In a and advocacy campaigns, TV media on childcare multisectoral setting of multiple projects operating practices, media distribution on WeChat, and the jointly or independently in the same functional areas, provision of parent education kits at primary care coordinating messaging is crucial. In Rwanda, the facilities. While it was not strictly a multisectoral same BCC messaging was delivered across sectors, project, it adopted a holistic approach to addressing ensuring beneficiaries received one set of simple, early childhood education. memorable information. The project has improved early childhood education A community-based approach is the most effec- in China. In addition to the significant construction tive at improving early childhood outcomes. and renovations of classrooms, including in remote Community-based approaches rely on local institu- villages, the project increased kindergarten enroll- tions or soft infrastructure to coordinate activities at ment dramatically (from 54 percent to 89.4 percent) the community level. In Rwanda, a robust community and improved the quality of education (both in terms health worker program proved particularly effective. of a better pupil-teacher ratio and a higher propor- Local leaders are an invaluable resource in terms of tion of qualified teachers). The time parents devote promoting behavioral change in their communities to teaching their children has increased, supported and relaying information about community-specific by videos that showcase home-based learning and barriers that can be accounted for in program play activities that promote the development of design/modification. Community members can also cognitive, motor, and socioemotional skills. be used as role models to bring about behavioral change. The positive deviance approach involves identifying successful community members with Lessons learned from the positive behavior to encourage similar behavior multisectoral case studies among other community members. Effective multisectoral action requires a clear Although the authorities can identify national policy plan for involving different sectors and combining issues, the associated determinants and risk factors supply- and demand-side solutions at both the can vary across local populations. Effective solutions national and local levels. There are different ways may look slightly different across different popu- to design multisectoral programs. In Rwanda, there lation groups. In cases where there are program was close collaboration between sectors, although conditionalities, it is important to, for example, 30 Mauritania Human Capital Review ensure they are feasible in the context of existing Increase the quality of health services in pre- and supply-side programs and the overall environment. postpartum periods The China project employed a holistic approach To improve maternal health, the authorities need to to early childhood education, recognizing that the address the barriers to accessing health services, determinants of better learning differ between urban the availability and quality of service delivery, and and rural areas and between formal and informal the urban/rural divide in the health sector. Invest- childcare settings. The project therefore designed ments in the health sector are needed to ensure that tailored solutions for each population subgroup. even remote populations have access to primary health services of decent quality. The Ministry of Health has adopted PBF mechanisms as a national Policy recommendations strategy to improve health outcomes. PBF is being used to transition systems toward results-oriented for building human capital management with improved equity, and the PBF in early childhood mechanisms have been enshrined in the Accel- erated Growth and Shared Prosperity Strategy Table 3.1 summarizes the main issues that prevent 2016–2030 (Stratégie de la Croissance Accélérée Mauritania from building human capital, demon- et de la Prospérité Partagée, SCAPP).27 strates why addressing these issues is strategically important for the country, and provides recommen- The Ministry of Health has leveraged mobile health dations for how to enhance the current approach. units to reach populations in remote areas, a practice that could be strengthened. To continue to incen- tivize health workers to serve in rural and remote Maternal health and nutrition areas, the government could consider financial incentives, such as hardship allowances or housing, Increase access to and use of family planning depending on the needs of health workers. As part There is a need to meet the demand for family of PBF, for example, health facilities have the right to planning and increase the availability of modern hire and fire medical personnel as needed, and they contraceptives. Efforts should focus on social and are relatively autonomous in setting the contract behavioral change communication, empowering duration and salaries of additional personnel. Health women and girls to increase demand for family facilities that manage additional activities or provide planning. Influential community leaders, women’s better quality of service (according to a predefined groups, and service providers also need to be set of indicators) could receive additional premiums engaged on family planning and reproductive health. that could be used to incentivize staff. To keep civil The critical inputs (commodities and qualified staff) servants in remote or less desirable locations, a few need to improve to meet the demand—including, for countries have explored the idea of regionalizing example community-based distribution of contra- certain civil service occupations such as teachers ceptive commodities—to ensure that supply follows or health workers. In the regionalization of hiring, growing demand in communities. the central government could remain responsible 27  Indeed, the World Bank–financed INAYA project has demonstrated improvements in utilization of essential health and nutrition services by the vulnerable population, including refugees, and shows its effective implementation strategies of financial incentives to increase autonomy and performance of health facilities. 3  Building early childhood human capital 31 Table 3.1  Addressing key issues to building early childhood human capital in Mauritania Impact on the accumulation of Policy to build human capital in Key issue human capital early childhood Outcome ■ Increase access to and use of ■ Improved maternal ■ Poor health and nutritional status family planning health and reduced of women of reproductive age maternal mortality High maternal affects early childhood outcomes ■ Increase the quality of health mortality rate and services in pre- and post- ■ Improved birth poor maternal ■ Disruptions to maternal health partum periods outcomes (such as health outcomes and/or nutritional status post- reduction in still- partum negatively affect ■ Support the adoption of births, preterm childcare and feeding practices recommended health/nutrition births, low birth- practices weights) ■ Poor health outcomes among children have led to premature ■ Improve infant and young child deaths and preventable child- feeding practices hood illnesses ■ Increase access to water and sanitation facilities ■ Improved child ■ Inadequate infant and young nutrition status child feeding practices led to a ■ Improve water, sanitation, and and reduced Poor child health high and increasing prevalence hygiene practices child stunting and and nutrition of stunting, then reduced child ■ Increase childhood vaccina- wasting outcomes cognitive and physical develop- tions ment ■ Improved ability to ■ Strengthen community-based learn and develop ■ Low immunization rates and case management for preven- physically poor water, sanitation, and tion, early detection, and hygiene practices increase the treatment of childhood malnu- risk of severe illness and lifelong trition morbidities ■ Lack of early childhood educa- tion and stimulation results in children scoring lower than expected on indicators related to literacy/numeracy, social-emotional skills, learning, ■ Improve knowledge of respon- and physical development sive caregiving among caregivers ■ Lack of resources and aware- ness of early childhood ■ Improve knowledge on early development results in (1) low learning through play/reading Low learning caregiver knowledge/awareness ■ Increase the availability of Improved learning outcomes of early learning practices, (2) high-quality childcare facilities outcomes limited access to tools/resources ■ Support in-service and to strengthen early learning at preservice teachers to teach home, and (3) low access to effectively high-quality early childhood education centers outside the ■ Turn classrooms and schools home into learning spaces ■ The system is failing in-service and preservice teachers who are not equipped to teach children effectively ■ The large share of children with no birth certificates has limited ■ Reduced vulner- Non-enforcement access to social services and Ease birth registrations by elim- ability to harmful of child protection protection against child marriage inating penalties and increasing practices policies ■ Female genital mutilation remains knowledge of the process ■ Increased access widespread despite its ban in to social services 2015 32 Mauritania Human Capital Review for screening (through national exams) while local- Child health and nutrition izing decisions regarding assignments and career progression.28 Improve infant and young child feeding practices Mauritania needs to urgently implement measures Support the adoption of recommended health/ aimed at addressing the high prevalence of under- nutrition practices nutrition among children under five years old. Efforts should target vulnerable communities and house- There is a need to reduce the high prevalence of holds with lactating women and/or children under malnutrition, morbidity, and mortality among women age five with information, cash transfers (if below of reproductive age and the associated impacts on the poverty threshold), and the direct provision of fetal and neonatal health. Efforts should target preg- nutritional supplements—for example, preventative nant and lactating women, particularly in vulnerable small-quantity lipid-based nutrient supplements populations (e.g., women in lower-income deciles (SQ-LNS) have been highly successful in reducing and rural areas). This would require implementation acute to moderate malnutrition.29 Existing research of a multisectoral program that addresses the multi- emphasizes the need for a package of interventions faceted challenges to improving health and nutrition. and not just stand-alone programs. Programs that From the social protection side, the provision of cash have successfully reduced childhood undernutri- transfers to vulnerable households could be consid- tion include a variety of different interventions.30 ered, alongside the provision of accompanying School feeding programs in vulnerable communities measures such as social and behavioral change could increase household resources available for communication that encourages behavioral change non-school-age children; while health-related social related to maternal health and nutrition. The national and behavioral change communication could inform safety net program, Tekavoul, is close to reaching its households about immunization, WASH, and air target of covering 100,000 households, which corre- pollution. The authorities could strengthen energy sponds to all extreme poor households in Mauritania. infrastructure in vulnerable communities to make The program could be used to encourage positive electricity more accessible and affordable, collabo- health-seeking behavior. Previous efforts to provide rate with the private sector to identify and subsidize top-up transfers to encourage the vaccination of clean cooking technologies, and monitor/regulate children could be expanded to other health-seeking pollutant emissions by public and private firms. behaviors such as attending prenatal visits. Programs aimed at keeping young girls in school and helping them continue to secondary education have been shown to delay the first birth, thereby reducing total fertility and the likelihood of adverse outcomes due to childbirth. 29  A systematic review and meta-analysis of 14 random- ized controlled studies in LMICs found that providing SQ-LNS to children age 6–23 months for three months or longer was associated with improvements in child growth and development and lowered the incidence of undernu- trition (Dewey et al. 2021). 30  In Madagascar, the provision of SQ-LNS was done The central government would remain responsible for 28  monthly through existing growth monitoring and promo- accreditation through a national exam to set the standards tion clinics. In these community clinics, mothers were for the profession. However, regional hiring of medical educated about infant and young child feeding and personnel could take place after the initial screening WASH behavior. Community health workers also regu- process, with local career development and the potential larly conducted cooking demonstrations using local and for regular rotations within regions. affordable food items (Stewart et al. 2020). 3  Building early childhood human capital 33 Increase access to water and sanitation facilities human capital–accompanying measures (as part of the promotion sociale) that have been successful in Poor outcomes for early childhood development are inducing behavior change among participants and exacerbated by the limited and uneven coverage of increasing the amount of time parents spend with basic WASH services. Slightly more than half the their children (along with the quality of interactions). population has access to safe water (57 percent) Lessons learned from Tekavoul could be imple- and 40 percent benefit from improved sanitation. mented in national programs targeting childhood Despite progress in recent years, this still compares development. In the absence of widespread formal poorly with regional and international standards. In childcare arrangements, almost all Mauritanian chil- Senegal, for example, the corresponding shares are dren are cared for by their immediate family. Mothers, 92 percent and 48 percent, respectively. There is grandmothers, and other female family members are a significant gap between rural and urban areas: the predominant caregivers. Information campaigns only 14 percent of Mauritania’s rural areas have need to reach all potential caregivers. For example, access to sanitation versus 58 percent of urban the China case study demonstrated the impact of areas, suggesting a prevalence of open defecation. brochures at primary health facilities, radio and TV Because of the lack of sanitation, diarrheal diseases messages, social media campaigns via What’sApp, accounted for almost one in six neonatal and under and screening educational material in more remote age five deaths (16 percent) in 2013 and are one settings. It is equally important to engage tradi- of the top causes of mortality and disability (IMHE tional figures of authority such as village or religious 2015; WHO 2014). leaders in information campaigns. Acute deficits in access to water and sanitation in rural areas and underprivileged urban areas reflect Increase the availability of high-quality childcare a combination of weaknesses in the legal and facilities policy framework. Concerted efforts are needed to More and better-quality investments in childcare improve the quality of service provision by strength- could improve outcomes for women, children, fami- ening institutional and individual capacity at both lies, and businesses. The childcare sector provides the central and decentralized levels. While decen- an opportunity for women to own their own busi- tralization processes will take time to develop, there nesses and offers employment opportunities. It are immediate gains to be made from harnessing also enables women to continue and complete their the potential for citizen engagement in monitoring education (IWPR 2021). Quality childcare can enable service delivery provision. To support the reform women to participate fully in the workforce while agenda, it is necessary to analyze allocation of supporting children’s development and school read- resources and the performance of public and private iness. It is important that these facilities are of high providers of WASH services. quality, as low-quality childcare centers can be detri- mental to children’s development (Blimpo et al. 2022). Child education Support in-service and preservice teachers to teach Improve knowledge of responsive caregiving and effectively of early learning through play/reading among caregivers More investments are needed to give teachers Caregivers need to be empowered to stimulate the skills and motivation to teach effectively. This children’s cognitive and behavioral development. requires urgent investments in the quality of teacher The Tekavoul social safety nets program includes training so teachers are themselves able to master 34 Mauritania Human Capital Review the content they are teaching. In the short run, Child protection this includes a package of integrated interven- tions focusing on improving teaching practices and Ease birth registrations by eliminating penalties and increasing knowledge of the process pedagogy in the classroom through regular teacher training and coaching, structured pedagogy, and the Birth registration needs to increase to allow all provision of adequate classroom learning materials children to reach their full potential. Making birth for students. In the medium to long run, a rethinking registration free of cost and linking it to other of the teacher profession is needed. Teaching benefits and support services has been shown to should be a meritocratic profession, with clear and increase registration rates. In many countries, birth structured career paths. Teachers’ management is registration is integrated into health system facilities, an integral part of a quality education system to significantly reducing the burden on parents and make sure teachers are motivated, held account- increasing registration rates. This is precisely what able, and are present in the classroom—and can Mauritania is envisioning staring January 2024. In therefore teach effectively. countries where home births are prevalent, other solutions have been found, including through the use of mobile devices by birth attendants, links to Turn classrooms and schools into learning spaces local population registers, and recognition of trusted Classrooms and schools need to be equipped to local officials as birth witnesses. These solutions still enable students to learn. In the classroom, this need to be defined in Mauritania to ensure no child includes having books and supportive technology is left unregistered. Vaccination and other health available with content suitable to students’ levels so campaigns are another opportunity to facilitate the teachers can teach at the right level. It also includes registration of children born outside health facili- teaching in the mother tongue so students can ties through coordination between health and civil understand the content they are meant to learn. registry services. Registration could also be made On the school side, this includes providing the available during school enrollment. Finally, social minimum infrastructure needed to make schools protection programs that reach the poorest provide safe and inclusive spaces—such as functional toilets an opportunity to promote awareness of the impor- and sufficient light in the classroom—and to ensure tance of, and to facilitate, birth registration. Social that students with any disability are receiving the mobilization efforts to increase awareness of the right services. Regular monitoring through granular importance and process of civil registration should data can inform teaching and learning. continue. Partnerships with local organizations that provide support to disadvantaged populations through an often complex civil registration process could reduce reliance on intermediaries. 4 Utilizing human capital   chapter describes the current state and evolution of Key messages human capital utilization in Mauritania, benchmarks ● Mauritania is not fully utilizing its human capi- it against comparable countries, discusses current tal—a significant share of the potential labor policy approaches to enhance the use of human force is not gainfully employed and returns to capital, and concludes with policy recommendations human capital are low. aimed at improving the utilization of human capital. ● Human capital per capita has been falling in Mauritania during the last two decades. ● Poor utilization of human capital particu- larly affects women and youth and negatively Measures of human capital affects investments in future human capital. utilization ● Better utilization and higher valuation of Human capital and the human capital in Mauritania is possible and would bring economic and social benefits to wealth of nations the country. The Wealth of Nations approach separates national ● Mauritania deploys policies and programs to wealth into natural, physical, and human capital. improve functioning of the labor market and Wealth is one measure of prosperity, capturing a job creation. Bringing those initiatives to scale based on rigorous evaluation will be required to stream of benefits into the future. The approach make a dent in the problem of underutilization. uses the lifetime income stream methodology developed by Jorgenson and Fraumeni (1989) and Fraumeni (2011) and is utilized by the Organisa- Economic gains from human capital accumulation tion for Economic Co-operation and Development can only be realized if people can utilize their skills (OECD 2023) and the World Bank (e.g., World Bank and ingenuity over a long and productive lifetime. The 2011, 2018a) According to this approach, human extent to which human capital is equitably distributed capital is estimated as the total present value of across the population affects the sustainability and the expected future labor income of the current inclusiveness of socioeconomic development. The working population. The Wealth of Nations’ measure economy and society at large drive returns to human of human capital focuses on the economic bene- capital, which makes the adoption of multisectoral fits that a well-educated and healthy workforce policies important for realizing a country’s human generates. It brings together a host of factors capital potential. Reflecting this complexity, this that shape the stock and utilization of a country’s 35 36 Mauritania Human Capital Review human capital: the total population and its structure, human capital. However, the risk of mismanaging people’s expected lifespan (a measure that reflects commodity revenue is high,3 and resource wealth health conditions), their educational attainment, and may lead to slower economic growth and higher their labor market experience in terms of employ- inequality, especially if countries are endowed with ment probabilities and earnings. weak political institutions (van der Ploeg 2011; Venables 2016). The countries with the stron- Mauritania’s human capital per capita wealth has gest economic growth in 1995–2018 were those declined over the last 20 years. Human capital that experienced the strongest increase in human accounts for an estimated 64 percent of global capital, which allowed them to transition from wealth.1 While its contribution to overall wealth low-income to upper-middle-income status. Using increased between 1995 and 2018 globally, it a simple growth accounting framework4 illustrates decreased in Mauritania (figure 4.1). In 1995, Mauri- that the elasticity of gross domestic product (GDP) tania’s level of human capital wealth per capita was growth in Mauritania remains higher in terms of higher than that of comparable countries, repre- human capital (for each percentage increase in the senting 71.7 percent of its wealth. However, the stock stock of human capital, GDP increased by 0.57) of human capital per capita in Mauritania had declined than with respect to natural and physical capital by 2018, shrinking by an average of 1.6 percent per (0.43). Therefore, investment in and better utiliza- year. This was because the accumulation of human tion of human capital should be at the forefront of capital in the country was lagging behind population Mauritania’s growth strategy. growth, reflected in the falling employment rate and stagnant rates of returns to education. The deple- tion of human capital in Mauritania resulted in human Utilization-Adjusted Human capital representing only 50 percent of total wealth, Capital Index less than in most other countries (table 4.1). This fall The basic Utilization-Adjusted Human Capital Index was particularly pronounced for women, who expe- (UHCI) shows that the utilization of human capital in rienced a sharper reduction in per capita volume of Mauritania is remarkably low, especially for women.5 human capital than did men, reflecting falling employ- Like the original Human Capital Index (HCI), the UHCI ment rates and diminishing returns (table 4.2). In refers to a child’s future productivity (appendix A 2018, women held only 20 percent of total human provides an overview of the calculation of the UHCI). capital wealth in Mauritania. Adjusting Mauritania’s HCI value for the utilization of Mauritania was one of just three countries in the world that became a lower-middle-income country (LMIC) between 1995 and 2018 despite a reduction 3  Distortions can occur through three channels: (1) risk of Dutch disease, leading to suboptimal level of development in its human capital wealth.2 These countries’ tran- for nonproductive nontradables; (2) strong distortions in sition to LMIC status was largely due to the rapid the gender distribution of human capital, which are related to the nature of resource-driven growth; and (3) large growth of fossil fuel and mineral wealth (figure 4.2). public sector distortions, with overblown public employ- The discovery and exploitation of mineral assets ment and insufficient investment in both human and physical capital. does not necessarily lead to underinvestment in 4  Cobb-Douglas production function with constant returns to scale. 1  Seventy percent in high-income and 41 percent in 5  The most recent data for Mauritania are from the low-income countries (World Bank 2021a). 2014–15 Labor Force Survey, which may not fully reflect the current situation. However, an analysis of employ- The other two countries were Zimbabwe and the 2  ment trends demonstrates few to no changes over the Republic of Congo. last 10 years. 4  Utilizing human capital 37 Figure 4.1  Mauritania’s human capital wealth has declined over the last 20 years (1998–2018) 30,000 Human capital Total wealth 25,000 Constant 2018 $ 20,000 15,000 10,000 5,000 0 1995 2018 1995 2018 1995 2018 1995 2018 1995 2018 1995 2018 1995 2018 1995 2018 Mauritania LICs LMICs Sub-Saharan Mauritania LICs LMICs Sub-Saharan Africa Africa Source: World Bank 2021a. Note: LICs = low-income countries; LMICs = lower-middle-income countries. Table 4.1  Mauritania’s per capita human capital wealth growth rate is negative (1995–2018) Human capital as share of wealth (%) Per capita human Per capita total capital growth rate wealth growth rate Country/region 1995 2018 (%)a (%)a Mauritania 71.7 50.1 −1.6 1.0 Low-income countries 38.2 50.3 4.7 1.7 Lower-middle-income countries 56.2 62.1 7.4 6.0 Sub-Saharan Africa 45.6 60.0 4.3 1.4 Source: World Bank 2021a. a. Growth rates are annualized over 1995–2018. Table 4.2  Human capital held by males and females in Mauritania, 1995 and 2018 Males Females Measure 1995 2018 1995 2018 Total human capital (constant billion 2018 $) 21.4 32.5 5.7 8.3 Percentage of Mauritania’s human capital 79 80 21 20 Per capital human capital (constant billion 2018 $) 18,496 14,773 4,927 3,773 Percentage change 1995–2018 in per capita human capital −20 −23 Source: World Bank 2021a. human capital reduces it from an already low 0.38 access to economic opportunities. Differences to 0.15 (figure 4.3). This index means that children between men and women are stark: the UHCI value born in Mauritania today can expect to utilize only is only 0.10 for women compared to 0.22 for men. 15 percent of their human capital potential by the Mauritania is an outlier for its income group, as its time they turn 18, compared to a child in full health, UHCI is on par with conflict-affected states or small with the best possible education and unrestricted islands. 38 Mauritania Human Capital Review Figure 4.2  Mauritania became a lower-middle-income country despite a reduction in human capital wealth 30,000 Armenia Albania Per capita human capital, 2018 (2018 $) 25,000 Bosnia Lao PDR and Herzegovina 20,000 Nigeria Ghana Congo, Rep. 15,000 Zimbabwe Cambodia Low-income, 1995; lower-middle-income, 2018 10,000 Low-income, 1995–2018 Ethiopia MAURITANIA Low-income, 1995; upper-middle-income, 2018 Rwanda 5,000 Mozambique 0 5,000 10,000 15,000 20,000 25,000 30,000 Per capita human capital, 1995 (2018 $) Source: World Bank 2021a. Figure 4.3  Mauritania is among countries with the worst utilization of human capital 0.70 Singapore 0.60 Vietnam 0.50 Cambodia Chile 0.40 Malaysia UHCI (basic) Mongolia Tanzania 0.30 Ghana Tunisia Morocco 0.20 Malawi Mauritania Pakistan South Sudan Yemen 0.10 0.00 2.000 3.000 4.000 5.000 GNI per capita, $ in logs Source: World Bank 2021a. Note: Data are for 2017. GNI = gross national income. 4  Utilizing human capital 39 While there is potential for Mauritania to utilize all capital when the HCI increases. Mauritania is at the its human capital, the country remains at the bottom bottom of the inverted U-shape and may risk seeing of the UHCI distribution. The full UHCI is using a further deterioration in its UHCI, if the improvements concept of “better jobs” (defined as non-agricultural in employment rate and quality of employment are wage employment and employers). It assumes that not achieved. these jobs are fully utilizing the available human capital of those employed at these jobs. For the remaining workers it assumes that all potential workers—whether they are currently employed, inac- Dimensions associated tive, or unemployed—are in substandard informal with low utilization jobs, utilizing only the minimum level of their human of human capital in capital (equal to 0.2). For Mauritania, this assump- Mauritania tion of full employment for currently not working potential workers slightly increases its full UHCI Three factors determine Mauritania’s low utilization to 0.23—still well below the actual HCI (0.38), but of human capital: low employment, poor quality/ above its basic UHCI (0.15). Its full UHCI places productivity of available jobs, and low educational Mauritania among countries with the worst utili- attainment. zation of human capital. This highlights the need to improve the quality of jobs while striving for Low labor force increased employment. participation and Efforts to increase human capital need to be comple- employment mented by measures to address its underutilization. Employment rates are low, especially for women. As illustrated in figure 4.4, countries tend to fall into Survey-based estimates of the labor market for the the trap of increasing underutilization of their human working-age population show that the rate of employ- ment in Mauritania is low for the general population and even lower for women6 (table 4.3). Women also Figure 4.4  Penalty for underutilization of human tend to drop out of the labor market at a higher rate capital versus the level of HCI than men: 57 percent of women do not work for .45 earnings and are not looking for a job. In Mauritania, .40 there is a very gradual increase in employment over .35 a person’s lifetime, reaching a peak at ages 45–49, P = HCI – basic UHCI .30 before starting to fall after age 55 (figure 4.5). .25 Mauritania .20 Low quality of employment .15 .10 Most employment in Mauritania occurs in the .05 informal sector. Job quality is commonly measured .00 .20 .30 .40 .50 .60 .70 .80 .90 HCI Source: World Bank 2022c. 6  The World Bank and the International Labour Organi- zation use 15–64 as working age, even though there are Note: The “penalty” (P) shows how the lack of employ- different legal starting ages in Mauritania (the legal age ment opportunities reduces the valuation of human for employment in the private sector is 14, and 18 in the capital. public sector). 40 Mauritania Human Capital Review Table 4.3  The employment rate is low, especially among women Employment status of working-age population Male (%) Female (%) Employed, > 6 hours/week 55 23 Employed, < 6 hours/week 1 2 Unemployed, new entrant 6 7 Unemployed, lost job 6 2 Inactive, willing to work 3 9 Inactive, not willing to work 30 57 Source: Based on data for working-age population (15–64 years old) from ONS 2017. Figure 4.5  Employment peaks in middle age and sector employment continues to dominate, repre- declines quickly thereafter senting over 12 percent of jobs (table 4.4). 100 Hours of work are often unregulated and are either Employment share (%) 80 Males excessive or insufficient. Both excessively long hours and insufficient hours of work represent 60 worse forms of employment than a regular working 40 Females week with a predictable schedule.8 Excessively 20 long hours are a bigger challenge for the Maurita- nian workforce than underemployment. More than 0 67.4 percent of the country’s employed workers 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-59 35-59 60-64 65+ worked more than 40 hours/week in 2017, up from 63.3 percent in 2012, driven by the informal sector. Age group Mauritania’s underemployment rate was 6.1 percent Source: International Labour Organization ILOSTAT. in 2017, and it is slightly higher among men and the youth (ONS 2017). along three dimensions: type of workers’ rights A significant share of jobs are considered precar- protection (formal/informal), hours of work (over- ious. Workers in casual, seasonal, and temporary work or underemployment), and (in)stability of work. occupations are particularly at risk of losing their The informal sector in Mauritania employs about jobs or making insufficient income from work. In two-thirds of the economically active population, 2017, 20 percent of the employed working-age of which about 35.7 percent are employed in the population was in unstable, precarious jobs. This informal non-agriculture sector (table 4.4). Informal relatively high degree of job insecurity affects both jobs,7 which are especially prevalent among youth, men and women to similar degrees. Precarious offer no or only minimal protection of workers’ jobs are more prevalent in rural areas (representing rights and no social security. The formal private 33.7 percent of total employment) than urban areas sector constitutes only 6.6 percent of total employ- (13.0 percent). ment, with less than 3 percent of working women employed by formal private sector firms. Public 8  Underemployment refers to working less than 40 hours/ week when the respondents express their willingness An informal job is defined here as a job without a written 7  to work longer hours. Excessively long hours refers to contract and no social security coverage for the employee. working more than 40 hours/week. 4  Utilizing human capital 41 Table 4.4  Public sector employment dominates, 2017 Employed population (number) Employed population (%) Employment Male Female Total Male Female Total Central administration 29,560 12,280 41,840 6.8 4.8 6.0 Public administrative establishment 21,626 8,349 29,975 4.9 3.3 4.3 State-controlled nonfinancial company 14,485 1,493 15,978 3.3 0.6 2.3 Private financial company 12,271 2,193 14,464 2.8 0.9 2.1 Private nonfinancial company 26,557 4,916 31,473 6.1 1.9 4.5 Individual or family business 277,89 185,00 462,89 63.5 72.3 66.7 Household 51,783 32,858 84,641 11.8 12.8 12.2 Other 3,673 8,770 12,443 0.9 3.4 1.8 Total 43,784 25,586 69,370 100.0 100.0 100.0 Source: Based on data for working-age population (15–64 years old) from ONS 2017. Note: “Other” contains nongovernmental organizations (voluntary or wage) and international organizations. Low educational attainment, and unemployment show a typical pattern of raising lack of skills, and job employment probabilities with higher levels of educa- mismatch tional attainment, unemployment rises for certain degrees, reaching 41 percent for women with tech- A large share of the country’s working-age popu- nical education (this is, however, based on a small lation has low levels of education, but higher sample of women) and 28.8 percent for people with educational attainment does not necessarily lead only secondary education. This may indicate that to better employment outcomes. Most Mauritanians secondary school is not providing students with the of working age have at most a primary education or skills demanded in the labor market. no education (or have only attended koranic school) (table 4.5). Only a quarter of the labor force has The high unemployment rate for technical educa- a secondary degree or above. While employment tion is unexpected, as it is generally considered Table 4.5  Many Mauritanians have low levels of education, 2017 Employment rate (%) Unemployment rate (%) Labor force (number) Highest level of education completed Men Women Total Men Women Total Men Women Total No complete education 71.6 31.4 44.5 4.0 4.8 4.4 93,265 85,529 178,794 Koranic 62.5 26.5 41.6 6.4 7.6 6.8 129,752 77,184 206,936 Mahadra 50.5 19.2 41.9 11.8 18.0 12.6 19,212 2,938 22,150 Primary 56.5 22.8 35.5 22.0 33.3 26.9 136,902 106,735 243,637 Secondary 36.7 18.1 26.9 24.3 35.9 28.8 100,577 65,600 166,177 Higher 59.5 39.8 53.7 16.2 26.9 18.8 40,511 13,112 53,623 Technical and professional 58.2 35.9 52.3 16.5 41.3 22.4 5,085 1,594 6,680 Total 53.1 24.5 36.6 10.9 13.3 11.8 525,304 352,692 877,997 Source: Based on data for working-age population (15–64 years old) from ONS 2017. Note: Population aged 15–64; employment rate uses full working-age population as reference. 42 Mauritania Human Capital Review one of the solutions to a lack of relevance of status—and consequently the variety of constraints secondary schooling. However, this type of skill is faced by different types of youth—should lead to extremely rare in Mauritania: less than 1 percent of tailored responses. the working-age population holds a diploma with a technical degree. Still, their prospects in the labor Unrealistic expectations of young jobseekers also market indicate that vocational training is poorly play a role in the slow transition from education to preparing young graduates for productive employ- work. The results of a qualitative survey of youth ment (IIPE 2018). The employment rate of technical from poor and vulnerable families reveal that most of and professional training degree holders is just them drop out of school (having achieved minimum 52.3 percent; this rate for men (58.2 percent) than educational attainment); start looking for any jobs to women (35.9 percent). make ends meet; and accept temporary, low-paying, and precarious jobs. They also lack information on the labor market; are ignorant of employment Difficult transition from programs; have unrealistic expectations about the school to work steps needed to find stable employment; and do not seek additional training and skills development, Youth, who represent most of the active population leaving them uninformed about the demands of in Mauritania, struggle to transition from school to employers regarding the profile of recruits. This is employment. Young people age 15–35 represent combined with a lack of information and resources about 61.4 percent of the country’s population. While among employers: one-third of formal sector firms over 60 percent of the youngest cohort (aged 15–18) complain about the inadequacy of skills of young remains in education, 20 percent has dropped out recruits, and yet few offer on-the-job training or and has not entered the labor market (figure 4.6). A apprenticeships (World Bank 2019b, 2020a). significant share of young adults (15 percent) is still in search of their first employment by age 24, and only 20 percent are employed by age 34. Entering Dropouts and their job the labor market is therefore a long process for many prospects young Mauritanians. The number of young people not in education, employment, or training (NEET) is Young people face difficulties in progressing through especially worrying (table 4.6). the education system and completing their studies. Among those enrolled in formal primary education, The problem of youth not in education, employ- only 33 percent go on to pursue secondary studies, ment, or training is especially acute for the younger and only 5 percent continue to higher education cohorts. Mauritania stands out as the country with (World Bank 2020a). Hence, most young people the second highest rate in Sub-Saharan Africa (after only complete primary education or less. This group Niger) (figure 4.7). The rate has increased between faces challenges in finding remunerative employ- 2012 and 2019 from 39.7 percent to 44.8 percent. ment and lacks the basic skills to continue building In Mauritania, NEET touches girls disproportion- human capital. The main reasons for young people ately: 54.85 percent of young women are NEET not completing basic education or continuing their compared to 34.02 percent of young men. The studies are financial (lack of means), constraints sheer number of inactive young adults represents related to family circumstances (e.g., pregnan- a threat for social stability, reinforcing the need cies, disability, and need to start working), and to adopt comprehensive, multipronged strategies “failure to study” or failing to pass exams. Failure to regarding youth employment. The diversity of NEET study/failing exams accounts for the largest share 4  Utilizing human capital 43 Figure 4.6  Youth struggle with the school-to-work transition 100 Share by labor market outcome (%) 80 Unemployed, new entrant Unemployed, lost job Employed,< 6 hours/week 60 Employed, > 6 hours/week Inactive,willing to work Inactive, ineducation 40 Inactive, not willing to work 20 0 Age 15–18 Age 19–24 Age 25–34 Age 35–59 Age 60+ Source: Based on data from ONS 2017. Table 4.6  NEET rates are high across levels of education NEET rate (%) Unemployment rate (%) Highest level of education completed Male Female Male Female Primary 31 59 16 12 Secondary 13 22 10 9 Higher 15 18 15 19 Koranic 17 47 7 9 Mahadra 11 19 10 8 Technical and vocational education and training 21 53 18 40 Total 18 37 12 10 Source: Based on data for youth (15–29 years old) from ONS 2017. Figure 4.7  Mauritania has the second highest NEET rate for youth 15–24 in Sub-Saharan Africa 80 Share of NEET youth (%) 60 40 20 0 Niger Afghanistan Yemen, Rep. Mauritania Somalia Burkina Faso Liberia Chad Benin Pakistan Guinea Senegal Sierra Leone Namibia Tunisia Congo, Dem. Rep. Zambia Mali Zimbabwe Rwanda Lao PDR Togo Turkiye Guinea-Bissau Ghana Angola Kenya Malawi Cameroon Tanzania Cambodia Côte d’Ivoire Source: World Bank, Gender Data Portal. 44 Mauritania Human Capital Review of dropouts, ranging from 48 percent for those Public sector employment is characterized by higher who abandon school following primary educa- wages. In 2017, public sector jobs paid a wage tion and 39 percent for koranic school graduates premium of 30 percent compared to wages in other to 22 percent for those who have not completed sectors, controlling for education, location, industry, their primary schooling. This suggests that remedial gender, and type of contract (World Bank 2020a). education should be made available to vulnerable This premium is distorting incentives for seeking youth to increase their chances of staying in school. employment and leads to “wait unemployment,” especially among people with higher education attainment. Returns to education Returns to education in terms of earnings are low Patterns of job creation in in Mauritania, although returns are higher beyond Mauritania primary education. An analysis of age-specific average wages for different levels and types of Economic growth has been driven by education completed shows that those who only capital-intensive natural resource extraction (World complete koranic school earn a lower wage than Bank 2020a). The extractive sector has traditionally people (across age groups) who complete other been the biggest contributor to GDP growth,9 leading types of education (figure 4.8). The profile is also to growth in the nontradable and service sectors flat over the lifespan, suggesting little accumula- (e.g., construction, retail, and public services), which tion of human capital through on-the-job training has generated some jobs (table 4.7). Still, growth or few returns to seniority. The returns to higher driven by natural resource extraction has resulted education and technical and vocational education in limited job creation. While the traditional primary seem similar and exceed the wages of those with sectors of agriculture and fisheries have made the only a primary education. On-the-job accumulation biggest contributions to GDP and employment, of human capital continues throughout a person’s’ these sectors have been growing more slowly than productive life through (1) progression to higher the overall economy. Their share of employment has productivity or skills at the same place of work; and been falling but remains high. (2) acquisition of new skills, resulting in higher pay by transitioning between jobs. The data also show Labor has transitioned from rural areas and agricul- a rather steep age gradient, suggesting a more ture (with its volatile returns) to the less productive normal learning by doing and a wage premium for urban sectors (such as services and petty trade) experience. Indeed, controlling for gender, location, that are dominated by informality and limited value education, and sector of employment, each addi- added. The mining sector, which has been the main tional year of experience is associated with a wage driver of recent growth and exports, employs a mere increase of 5 percent, but these returns diminish 1 percent of the country’s employed population. and peak at the age of 50. The prevalence of tran- Mauritania’s small manufacturing sector averages sitions and secondary employment is low. During the only 9 percent of GDP and constitutes 12 percent year preceding the survey, only 5 percent of those of employment. There is a difference in employment currently employed changed their place of work and 4 percent report any secondary activity, indicating 9  As a result of the dramatic rise in global commodity prices, the value of mineral exports jumped from that the labor market is not dynamic. $318 million in 2003 to $2,652 million in 2023. Over the period, the extractives sector represented, on average, 25 percent of GDP, 82 percent of exports, and 23 percent of domestic budgetary revenue (World Bank 2018b). 4  Utilizing human capital 45 Figure 4.8  Returns accrue only beyond primary education a. Primary b. Secondary c. Higher 5 Fitted values 4 3 Age 20 Age 40 Age 60 Age 20 Age 40 Age 60 Age 20 Age 40 Age 60 d. Koranic e. Mahadra f. Technical and vocational 5 Fitted values 4 3 Age 20 Age 40 Age 60 Age 20 Age 40 Age 60 Age 20 Age 40 Age 60 Source: Based on data from ONS 2017. Table 4.7  Agriculture and services continue to drive employment Employment (number) Structure of employment (%) Sector Male Female Total Male Female Total Agriculture, including livestock 140,490 65,669 206,159 31.1 23.6 28.2 Fisheries 18,658 575 19,233 4.1 0.2 2.6 Mines 8,471 460 8,931 1.9 0.2 1.2 Manufacturing and energy 43,299 46,831 90,130 9.6 16.9 12.3 Construction, transport, and communications 32,835 734 33,569 7.3 0.3 4.6 Commerce 72,446 85,050 157,496 16.0 30.6 21.6 Services 136,258 78,523 214,781 30.1 28.3 29.4 Total 452,457 277,842 730,299 100.0 100.0 100.0 Source: Based on data for working-age population (15–64 years old) from ONS 2017. between men and women within each sector. For Employment patterns vary by poverty incidence and example, while manufacturing employment is almost location. The primary sector (agriculture, livestock, equally split between men and women, female and fisheries) is characterized by low productivity. industrial workers are mostly employed as seam- Household heads relying on these sectors as well stresses and food production workers; while men as on self-employment for their primary activity are mostly manual workers, electricians, carpenters, have the highest poverty incidence (figure 4.9). and administrative personnel in enterprises. High patterns of migration to Nouakchott have led 46 Mauritania Human Capital Review Figure 4.9  Poverty rate by employment/activity status of head of household Employment category Sector of activity 54.3% 44.6% 35.7% 32.5% 32.7% 31.8% 29.6% 27.3% 25.9% 27.3% 19.8% 18.5% 11.7% National Self-employed/employer Private employee Public employee Agriculture Livestock Fisheries Commerce Processing industry Construction, transport, and communications Services not specified Administration, education, and health Other branch Source: World Bank Poverty Assessment on Enquête Permanente Auprès des Ménages—EPCV 2014–19. to a concentration of the population in the capital in terms of connectivity and electricity access. The city, which is now home to more than 50 percent challenging business environment is compounded of the urban population. Economic activity has by high import tariffs that shield domestic producers not kept pace with the growing number of urban from international competition and impede access dwellers. As in other resource-rich countries with 10 to cheap imported inputs. Beyond tariffs, the preva- high urbanization rates, the largely informal and lence of nontariff measures and the absence of clear low-productivity commerce sector has increased procedures hinder trade (World Bank 2020a). in size, absorbing most of the rural migrants. These trends indicate that urban centers in Mauritania Patterns of finding have not been able to absorb poor households into employment highly productive sectors, resulting in worse living conditions in cities, particularly Nouakchott. Despite efforts to expand them, the role of labor market intermediation agencies remains limited. Several constraints have been associated with lack Matching workers to jobs through intermediation, of dynamism of private sector employment and job coaching, and information exchange is important to creation. The real exchange rate is overvalued due to improve the utilization of skills and planning of educa- limited exchange flexibility and ineffective monetary tion. Intermediation in Mauritania is limited, and the policy. Moreover, Mauritania suffers from financial country does not have a (functioning) intermediation vulnerabilities and barriers to access finance, espe- system. In 2017, only 2 percent of jobseekers used cially among small and medium-sized enterprises. private employment agencies, 1 percent used regular The business environment is further impaired by public employment services, and 4 percent were limited competition and poor infrastructure, especially registered with the National Youth Public Employ- ment Agency (Agence nationale pour la promotion de l’emploi des jeunes—ANEPEJ). Data on placements Although there is a lack of data, it is likely that migrating 10  populations were predominantly poor, unskilled laborers are not available, and no information is collected by who could not find a job due to mechanization of agricul- public employment services on the demand for labor ture or inability to purchase livestock, resulting in a shift of poverty from rural to urban areas. (i.e., employers wishing to fill jobs openings). The lack 4  Utilizing human capital 47 of formal intermediation mechanisms is reflected in Limited opportunities to how workers search for and find jobs. Less than pursue education 1 percent of those currently employed found their job through a labor intermediation agency, and only Women have lower educational attainment than 5 percent found their job through some form of formal men in Mauritania. More women than men have no recruitment. Most Mauritanians rely on personal and education (32 percent versus 21 percent). While family connections for their jobs or are absorbed in women are slightly more likely than men to have their families’ enterprises. completed primary school (22 percent versus 19 percent), they are far less likely to complete Due to the lack of labor market information, the secondary school (23 percent versus 30 percent), unemployed typically have a very vague idea about and only 2 percent of women (compared to the employment they could seek. In surveys of 5 percent of men) have completed higher educa- the unemployed population, almost 50 percent of tion (ANSADE 2021). Educational attainment is respondents say that they would take “any job” avail- correlated with place of residence and poverty, with able, while 20 percent express a preference to work rural and poor women displaying the lowest levels of for the public sector—a share that is especially large educational attainment. Notably, nearly half of poor among higher education graduates. Given relatively women (48 percent) have no education, higher than high unemployment rates for graduates of higher 32 percent of poor men, 22 percent of nonpoor education institutions, there is a clear gap between women, and 13 percent of nonpoor men. expectations and reality and opportunities to improve the outcomes through labor intermediation. Low labor force participation Gender disparities and Female labor force participation is lower in Mauri- tania than among regional peers. Among people human capital utilization age 15 and older, the labor force participation rate Women’s human capital is being underutilized is 27 percent among women, much lower than through their low participation in the labor force, 61 percent among men (ANSADE 2021). Young low employment, poor quality of employment, and women age 15–24 have a particularly low labor force low pay. The low human capital of Mauritanian participation rate of 19 percent, lower than in neigh- women can be attributed to (1) limited opportuni- boring countries such as Burkina Faso (57.2 percent), ties to pursue education, especially for girls from Chad (46.9 percent), Mali (57.7 percent), and Niger poor and vulnerable families; (2) early marriage (61.7 percent). One possible explanation for Mauri- and pregnancy, which affects a critical period of tania’s low labor force participation among women human capital accumulation and entry into the labor is the country’s social norms, which value women market; (3) penalties based on social norms priori- for their domestic work rather than their presence tizing care responsibilities, forcing women to work in the labor market. Women’s labor force participa- part time to meet family needs (these penalties may tion is slightly higher in urban (28.5 percent) than also lead to preferences on the part of women for rural (26.3 percent) areas. Higher levels of educa- occupations that are lower paid); (4) legal barriers tion are correlated positively with higher labor force that prevent women from attaining similar economic participation. opportunities as men; and (5) lack of women in lead- ership positions in the workforce. 48 Mauritania Human Capital Review Poor quality of jobs in favor of men, which means that women earn, on average, 60 percent of the salary men are paid for Most women are engaged in poor quality employment comparable work (ANSADE 2021).12 The gap is more in the informal economy. As much as 76 percent of pronounced in rural than urban areas and among female employment is self-employment or employ- workers with a primary education compared those ment in a family business, much higher than with no education or secondary/higher education. 41 percent of male employment. Out of all women 11 Some of the country’s current labor market regulations who are currently working, 11.8 percent are only reinforce many of these gender trends and contribute engaged in household and domestic work (ONS, MS, to women’s low earnings. For example, there is no law and ICF 2021). Women are more likely than men to mandating equal remuneration for work of equal value, work without a written contract, making them vulner- and there is no legislation on criminalization of sexual able to exploitation. The share of Mauritanian women harassment at the workplace (World Bank 2021d). who are employees or employers outside of agricul- ture is just 5 percent, one of the lowest rates in the world. This is concerning, given the observed correla- Social norms, legal barriers, and gender imbalances tion between the share of women in better jobs and gross national income (GNI) per capita (figure Variations in social norms may further affect women’s 4.10). Even more worryingly, the proportion of wage opportunities. Early marriage, particularly among workers among females has decreased over the past girls, is widely practiced in Mauritania and affects years and is currently less than a quarter of the share both the prospects of completing education and of wage workers among males (ONS 2017). productively engaging in the labor market. One out of three women age 16–20 is married (ONS, MS, Figure 4.10  Women’s better employment rate is and ICF 2021), and almost 20 percent of women correlated with income per capita age 18–22 had their first child before age 18. Early marriage is more prevalent among poor women and 50,000 women with no education: 58 percent of women age GNI Per per capita, 20–24 from the poorest income quintile were married $, log scale by age 18; this is much higher than the 15 percent of 5,000 women from the highest income quintile. The likeli- hood of being married by age 18 decreases among Mauritania women who have at least some education. Social 500 norms reinforce the idea that housework and caring 0 10 20 30 40 50 60 70 80 for dependents are reserved for women and girls, % of women outside agriculture as employees or employers which underutilizes their human capital. Source: World Bank 2022a. The slow progress in achieving better health and nutrition outcomes for the new generations of Mauri- Gender wage gap tanians is attributable to gender inequality. One in 10 Women who work earn lower wages than men. In Mauritania, the wage parity index stands at 0.60 There was a slight improvement in the gender parity 12  index in earnings from the main job between 2014 and 2019 (from 0.53 to 0.60), according to survey (Enquête Permanente Auprès des Ménages—EPCV) data for the 11  Source: World Bank, World Development Indicators. period. 4  Utilizing human capital 49 women in Mauritania is a victim of physical violence. considered appropriate under Sharia law (Personal Six percent of all women have experienced sexual Code, Art. 57). Women are also disadvantaged in violence; this level is more pronounced in rural ownership rights over immovable property and inher- areas (7.6 percent) and among the poorest quintiles itance of assets. A woman may only inherit half of (8.4 percent) (ONS, MS, and ICF 2021). This situa- what is allocated to a man, and a daughter may inherit tion is rooted in gender inequality, which contributes only half of the property entitled to her male sibling to poor health and nutrition outcomes—and even (Personal Status Code, Art. 253–259). Furthermore, premature deaths—of young women and newborns. under the Personal Status Code (Art. 58), for prop- In response, the government has proposed a national erty acquired during a marriage, there is no legal law on gender-based violence (which is still pending provision of joint ownership between the husband as a draft) and created a National Observatory for and wife. As a result, women have less access to the Rights of Women and Girls. However, there is productive assets, resulting in only 6 percent of still no comprehensive legal provision addressing women owning land in Mauritania.14 gender-based violence, and challenges pertaining to gender equality remain. Nevertheless, in practice, Women are also underrepresented in politics and the government and religious leaders have engaged other forms of social activities. Even though the in programs that combat these harmful practices. share of seats held by Mauritanian women in Parlia- ment increased dramatically from 4 percent in 2000 Women are not regularly involved in household to 20 percent in 2021, it remains far below that of decision-making. Only 55.1 percent of women age most regional peers such as Chad (32.3 percent), 15–49 participate (alone or jointly with their partner) Mali (27.3 percent), Niger (25.9 percent), and in major decision-making activities in the household, 13 Senegal (43.0 percent).15 Women’s political repre- while 22 percent do not participate at all (ONS, sentation has likely improved due to the introduction MS, and ICF 2021). Decision-making power within of the quota system in 2012, which stipulates that the household increases with wealth: where only women should make up at least 20 percent of legis- 52 percent of women from the poorest wealth quintile lative candidates (Organic Law Promoting Women’s participate (either alone or jointly) in decision-making Access to Electoral Mandates and Elective Offices regarding their own health, 73 percent of women Law 2012-034, Art. 4A). Still, women are largely from the richest income quintile do. absent from senior positions in the public sector. Existing legal provisions strongly affect women’s There is evidence that social norms in Mauritania economic opportunities, constraining their access are not rigid and can be changed. While less than to certain jobs and ability to inherit and own property. 1 percent of employed women are entrepreneurs, Mauritanian women are prohibited from working in there is a minority of women, especially among the occupations that are likely to affect their health and Moorish ethnic group, who have overcome unequal physical integrity or “injure their morality.” Moreover, gender relations to form a group of successful busi- women are prohibited from working night hours in nesswomen (Lesourd 2014). specific environments, including factories, plants, and mining quarries (Labour Code, Art. 166). If married, a woman may pursue a profession outside the marital Gender disparities also exist in financial inclusion: 14  home, yet she is bound to those professions that are 1 percent of rural women have an account at a financial institution—which is lower than 5 percent of rural men, 10 percent of urban women, and 21 percent of urban men (ONS, MS, and ICF 2021). Decisions regarding own health, own earnings, and large 13  household purchases. 15  Source: World Bank, World Development Indicators. 50 Mauritania Human Capital Review Estimating the impacts of of potential workers do not live to the age of retire- boosting gender equity in ment. Second, the burden of noncommunicable human capital utilization diseases is growing.16 While the incidence of diabetes (3 percent) and hypertension (4 percent) in the Greater equity in earnings could increase human disease burden is low, it is growing. Obesity, partic- capital. In 2018, the global gender gap in human ularly among women, is highly prevalent: 54 percent capital was 57 percent, leaving the gap to close of women age 15–49 are overweight or obese (ONS, at 43 percent (table 4.8). In Mauritania, the gap to MS, and ICF 2021). This creates a double challenge close is much wider at 74 percent. Simulations using of completing the epidemiological transition while the gender gap in human capital to calculate the managing the new types of health conditions. gains that could be achieved from greater equity in earnings show that human capital worldwide The poor quality of the water supply is one of the could increase by 21 percent with gender parity. reasons for the country’s poor health outcomes. In low-income and lower-middle-income countries Mauritania has the lowest overall rate of access to where the gender gaps in human capital are more improved water in the region (World Bank 2017c). pronounced, the gains from gender parity would Limited access to improved water has contributed be larger. For example, Mauritania’s human capital to poor health, which in turn has led to a difference could increase by 37 percent with gender parity. of 10 percentage points in labor participation and employment among people age 55–64 compared to those age 45–55. In Mauritania, only 10 percent of workers age 50–65 stop working because there Human capital utilization is no need to continue employment. By contrast, as of older workers much as 16 percent of them list health problems, 28 percent cite family obligations, and 4 percent Older workers leave the labor force relatively early point to the absence of suitable employment as partly due to poor health. To participate in produc- reasons to quit working. tive economic activities later in life, it is essential to be in good health and have working conditions that are adapted for older workers. There are several health-related challenges facing the Mauritanian Acute respiratory infections and diarrhea, followed 16  labor force. First, the adult survival rate for people by helminthiasis and malaria, are the leading causes of morbidity in Mauritania—acute respiratory infections and age 15–60 is 80 percent, meaning that 20 percent diarrhea account for 52.0 percent and 28.4 percent of confirmed cases of common pathologies, respectively. Table 4.8  The potential gain from achieving gender equity in human capital is large Gender gap ratio in the value of Potential gain from gender equity (increase human capital per capita (%) of human capital as % from base) Country/region 1995 2018 1995 2018 Mauritania 27 26 37 37 Low-income countries 51 47 25 27 Low-middle-income countries 36 28 32 36 Sub-Saharan Africa 78 49 11 25 World 55 57 23 21 Source: World Bank 2021a. 4  Utilizing human capital 51 Policies to improve the inclusive economic development. In connection with the SCAPP, the Ministry of Employment, Vocational utilization of human Training, and Information Communication Technolo- capital in Mauritania gies has drawn up the National Employment Strategy (Stratégie Nationale pour l’Emploi—SNE) for 2018– Mauritania needs to strengthen and increase the 2030, which was approved by the government in utilization of human capital to accelerate and sustain March 2018.17 Its main objective is to increase the inclusive growth. The country is positioning itself to number of youth accessing jobs through employ- sustain and accelerate inclusive growth by lever- ment programs from 20,000 in 2018 to 110,000 by aging its existing comparative advantages such 2030. This expansion is essential, as it will enable as exploiting resources related to the extractives, the ANEPEJ to manage the annual influx of grad- fisheries, and livestock industries. Meanwhile, it is uates to the labor market and help develop a more gradually shifting to private sector–led diversifica- comprehensive and better-tailored approach for tion in urban-based competitive, labor-intensive various groups. The strategy defines “the priority sectors, which requires a well-educated workforce. targets of Mauritania’s employment policy as In addition to the macroeconomic, governance, and women, youth (aged 15–24), and lower skilled with fiscal policies that are necessary for enabling human primary and secondary education.” A Demographic capital–based development, specific human devel- Dividend Laboratory has been established, and it opment–related policy action is needed. This section has been an important part of monitoring the imple- provides an overview of existing policies to better mentation of Mauritania’s human capital strategy. utilize human capital, identify current policy gaps, and formulate policy recommendations. SCAPP implementation has so far been slow, partially due to extreme institutional fragmenta- tion. For example, a recent stock-take of youth Labor market policies in Mauritania employment programs identified a range of initia- tives managed by 19 international organizations18 Mauritania has taken steps to reform its Labor Code, (World Bank 2019a). Supply-side programs have Social Security Code, and collective bargaining dominated in Mauritania, and there have only been agreements which date back to 1974. The country a few demand-side programs focused on boosting aims to provide workers in informal and occasional occupations in some sectors (e.g., transportation) with formal wage contracts and extend social secu- its general policy statement delivered in September 17 In 2019, the government of Mauritania reiterated that rity benefits, including health insurance. Alongside increasing employment is one of its strategic priorities. these reforms is a renewed emphasis on strength- It announced its intention to “implement an employment strategy that will create tens of thousands of new quality ening job inspection to improve the enforcement of jobs in an inclusive and equitable manner,” and to set up labor regulations as well as to reduce child labor. “an annual youth employability program, particularly in promising sectors.” Optimizing labor regulations and social security will become increasingly relevant as Mauritania looks to 18  These include the European Union, the Agence Française de Développement, the African Development accelerate the growth of better jobs. Bank, the German Credit Institute for Reconstruction (Kreditanstalt für Wiederaufbau—KfW), the German Federal Ministry of Economic Cooperation and Devel- In its Accelerated Growth and Shared Prosperity opment (Bundesministerium für wirtschaftliche Strategy 2016–2030 (Stratégie de la Croissance Zusammenarbeit und Entwicklung—BMZ), the United Accélérée et de la Prospérité Partagée, SCAPP), the States Agency for International Development, Interna- tional Organization for Migration, and the International government has prioritized employment to increase Labour Organization. 52 Mauritania Human Capital Review enterprise development for small and medium-sized and employs an integrated approach to address enterprises. Most of these demand-side programs key constraints for youth to access jobs. On the have a relatively small budget (between $0.3 million supply side, the project offers life and technical skills and $10 million) and cannot be sustained without training in both formal and informal sector firms. On donor financing. the demand side, the project fosters entrepreneur- ship and self-employment through business skills To successfully implement planned labor market training, cash grants, and business development policies, the authorities need to ensure better services. The involvement of the private sector in the monitoring and assess labor regulations and their upstream identification of training aims to improve potential impact on job creation. Certain sectors the relevance of programming and job placement are positioned to become drivers of growth through rates for young project beneficiaries/graduates. In increased private sector development (e.g., mining, addition, the PEJ strengthens the capacity of labor tourism, agriculture, and digital services); these market services and intermediation centers such as sectors, along with enabling sectors such as Techghil to provide job orientation and counseling as personal services, commerce, transportation, and well as labor market information. The project further housing, have the potential to spur job creation. This supported building a cloud-based management needs to be closely monitored through, for example, information system, which could serve as a plat- dedicated jobs indicators (table 4.9). form for intermediation going forward. The project is using the social registry to target vulnerable youth The World Bank–supported Youth Employability from poor households. Project (Projet d’employabilité des jeunes—PEJ) is the largest employment project in Mauritania Table 4.9  Suggested indicators to track outcomes along different dimensions of jobs Job creation Job access Job quality Job creation Labor force participation Worker productivity ■ Number of direct or indirect jobs Extent to which population is Value of total volume of output ■ Number of short- or long-term jobs economically active (employed or produced (in US$ or local currency actively looking for work) unit) during a given time period divided by the number of full-time- equivalent employees during the same period New enterprises Working of labor market Working conditions and benefits Number of new firms ■ Functioning of labor market in ■ Physical work conditions balancing supply of labor (workers) ■ Work satisfaction and demand for labor (firms) ■ Number of hours worked ■ Number of workers using (public or private) employment services ■ Coverage by social security insurance, e.g., pension, ■ Average length of time to fill a unemployment insurance vacancy Entrepreneurs/self-employed Access to and opportunity for jobs Earnings/livelihoods Number of existing and new Access to employment opportunity Improved income or savings due enterprise owners who employ at for disadvantaged groups (women, to livelihood/income-generating least one nonfamily worker; farmers, youth, poor and vulnerable activities self-employed populations) Source: Adapted from World Bank, Jobs M&E Toolkit. 4  Utilizing human capital 53 To address the low economic inclusion of women, appropriate skills, and it is further weakened by the the Sahel Women’s Empowerment and Demographic absence of integration with trade and secondary Dividend project aims to create an environment for agri-businesses. Moreover, job creation in untapped Mauritanian women to achieve equal rights with sectors such as construction, industry, and fish- men regarding education, reproductive health, and eries has been dampened by the country’s poor productive income. This multicountry, integrated regulatory framework, corruption, and clientelist project combines health, education, economic hiring practices. Employers also face challenges empowerment, and behavioral change of adolescent in recruiting workers because of lack of practical, girls with country-specific activities. The project is job-relevant skills. Mismatched labor regulations in financed by the World Bank and receives technical terms of contracting restrictions and high labor taxes assistance from the United Nations Population Fund may be driving firms to remain in the informal sector, (UNFPA) and other partners. It includes a subcom- dampening wages and opportunities for improving ponent dedicated to the economic empowerment the quality of jobs. To meet these challenges, the of women and girls, including training in nontra- country has taken steps to improve macroeco- ditional professions to provide them with higher nomic fundamentals such as adopting tax and income-earning opportunities and grants for land reforms. However, unaddressed constraints to self-employment and entrepreneurship. The project private sector growth, including access to finance, is unique in that it relies effectively on local religious reduce job creation and hinder the employment authorities to advance the family planning agenda prospects of especially vulnerable groups. and combat gender stereotypes that prevent the full utilization of women’s human capital. It further There is a need to optimize the country’s labor supports a dialogue on national legislation and an market intervention programs. This could be done exchange between parliamentarians and legal asso- by first ensuring the effective monitoring and eval- ciations on national and regional priorities to ensure uation of existing mechanisms and understanding the national legal framework respects women’s their impact on the labor market. After a rigorous rights to health and education. evaluation, including an assessment of the results of the various programs being implemented, the authorities could streamline initiatives and better Opportunities to strengthen target youth and women. The government could also the utilization of human develop a strategy to promote the green economy capital and encourage the specialization of women. In addi- tion, it could develop organic agriculture, particularly Based on the analysis of human capital utiliza- in rural areas, which would require more resources tion, table 4.10 summarizes the main issues that to train and support women. prevent Mauritania from fully reaping the benefits of its human capital, and clarifies why addressing The authorities need to ensure that Mauritania’s these issues is strategically important and how the vocational training centers address young people’s current approach can be enhanced. poor labor market prospects. Low employment rates for youth and very low starting earnings for Lack of job opportunities is due to various younger workers suggest an inadequate education demand-side constraints. Since the agriculture system (e.g., lack of relevance of skills and overall sector is the largest employer in Mauritania, low poor quality of education, including literacy and agricultural productivity impedes growth. The agri- numeracy); lack of dynamism of the private sector; culture sector is hampered by lack of expertise and and failure of the labor market to match jobseekers 54 Mauritania Human Capital Review Table 4.10  Addressing key issues of human capital utilization in Mauritania Impact on the utilization of Policy to enhance the utiliza- Key issue human capital tion of human capital Outcome ■ Improve the quality of High youth unemployment education leads to delayed entry to the ■ Implement remedial ■ Improved social cohesion Challenging labor market, loss of human programs to support ■ Higher incomes transition from capital, poor matching of skills continued education and ■ Retained talent education to to jobs, reduced earnings targeted youth employment work over the life cycle, and and skills programs ■ Lower unemployment discouragement of continued ■ Better integrate social ■ Lower informality education protection and employment policies ■ Prevalence of low-return, ■ Diversify the economy and low-quality informal sector private sector development jobs ■ Improve labor market Underutilization ■ Low accumulation of skills information and ■ Increased labor incomes of the human at work intermediation and poverty reduction capital of ■ Inflexible career pathways ■ Enhance labor market ■ More flexibility to adapt to prime-age workers ■ Low job occupational regulations technological change mobility ■ Establish system for lifelong ■ Poor matching of skills to learning in partnership with jobs the private sector ■ Underutilization of women’s ■ Improve girls’ access to human capital in the education economy ■ Enhance adolescent health ■ Full utilization of women’s Gender human capital ■ Unmet needs of adolescents ■ Increase the economic and disparities in and youth on their social empowerment of ■ Improved demographic terms of access reproductive health and women dividend to opportunities rights ■ Remove legal barriers ■ Reduced violence against and distribution ■ Low female ownership of women of care ■ Change social norms responsibilities productive assets ■ Improved equity ■ Promote female ■ Barriers to participate in the entrepreneurship by ■ Greater resilience labor market and increase improving women’s access financial/economic inclusion to finance ■ Improve primary health and ■ Tendency to drop out of the preventive care access and labor market relatively early affordability ■ Reduced vulnerability Underutilization due to poor health ■ Improve the safety and ■ Enhanced income security of older cohorts’ ■ Limited transfer of job accessibility of jobs Better transfer of knowledge skills experience to younger ■ cohorts ■ Scale up apprenticeship and competencies programs and social ■ High dependency rate pensions to jobs. When new entrants to the labor market must To address low youth employment, the govern- wait for extended periods to get their first job and ment needs to ensure greater integration between have to accept jobs that may not be reflective of education/professional training (including remedial their skills, there is a depreciation of human capital education for underperforming youth), the private gained through education, reducing people’s life- sector, and social safety nets. For example, there long earnings prospects. could be a greater focus on supporting the informal sector in hiring young graduates. In Mauritania, 4  Utilizing human capital 55 there are many young people with the potential to utilize their human capital effectively by creating Box 4.1  Experiences with employment subsidies for vulnerable populations: enterprises, but they lack access to credit. To lessons from Jordan increase access to financing, the PEJ is providing seed funding for vulnerable youth entrepreneurs. Global experience suggests that employment This initiative needs to be evaluated, and the subsidies for hiring vulnerable groups such as youth and women may be a cost-effective and insights should inform efforts to scale similar type well-targeted tool to facilitate entrance into of programs. The government could further consider the labor market. The target populations for introducing employment subsidies so vulnerable subsidized employment programs tend to be groups such as youth or women could gather first more-vulnerable youth and those who need assis- work experience (see box 4.1). Even though there tance to overcome labor market frictions. While are programs in Mauritania that cover the cost of these programs have traditionally focused on the training or the provision of start-up kits (World Bank formal sector, subsidizing employer social security contributions, recent experiences have looked at 2017b), subsidies to employers have not yet been the potential for the informal sector. Subsidizing evaluated. initial employment offers a chance for vulnerable groups to gain work experience and demonstrate Many prime-age working adults in Mauritania fail their productivity to employers who might be to be fully employed, and those who do suffer underestimating it (e.g., because of social norms). from low labor productivity, reflected in low earn- ings. Relatively flat age earnings profiles suggest As an example, Jordan’s New Opportunities for Women (Jordan NOW) pilot offered a wage lack of on-the–job skills acquisition and continued subsidy voucher to reduce the cost of employing poor matching of jobs, and there are large regional women. Employers may see females as having a differences in employment rates and earnings. The higher probability of leaving early, which lowers authorities could potentially enhance workers’ labor any estimated returns from training them and from market experience through better labor market the experience females accumulate over their information systems, enforcement of existing tenure with the employer. If the expected benefit laws protecting workers, and a focus on boosting is lower, wage subsidies can keep the expected return of investing in female employees posi- productivity by promoting sectors with promising tive by partially offsetting the costs of employing potential. Migration management and policies to them. Community college graduates were given a facilitate the mobility of workers could also address nontransferable job voucher that they could take spatial mismatches. Strengthening opportunities to a firm while searching for jobs. The voucher for formal wage employment entails a two-pronged paid employers the minimum monthly wage for a approach: (1) enhancing job creation incentives for maximum of six months if they hired the worker. A randomized controlled trial evaluating the short-term impacts, and (2) reforming labor regu- program found that the wage voucher led to a 38 lations to improve jobs over the mid to long term. percentage point increase in the short run (Groh Restructuring labor regulations to improve pros- et al. 2016). In this particular case, the evaluation pects for the 84 percent of the workforce located finds that the program did not lead to long-term in the informal sector will be critical. Key issues employment increases, as productivity levels that remain include ensuring that employment remained below the binding minimum wage for contracts and social security policies facilitate a college graduates. This highlights that employ- ment subsidies can be an interesting tool to offer gradual transition from precarious jobs to employ- initial work experiences but need to go hand in ment with working conditions and incentives hand with a strong and relevant education system adapted to a modern, inclusive economy. Increasing to prepare productive workers. 56 Mauritania Human Capital Review transparency in recruitment for public jobs is also access to primary health, (4) implementing incen- necessary, as nepotism remains the general rule, tives to prevent child marriage, and (5) empowering preventing the efficient use of human capital and women to establish their own businesses and discouraging applications. providing them with nontraditional skills. Priorities include interventions focusing on skills, financing, Promoting green jobs could also improve produc- and behavior (World Bank 2017b). tive employment prospects. Transitions to green jobs affect close to 3 percent of employment in There needs to be better targeting and delivery of emerging markets. For Mauritania, an analysis of 19 lifelong education support to young women, driven the green economy could provide additional insights by private sector demand. The authorities need to on how to harness skills associated with traditional ensure that financial instruments reach women and knowledge in rural areas to improve the utiliza- provide them with better access to bank accounts, tion of existing human capital. These green jobs access to mobile money, and alternative forms of focus on conservation, resource management, and collateral. This can be supported by leveraging climate resilience, safeguarding rural livelihoods, solutions that utilize information and communica- and increasing incomes in rural areas. The govern- tion technologies. To address important constraints ment can play a vital role in supporting these types related to social norms, the government needs to of jobs (IFAD 2023; UNCCD 2020). Moreover, the support behavioral change among Mauritanians green economy could offer a new niche for young by, for example, raising awareness of opportunities people and women to specialize (box 4.2). This available to women; ensuring greater legal enforce- could entail further developing organic agriculture, ment of restrictions on child marriage and sexual particularly in rural areas; but would require voca- harassment; enhancing the visibility of advances tional training centers providing more support and made by Mauritanian women; increasing the public training for women. participation of women at all levels of society; and providing services such as household-based coun- Improving women’s participation in the labor market seling. requires the adoption of multisectoral policies. Low employment rates for women and the poor quality of While Mauritania is a young country (with half its jobs available to them reflect labor market barriers population below the age of 20), it needs to ensure facing women and girls and low investment in the full utilization of older workers’ human capital. their human capital. No country can reach its full Mauritania’s population over age 60 is expected potential unless it utilizes the talents, skills, and to grow rapidly in the coming decades, tripling energy of women in the economy. In Mauritania, between 2020 and 2050. Despite this growth, few efforts to improve women’s labor market participa- policies are implemented designed to support older tion include (1) ensuring better adaptation of the populations. Further, little research in economics education sector to gender-specific constraints has specifically examined aging in Mauritania, to complete their education, (2) integrating labor though many opportunities exist for economists to market programs with safety nets to create addi- generate research evidence to inform the design tional incentives to complete schooling (e.g., of effective policies in this area. Despite no income through conditional cash transfers), (3) improving security in old age, workers in Mauritania tend to withdraw from the labor force relatively early, reflecting their deteriorating health and the preva- Source: International Monetary Fund PowerPoint 19  lence of jobs not suitable for older workers. Better presentation made to September 2023 meeting of the Senior Gender and Inclusion Advisory Group. public health care and preventative programs could 4  Utilizing human capital 57 Box 4.2  Approaches to estimate the potential of green jobs The International Labour Organization (ILO) and the Organisation for Economic Co-operation and Development (OECD), along with many countries around the world, are developing methodologies to estimate the scale of labor reallocation from polluting industries to new green occupations. The ILO (2011) adopts the direct carbon emissions per unit of value as a proxy to classify high (or low) carbon-intensive sectors as those above (or below) the median of carbon dioxide emissions across industries. The OECD (2012) classifies polluting indus- tries by using carbon dioxide emissions intensity to help identify the top 10 polluting sectors that are most likely facing the strongest structural adjustment pressures. The United Kingdom uses greenhouse gas and carbon dioxide emissions intensity as the level of emissions per unit of economic output, while the US Energy information Administration applies carbon intensity as the amount of carbon by weight emitted per unit of energy consumed. The Emissions Trading System of the European Union uses a list of specific sectors based on the rate of direct emissions plus emissions derived from electricity consumption (in kilograms of carbon dioxide), divided by the gross value added of those sectors. Finally, Statistics Canada utilizes a measure of the economywide effect on energy consumption or greenhouse gas emissions brought about by a change in the demand for an industry’s output. In most countries—including in Mauritania—the most polluting industries are often in the energy, transport, intensive agriculture, and manufacturing sectors. A growing number of national governments are developing their own definitions of green jobs. The US Bureau of Labor Statistics use two different approaches: (1) an output approach, which identifies jobs in businesses that produce goods or services that benefit the environment or conserve natural resources; and (2) a process approach, which identifies jobs in which workers’ duties involve making their establishments’ production processes more environmentally friendly or use fewer natural resources. Of 1,500 occupations, the US Bureau of Labor Statistics has identified 127 as green. In Germany, the definition of green jobs refers to “employees who produce environmental goods and services, or employees involved in environment-related activities.” Other countries such as France do not have an official definition of green jobs, even though the country’s statistical agency reports on green employment counts. China in 2010 defined green jobs as those related to the develop- ment of a low-carbon, environmentally friendly economy, including low-carbon development and environmental protection. In 2008, the ILO, in cooperation with the United Nations Environment Programme, the International Organisation of Employers, and the International Trade Union Confederation, developed a broad industry-based definition of green jobs and stipulated that green jobs must also offer adequate wages, support workers’ rights, and offer safe working conditions. China’s green occupations accounted for 7.03 percent of all jobs and totaled about 54.42 million in 2015; these occupations are projected to double by 2035. Source: World Bank 2021e. help the older population stay healthy and retain sustain efforts in scaling up health insurance to their productivity. Moreover, Mauritania should support the older workforce. consider implementing a retirement scheme and 5 Assessing the strengths and gaps in protecting human capital   Key messages Human capital risks and ● Mauritanian households are highly exposed policy responses to individual- and population-level shocks Understanding the types, complexity, interaction, that affect the accumulation and utilization of human capital. These shocks are likely to and drivers of concurrent shocks is critical to devel- be further amplified by climate change, food oping a prevention, preparedness, and response insecurity, and greater volatility in the global strategy. An effective response to shocks considers economy as well as increasing insecurity in various needs and ensures the appropriate timing, the Sahel region. scale, design, and delivery of response measures. ● Households’ coping mechanisms in the event In the Sahel region, overlapping dynamic covariate of a shock often have negative effects on shocks are characterized as either slow and rapid human capital. shocks, which are predictable and recurrent; and ● An effective and comprehensive adaptive unpredictable shocks, many of which individually social protection system can protect house- or concurrently lead to protracted crises. There holds from individual- and population-level are also shocks that are idiosyncratic—specific to shocks. The government has made significant a household such as illness of a family member. investments and advances in strengthening its adaptive social protection system. Traditionally, Mauritanians have relied on strong ● To enhance the protection of human capital, family and community ties to weather shocks. These human development–related service delivery types of informal safety nets are, however, increas- needs to become more adaptive and resil- ingly under stress and are unable to efficiently cope ient, which will require further investments in data and information, such as early warning with covariate shocks. The COVID-19 pandemic systems, delivery platforms, tools, and coordi- reversed progress in poverty reduction with an nation. increase of extreme poverty to 6.1 percent in 2020, and of the overall poverty rate to 33.6 percent in 2021 (World Bank 2022d). As a result, households This chapter provides an overview of various shocks often rely on coping strategies that can lead to affecting Mauritania, responses to those shocks, losses in human capital accumulation or utilization, and options to strengthen social risk management such as taking children out of school or reducing the to prevent negative coping strategies. nutritional content and quality of foods consumed; or strategies that can impoverish households, such 58 5  Assessing the strengths and gaps in protecting human capital 59 as herders decapitalizing livestock, leading to a Adaptation Index,3 behind many peer countries in collapse of livestock prices. the region such as Ghana, Senegal, Côte d’Ivoire, Morocco, and Algeria. Mauritania is among the coun- Climate-related disasters are particularly prev- tries most vulnerable to climate change, and its level alent in Mauritania, which is located between an of preparedness for climate change is lower than the expanding desert and an eroding coastline. The average of peer countries. The World Bank (2022e) livelihoods and food security of Mauritanians— predicts that Mauritania’s gross domestic product especially those who rely on livestock rearing, (GDP) will be reduced by 2.8 percent by 2030 due agriculture, or fishing or live in precarious informal to climate change impacts, with an amplification of urban settlements—are jeopardized by encroaching economic losses by 2050, if urgent investments in desertification, rising temperatures and ocean climate adaptation are not implemented. levels, warming seawater temperatures, ocean acid- ification, biological overexploitation of fish stock, The main shocks reported by households relate to the increasing scarcity of water, and flash flooding, agropastoral activity and include the loss of cattle, coupled with the greater regularity and intensity of drought, and floods. Almost half of all house- drought and soil erosion. In 2022, Mauritania expe- holds and two-thirds of rural households report rienced one of the worst lean seasons since 2012: having experienced shocks over the previous over 875,000 people (20 percent of the population) year (2017/18 Resilience Index Measurement and were considered in crisis in terms of food and nutri- Analysis Survey). The most prevalent are idiosyn- tional insecurity; this was more than twice as many 1 cratic shocks, especially serious illnesses in the as in 2021, and was due to a combination of drought household or loss of cattle;4 followed by covariate and global price pressures. Mauritania also experi- shocks, such as floods and drought.5 Poverty rates enced some of its worst flooding in 2022 because among pastoral households can increase by up to of strong and erratic rainfall, which affected nearly 27 percent during periods of drought (World Bank 40,000 individuals and destroyed 3,800 buildings, 2022c). Households located in inland regions are mostly in the poorest areas of the country (World more affected by shocks than households in coastal Bank 2023d). It led to disruption or destruction of zones (figure  5.1). While rural households are roads, water, and sanitation infrastructure; schools; more likely than their urban counterparts to suffer health facilities; and more. weather-related shocks, people living in urban areas are also at risk, as they rely on livestock as a mech- Climate change will likely aggravate current trends, anism to accumulate wealth. especially considering the gaps in the country’s preparedness.2 Annual mean temperatures have already increased in Mauritania by approximately 3.1°C since the 1950s, and the country ranks 145th out of 185 countries on the Notre Dame Global The Notre Dame Global Adaptation Index shows a 3  country’s current vulnerability to climate disruptions and assesses its readiness to leverage private and public sector investment for adaptive actions. Source: United Nations Office for the Coordination of 1  Humanitarian Affairs (OCHA) Reliefweb, Mauritania: Many rural households regularly deal with zoonotic 4  Drought - Jun 2022. diseases that kill livestock and pests decimating crops. Mauritania is a breeding ground for desert locusts and 2  Mauritania is likely to experience an increase in average grasshoppers. temperatures of 2.0⁰C to 4.5⁰C by 2080 relative to prein- dustrial levels (AGRICA 2021). The number of very hot 5  One of the main challenges in Mauritania is the scar- days (maximum temperature above 35⁰C) is projected city of freshwater resources both for human consumption to increase substantially, with the southwestern areas and agricultural activities. The country consistently expe- reaching about 300 very hot days by 2080. riences large variations in precipitation. 60 Mauritania Human Capital Review Figure 5.1  Mauritian households, regardless of location, are affected mostly by agropastoral and climate shocks a. By agroecological zone b. Urban/rural Livestock death Livestock death Serious illness Serious illness Price shock Price shock Drought Drought Flood Flood Coastal Valley Rural Loss of harvest Loss of harvest Pastoral Urban Loss of employment Loss of employment 0 10 20 30 40 50 0 10 20 30 40 50 Percent Percent Source: Based on data from the 2017/18 Resilience Index Measurement and Analysis. Using traditional mechanisms to optimize the use of Higher temperatures will reduce productivity due to scarce resources, such as internal and cross-border heat stress and increase production costs; and they migrations by livestock farmers, has become more can severely affect learning, worsening the envi- difficult. Livestock farmers have traditionally prac- ronment for building human capital. The effects of ticed internal and cross-border migration to optimize higher average temperatures on labor heat stress, access to water and pasture, regularly crossing human health, and the availability of water and the border with Mali and Senegal. However, these sanitation all directly affect the economy, primarily movements have been hindered by violent conflicts through labor productivity. Moreover, inland and climate change (IOM 2020). As a result, many flooding, sea level rise, and soil erosion directly livestock farmers have abandoned their traditional affect the use and availability of capital goods. livelihoods and have instead migrated to urban The shock of higher temperatures on productivity centers—specifically the capital city of Nouak- can be as large as 15 percent by 2050, depending chott, which now accounts for half of Mauritania’s on the scenario (ILO 2019). Lack of safe drinking urban population. However, a large part of the water is likely to contribute to local outbreaks of city is located below sea level (42.9 percent), and water- and vector-borne diseases in addition to the quality of its housing stock and infrastructure causing food shortages and malnutrition in chil- makes it highly vulnerable to rising sea levels, more dren (UNICEF 2022), negatively affecting children’s frequent and intense flooding, and extreme weather learning outcomes (Pabalan et al. 2018; Goodman et events. These topographic challenges are aggra- al. 2018). Floods and storms could directly damage vated by uncontrolled infrastructure building and school buildings and other assets, interrupt educa- inadequate drainage systems. The lack of sanitation tion, and reduce access to health facilities. Periods infrastructure and urban waste management makes of drought can also require children and young urban groundwater supplies particularly vulnerable adults to spend more time tending to family farming to floods and other shocks. operations, hampering learning. 5  Assessing the strengths and gaps in protecting human capital 61 Mauritania imports more than half of its staple 2019, almost 40 percent of nonpoor households in foodstuffs and struggles with high trade costs. The rural areas were at risk of falling into poverty, much country is self-sufficient in the production of red higher than the 9 percent of nonpoor households meat and fish, but imports 60 percent of staple living in urban areas (World Bank 2022c). foodstuffs, especially rice, vegetables, sugar, and cooking oil.6 Price shocks are widespread and affect Mauritania is exposed to fast-spreading outbreaks most households, even though not all are suffering of infectious diseases because it is at the cross- to the same degree. Variations in the international roads of Sahelian population movements and price of basic foodstuffs are worsened by high highly dependent on livestock. Due to its heavy trade costs. Despite declining over time, aggregate reliance on animals, many recurrent zoonoses are trade costs in Mauritania remain the highest among present in Mauritania, including rabies, Q-fever, peer countries (such as Senegal, Morocco, or The and Crimean-Congo hemorrhagic fever. The risk Gambia; see World Bank 2020a). Long distances of these diseases affecting the human population and the high cost of transportation limit the integra- is high. The capacity of human health and veter- tion of products and labor markets. Every spike in inary services to handle the risk is low due to a international prices of basic foodstuffs is thus multi- shortage of well-qualified health and veterinary plied by high transaction costs, leading to drastic paraprofessionals, the low capacity of provincial cuts in the purchasing power of households and laboratories, and lack of public awareness about undermining their food security and nutrition. human and animal health. In response, Mauritania has been investing in building a disease surveillance The country’s dependence on natural resource system to strengthen human health, animal health, revenue and imports of basic foodstuffs makes and disaster response systems to ensure resilience it extremely vulnerable to changing world prices to outbreaks and health emergencies (the One of basic commodities. The real exchange rate in Health approach). It also helped create a coordi- Mauritania is overvalued due to limited exchange nated approach to detecting and swiftly responding flexibility and ineffective monetary policy (World to public health threats and strengthened health Bank 2020a). This is coupled with financial vulnera- information systems, which allowed the government bilities that undermine economic diversification and to respond quickly to the COVID-19 crisis. increase the country’s exposure to external shocks. High import tariffs shield domestic producers from Protection against idiosyncratic health shocks is international competition and impede access to hampered by gaps in health insurance coverage. cheap imported inputs, and they amplify the impact The country’s insurance schemes do not provide of changes in international markets on domestic sufficient coverage. Neither the national health insur- prices. These challenges result in pervasive food ance scheme (covering 15 percent of the population insecurity in Mauritania. Every year, between only in the formal sector) nor the community-based 300,000 and 800,000 individuals are food inse- health insurance scheme (covering 0.35 percent cure during the lean agricultural period; 660,000 of the population) manage to cover those most in individuals were deemed food insecure in 2022.7 In need. As a result, 1.5 percent of the population is likely to fall into poverty because of catastrophic health spending (World Bank 2022c). The costs International Fund for Agricultural Development, 6  of services and medicines are prohibitive for the Mauritania webpage. 7  Source: Integrated Food Security Phase Classification (IPC), Cadre Harmonisé, 2022. During the 2012 lean of Mauritania’s total population—experienced food insecu- season, an estimated 1 million people—nearly 27 percent rity (van der Borght, Ishizawa, and Lefebvre 2023). 62 Mauritania Human Capital Review poorest households, and making special payment when most members of the community are affected arrangements or using personal connections to simultaneously. receive treatment is common. Households have traditionally relied on informal The COVID-19 pandemic has negatively affected community and family networks to cope with shocks, access to essential health and nutrition services. but these traditional safety nets are unable to keep Fear of infection and lockdown measures curtailed up with the high frequency of covariate events. community-based health education, promotion, Informal networks remain especially common and service utilization during the pandemic. While in the valley and pastoral areas, where aid from the country developed the National Action Plan informal risk-sharing networks is the most prevalent on Health Security in 2018 and is strengthening risk-sharing mechanism (44.5 percent). However, the One Health platform, the national prevention, the increased frequency and severity of covariate preparedness, and response capacity assessment, shocks overwhelms these networks, which have using Joint External Evaluation tools, was outdated already been eroded due to social and demographic in 2017. Furthermore, the 2022 flood revealed a changes.8 In addition, informal risk-sharing mecha- need for constant and timely multisectoral coordi- nisms do not guarantee protection for everyone in nation and collaboration among multiple ministries need (World Bank 2022c). and development agencies not only in response to emergencies but also for better preparedness at Households exposed to sudden shocks are forced both the national and subnational levels. to respond primarily by using negative coping strat- egies. Households that are the most vulnerable to shocks are also those that are the least equipped Existing coping strategies to invest in human capital. Only 27 percent of to respond to shocks and school-age children living in households identified human capital risks as vulnerable to shocks attend a formal school; this is one-third the enrollment rate of nonvulnerable Most households across Mauritania lack effective children (World Bank 2022c). As a result of the use mechanisms to cope with shocks. Households’ of negative coping strategies, the cycle of underin- main self-reported coping strategies during a vestment in human capital starts early in life. Acute drought are selling household assets (29.1 percent), malnutrition, which is highly correlated with shocks, reducing food intake (20.5 percent), seeking help is affecting 12 percent of Mauritanian children under from informal risk-sharing networks (27.2 percent), 5 years old during the lean season, and one in five increasing the supply of labor (8.3 percent), and children in the country is chronically malnourished.9 relying on child labor (0.7 percent) (World Bank Furthermore, the majority of the informal sector is 2022c). Several of these coping mechanisms are not covered by health insurance schemes and tends only useful in the presence of idiosyncratic shocks. to defer or forego necessary care. For example, it may not be possible to sell livestock or land when regionwide shocks have reduced the price of these assets. During a drought, there is a sell-off of livestock—a dangerous coping strategy that can impoverish herders because an increase Migration and changing social norms have led to shifts in 8  in supply leads to a collapse of prices. Similarly, household composition. The share of nuclear households informal risk-sharing networks may prove ineffective has increased, which has led to more fluid community compositions. 9  Source: World Food Programme, Mauritania webpage. 5  Assessing the strengths and gaps in protecting human capital 63 Social risk management is necessary to reduce the tive social protection can help improve the resilience negative impact of shocks on human capital. Given of poor and vulnerable households to shocks by that both idiosyncratic and covariate shocks are directly investing in their capacity to prepare, cope, prevalent in Mauritania, social insurance is needed and adapt to a crisis while building their resilience. to protect people from income loss due to illnesses, Therefore, adaptive social protection should be at unemployment, and life-cycle events and reduce the core of strategies to protect human capital and households’ reliance on negative coping strategies. build resilience to shocks. A public social security scheme that protects people needs to be complemented by a system of insur- Adaptive social protection programs build resilience ance mechanisms that protect productive assets by helping people better prepare, cope, and recover (e.g., crops and livestock insurance). In addition, from shocks. Preparedness relates to households’ there is a need for adaptive social protection and access to information and their efforts to mini- resilient delivery systems to protect households mize risks, such as (1) diversifying or adjusting from covariate shocks. Table 5.1 describes the key livelihood portfolios away from sources of income risks for Mauritanian human capital accumulation that are especially vulnerable to the impact of a and utilization. shock; (2) building an asset base, including produc- tive, financial, and human capital–related assets; and (3) leveraging assets to relocate away from an area of spatially concentrated risk. A more resil- Existing approaches to ient household typically has access to a range of protect human capital in private insurance and public social protection instru- Mauritania ments during severe shocks. The additional income provided through regular cash transfers aims to enable poor and vulnerable households, which Supporting household tend to underinvest in informal reciprocal safety resilience nets (i.e., family and the community), to strengthen traditional coping mechanisms of self-insurance Adaptive social protection programs are important to sustain repeated shocks. In the aftermath of a to avoid the use of negative coping strategies and shock, shock-responsive transfers support affected complement risk sharing through informal networks. households in their recovery efforts and prevent Social protection measures can help build social them from engaging in negative coping strategies. cohesion and maintain informal risk sharing in communities, enabling some of the most vulner- Historically, social safety net spending in Mauritania able households to access informal risk-sharing has been driven by the need to cope with cata- networks (de Milliano et al. 2021). Adaptive social strophic shocks, in particular food security shocks. protection systems use social protection tools (e.g., In 2013, 90 percent of spending on social safety a social registry, disbursement protocols, a payment nets was connected to a crisis response (World system, or a grievance redress mechanism) to Bank 2014), with food transfers representing an respond to a shock quickly and effectively.10 Adap- average of 82 percent of total spending. However, the response was extremely costly and not well targeted. The emergency program accounted for Adaptive social protection relies on an integrated 10  approach based on synergies between social protection, almost 10 percent of total government expendi- disaster risk reduction/management, resilient service ture from 2010 to 2013 and exceeded this level in delivery, and climate change adaptation; it aims to reduce the vulnerability of the poor and vulnerable to shocks. 2013 (11.8 percent) (World Bank 2019c). To better 64 Mauritania Human Capital Review Table 5.1  Key risks for Mauritania’s human capital accumulation and utilization Risk factor Impact on human capital Importance for Mauritania ■ The risk of serious illness is widespread in ■ A sick family member puts pressure on the Mauritania, affecting 20% of households; entire household, leading to the adoption of a sick family member has a strong negative strategies that may undermine investment in impact on all household members due to large or the utilization of human capital (especially out-of-pocket health care payments and lack Health-related of women, who are the primary care providers) idiosyncratic of access to care shocks ■ Multiple crises expose the population to risks ■ Existing disparities in service utilization may of worsening health and nutrition outcomes be further widened during and postcrisis and put health facilities under pressure to operate with elevated risks of disrupted essen- ■ The already low service readiness of health tial health service delivery facilities would further strain its capacity in the face of multiple crises ■ Droughts, which can result in famine, which in turn can hamper childhood development and ■ The country is exposed to regular droughts, lead to forced migration and displacement, whose frequency and severity are increasing lowering the utilization of human capital ■ Floods pose spatially concentrated risks ■ Floods, which can result in a loss of assets, to Mauritania, as a large part of the capital Increased which in turn can undermine human capital city of Nouakchott (42.9%) is located frequency investment and increase long-term health risks below sea level; households in the south are and severity ■ Temperature rise, which can result in heat also exposed to catastrophic floods due to of climatic stress, which in turn can lead to productivity changing precipitation patterns shocks loss (livestock and labor productivity loss) and ■ Temperatures are expected to increase by reduce learning 2–4°C by 2080 ■ Other shocks, including pests, which can ■ Recurrent locust invasions and death of cattle destroy crops and livestock; and pandemics, due to droughts undermine rural livelihoods which can reduce investments in human capital and negatively affect its utilization External economic shocks can result in vola- In 2014, the fall in commodity prices decelerated tile budget allocations for human development economic growth and reduced budget alloca- Exposure sectors if the financing of these sectors is tions for human development in Mauritania; to external dependent on (volatile) natural resource revenue; spikes in international food prices are ampli- economic moreover, price shocks are amplified throughout fied throughout the country’s economy due to shocks the economy, affecting growth and employment market imperfections and undermine food secu- prospects, and high exposure to international rity food prices leads to higher inflation Various negative coping strategies employed by households can have an adverse impact on Many Mauritanian households employ coping human capital: strategies that involve some or all of the ■ Reducing nutrition is especially harmful for following: children and women and can lead to malnutri- ■ Pulling children out of school Prevalence tion, increased morbidities of preventable and ■ Relying on child labor to supplement revenue of negative treatable diseases, and prolonged illnesses; (prevalence of child labor is 4%) coping strat- deferred and foregone care would cost the egies population and health systems more in the ■ Deferring or foregoing care longer term ■ Cutting meals, which undermines nutritional ■ Pulling children out of school interrupts chil- status, especially of mothers and children dren’s education (sometimes permanently) ■ Selling assets (as many as a third of house- ■ Selling assets and depleting savings limit holds sell assets when exposed to shocks) households’ capacity to recover after a shock Households experiencing life cycle–related crises can rely less on support from traditional Informal networks are especially important for Weakening networks; high unemployment and low employ- rural households (40% rely on them in case of traditional ment diminish the resources available to ensure of shocks), and very high dependency rates informal household and community resilience; informal in Mauritania reduce resources available for safety nets networks do not cover all in need of assistance, self-insurance and contribution to informal as they are based on reciprocity, and poor networks households have less to contribute 5  Assessing the strengths and gaps in protecting human capital 65 respond to shocks, the national emergency program the principles of adaptive social protection, which Emel was created during the 2010–11 droughts. Up means that it uses social protection tools (e.g., a until 2017, Emel was Mauritania’s largest safety net social registry, disbursement protocols, data from program, comprising both (1) a human component, an early warning system, and/or a payment plat- consisting of free emergency food distribution, form) to effectively respond to shocks. Elmaouna restocking of the country’s cereal banks, and the is closely integrated with the Tekavoul program’s Boutiques Emel program, which created a network terms of payments and data management. It has of over 1,200 shops selling basic food items at increased significantly in size since its inception and subsidized prices (e.g., wheat, rice, oil, sugar, and is now also responding to predictable shocks (e.g., pasta); and (2) an animal component providing live- the annual lean season). It has cumulatively reached stock support to pastoralists. In 2017, the program 168,192 households through shock-responsive cash was integrated into Taazour. transfers. In addition to cash transfers, Elmaouna provides access to Temwin stores (the former Mauritania has built the necessary foundation for an Boutiques Emel), which offer animal feed as well integrated adaptive social protection system, which as food suitable for people, offering an integrated includes both a regular and a shock-responsive service point for pastoralists. safety net program. Currently, there are two main social safety nets in the country: Tekavoul, a regular Despite the scale of the 2022–23 crisis, progress social safety net program targeting the chronic in building coordinated adaptive social protection poor; and Elmaouna, a shock-responsive program programs has improved the coordination of tech- targeting the chronic and transient vulnerable poor. nical and financial stakeholders and for the first Tekavoul combines regular cash transfers to the time ensured that cash transfers reach all in need extreme poor with social promotion activities and (in line with the National Response Plan). The Pres- productive inclusion measures to help chronically ident’s Flagship Expanded Program (Programme poor households build better resilience to shocks. Prioritaire Elargi du Président—ProPEP) 2020–2023 The coverage of Tekavoul is significant: the program was launched amid the COVID-19 crisis to support currently supports 97,886 households (including recovery and boost long-term inclusive growth with 7,214 refugee households), covering 47 percent the protection of vulnerable populations.11 There is a of households in the poorest income quintile. The strong endorsement of the government and its part- national coverage target of Tekavoul is all extreme ners’ adaptive social protection agenda and vision. poor households (100,000 households). The govern- In 2022–23, the government’s shock response ment’s commitment to funding Tekavoul is strong programs Elmaouna and Tekavoul reached 75,925 and growing. At its inception in 2020, the program households (455,550 individuals)—over 50 percent was entirely financed by donor resources. Since of those in need—while humanitarian partners then, the government’s contribution has grown, covered the remaining gap to reach the entire accounting for 25 percent of the total cost of the food-insecure population (850,000 individuals). program in 2021 and 50 percent in 2022. The shock response system and coordination mech- Under the National Social Protection Strategy, anisms have proven effective during the catastrophic the shock-responsive social safety net program floods in 2022. The Food Safety Commission Elmaouna is at the core of Mauritania’s adaptive (Commissariat à la sécurité alimentaire), the social protection system. Elmaouna aims to assist poor households affected by shocks that affect It also envisages fee exemption for obstetric care and 11  their economic capacity and well-being. It follows is supported by funding of approximately $50.8 million. 66 Mauritania Human Capital Review General Delegation for National Solidarity and the 70 percent of the Mauritanian population not yet Fight against Exclusion (Délégation Générale à la covered by a state-subsidized health insurance Solidarité Nationale et à la Lutte contre l’Exclu- scheme, in line with the National Health Develop- sion), Taazour, and the Mauritanian Red Crescent ment Plan and National Social Protection Strategy. were coordinated by an interministerial committee It was launched in three mughaatas in the Brakna under the leadership of the prime minister. The region and in the suburbs of Dar Naïm and Sebkha response was accompanied by the rapid evalua- in Nouakchott, before being gradually extended to tion of livelihood and infrastructure losses due to other regions of the country. However, important floods, which helped guide the response and assess challenges remain. For example, some members of its adequacy.12 This assessment revealed that the a household may fail to be included in the insur- response was not sufficient to cover all losses and ance scheme; and there is a problem of access to follow-up is needed to fully recover from the effect local health points, as opposed to access to regional of the floods (World Bank 2023d). hospitals, sometimes located far from their villages. Mauritania needs to protect human capital against shocks associated with health risks, given how Building the resilience of widespread these types of shocks are in the delivery systems country. The World Bank–supported INAYA project A social registry is at the core of an effective shock is working with Tekavoul and the United Nations response system. Mauritania’s system to respond to High Commissioner for Refugees to develop the shocks is based on its poverty map, an initial census eligibility requirements for the equity bonus.13 These of poor households, and subsequent verifications. bonuses incentivize health facilities to serve poor The work on expanding the country’s social registry patients and waive fees, and they enable facil- can be divided into two periods: a launch and first ities to recover the cost of delivering services to phase of expansion (2016–22), covering 28 percent extremely poor women and children, including those of the population; and a second phase of expan- among refugees and host populations. The govern- sion (2023–24), achieving the target of covering ment has also prioritized efforts to expand health 40 percent of the population, and the start of work insurance coverage, including among those in the to update existing beneficiary information. The informal sector. In November 2022, the govern- social registry includes complete data for 225,855 ment launched an insurance scheme through the households, of which 43 percent have up-to-date National Health Solidarity Fund (Caisse Nationale de records (less than three years old). The authorities Solidarité en Santé—CNASS), which aims to cover have initiated efforts to update and scale up the registry to increase its effectiveness as a coordi- 12  The assessment was guided by the General Delega- nation tool for social and humanitarian programs tion of Civil Security and Crisis Management (Délégation and activities.14 Générale de la Sécurité Civile et de la Gestion des Crises), which benefited from technical assistance and financing from development partners. The social registry is a crucial tool for the govern- INAYA was designed to support the implementation of 13  ment’s response during the lean season and is used the government’s 2015 results-based financing strategy by several partners. It is the main coordination tool (Stratégie Nationale du Financement basé sur les Résul- tats dans le Secteur de la Santé) in two wilayas and the and database to target beneficiaries, providing 2012 National Community Health Strategy. The results of INAYA’s core activities—improving the utilization and quality of assisted births, immunization, and prenatal The registry is expected to be fully updated in 2024/25, 14  care—have been satisfactory and offered lessons for at which point it should include 300,000 households, all nationwide scale-up of results-based financing. with up-to-date records. 5  Assessing the strengths and gaps in protecting human capital 67 reliable data to all partners involved in response efforts during the lean season (the registry is now Box 5.1  Coordinating the response to shocks used by 14 programs in Mauritania). The digital monitoring and payment platform developed by Mauritania has faced multiple simultaneous crises the social registry is further leveraged by several in recent years, including droughts, floods, and humanitarian partners for their cash transfer inter- the COVID-19 pandemic. The country has been ventions during the 2023 lean season. This platform unique in how stakeholders across human devel- opment sectors have come together to jointly allows for the monitoring of cash transfer interven- address these crises. These joint efforts included tion in real time and the leveraging of the existing the following: government contract with payment agents to ● A package of human development inter- distribute cash transfers. ventions combining health, education, employment, and social protection efforts, An important link has been established through including the social registry between the health insurance — The response to COVID-19, which tempo- scheme and the social protection system. This has rarily increased the value of cash transfers allowed the authorities to cover more poor house- under the Tekavoul safety net to house- holds by subsidized health insurance, resulting in holds with children below age five years 100,000 new beneficiaries being included in the and the Elmaouna program to facilitate a health insurance system.15 Some of Mauritania’s response to the lean season; successful multisectoral coordinations in shock — The provision of conditional cash trans- responses are highlighted in box 5.1. fers, providing a one-off financial incentive to households to have their children vacci- nated; and — The adoption of the One Health concept Options to strengthen aimed at employing a holistic approach and encouraging multisectoral collabo- the protection of human ration during a response to public health capital in Mauritania emergency events, such as the outbreak of high-impact infectious diseases emerging To protect human capital, public policies need to at the interface between humans, animals (domestic and wild), and the environment. build the resilience of households; invest in the resil- ience, agility, and adaptability of service delivery ● Integrated support for early childhood devel- systems; and prioritize the resilience of service opment and inclusive education. delivery tools. Households need to be protected ● The use of integrated payment platforms to against individual- and population-level shocks; easily reach target beneficiaries. delivery systems need to be operational without ● The use of integrated grievance redress mech- disruption and able to respond quickly in times anisms across human development sectors, of crisis; and public service delivery mechanisms such as the gender-based violence-responsive grievance redress mechanism supported through the Ministry of Social Affairs, Children and Family. 15  While an excellent starting point, beneficiaries report issues with this scheme. For instance, while the house- hold head might be included in it, the family is not; in same cases, beneficiaries do not have access to the local health point, but only to regional hospitals that are far from their villages. 68 Mauritania Human Capital Review need to be designed in such a way to ensure unin- digital payment platform pilot) to ensure it can be terrupted access to health and education during successfully promoted by government agencies and disasters. nongovernment partners alike. Human capital accumulation and protection is The country’s social protection programs are under- not only a productive investment but also critical going a transition as the first beneficiary households for green, resilient, and inclusive development. are set to complete the Tekavoul program. Following Investing in people supports the transition to a the registry update in 2023, around 20 percent greener economy and strengthens resilience to of current Tekavoul beneficiaries are expected to climate change. Education for girls, together with become ineligible, and an equivalent number of new family planning, reproductive and sexual health, and households will be enrolled for a five-year cycle (the economic opportunities for women, can have a posi- overall beneficiary number will remain the same). tive impact on resource use and the environment. This will make Tekavoul a truly dynamic program. People with good health and nutrition, relevant and Exiting Tekavoul households will be offered to partic- adequate education, savings and alternative liveli- ipate in economic inclusion activities to promote a hoods, and adaptive safety nets are more likely to soft transition out of the program by strengthening successfully weather a climate shock or pandemic. their productive capacity and resilience. These Service delivery systems that are adaptive and activities will represent the first completion of a full adequately staffed and supplied are also in a better Tekavoul cycle—from entry to exit and (re)enroll- position to respond to the next crisis. ment. Index-based insurance can support the finan- Resilience of households cial resilience of households to climate shocks. Index-based insurance schemes are private sector While Mauritania has built the necessary foundation solutions to reduce the adverse socioeconomic of an integrated adaptive social protection system, impact of climate shocks. They exist at different it can strengthen linkages with other sectors and levels, with policyholders being individuals, such as the agility of response efforts. The level of support farmers who take out policies from banks; coopera- and the agility of current response efforts could tives; or microfinance institutions; risk aggregators, be improved, and response programs lack integra- such as cooperatives; and governments within the tion with the early warning system and disaster risk international or regional reinsurance market. Mauri- management. Efforts to update the social registry tania has joined regional insurance mechanisms are under way; these are urgently needed, as less through the Africa Disaster Risk Financing (ADRIFI) than half of its records are up to date. The lack of program, which is part of the African Risk Capacity up-to-date records could make the social registry (ARC) initiative, to enable the country to take out an unreliable tool to coordinate a response. In addi- an index-based insurance policy for drought risk. tion, the productive elements of the safety nets, Index-based insurance products have traditionally such as their productive inclusion component, need focused on crop farmers, insuring a particular crop to be better monitored and evaluated to facilitate and providing a payout in case of drought based their expansion; the multiyear financing framework on a predefined index of drought, most commonly needs to be clarified; and the government needs through satellite data (e.g., the satellite normalized to promote the use of insurance instruments. The difference vegetation index or satellite rainfall esti- authorities also need to improve and expand the mates). Taazour payment platform (including evaluating the 5  Assessing the strengths and gaps in protecting human capital 69 Index-based insurance solutions have recently even in normal times and even less so in times of started to be developed for pastoralists to provide shocks; and the population has multiple, interrelated payouts in case of drought. Livestock farming is reasons to delay in seeking necessary care.17 They the dominant form of agricultural production in require multidisciplinary teams engaged in local Mauritania, as most of the country is not arable. surveillance and outreach activities. Such systems Like crop farmers, livestock farmers are very coordinate patients’ movements through the health exposed to climate-related shocks and vulnerable system, build trust-based relationships, and hold to droughts. Key features of these index-based themselves accountable for the health outcomes insurance schemes for pastoralists are the regular of local communities. monitoring of forage availability and payouts to pastoralists and other value chain actors in the Tackling high food prices for the urban poor will event of conditions that threaten livestock survival. require ensuring coordinated action between Satellite observations are used to measure forage improving the substitutability of domestic rice levels, which are then used to calculate potential production and enhancing the competitiveness of payouts using predefined rules. Payouts are made the rice importation market. High food prices and to pastoral groups or individual households, often amplification of global price volatility negatively using mobile payment systems to maximize access, affect the poor and vulnerable, especially in urban speed, and transparency. These types of schemes areas, and there is a strong case for further inves- have recently been introduced in northern Kenya tigating and addressing the indications of market and southern Ethiopia.16 domination and uncompetitive practices that appear to influence price levels. At the same time, The country’s health insurance scheme—key the government’s import substitutability program to improving resilience to idiosyncratic health could reduce the country’s food import dependency, shocks—has been expanding, but its current reach creating a buffer against food insecurity when world is small. While comprehensive health insurance food prices are high. This would require efforts to is critical to protecting households (in particular support producers in quality-enhancing initiatives poor households) against the risk of catastrophic across the value chain and longer-term efforts to health expenditures, Mauritania’s current scheme facilitate the pro-poor extension of small-scale irri- does not adequately cover the population. Out-of- gation. pocket health expenditures remain high, as many procedures are not currently covered by the basic Resilience of delivery insurance package. In addition, urgent invest- systems ments are needed to enable households to make use of health services. Resilient health systems To better protect human capital, Mauritania needs and health coverage require fit-for-purpose primary to move toward building agile, resilient, and adap- health facilities equipped with financial and human tive human development delivery systems. These resource surge capacities to respond to unexpected systems (1) can expand and contract quickly in shocks as well as improved care-seeking behaviors response to shocks, including the disbursement and user adherence to treatment. Currently, health facilities are unable to fully deliver adequate care Health facilities often lack equipment, space for consul- 17  tation, and human resource competencies to deliver health services: only 67 percent of facilities provide family plan- ning, 58 percent provide the basic package of prevention International Livestock Research Institute, Index-Based 16  services for children, and 69 percent provide assisted Livestock Insurance, 2022. delivery services (ONS, MS, and ICF 2021). 70 Mauritania Human Capital Review protocols; (2) promote interoperability and the COVID-19 project enabled the country to immedi- capacity of local stakeholders to make decisions ately respond to COVID-19 outbreaks and conduct in response to changing conditions, along with intensified COVID-19 vaccination campaigns nation- ensuring effective coordination; and (3) effectively wide with timely acquisition of COVID-19 vaccines. use data and technology. The project supported strengthening surveillance and diagnostic capacity. The project also supported To support those affected by shocks and ensure COVID-19 vaccination campaigns and routine vacci- access to services in case of covariate shocks, nation, which boosted overall COVID-19 vaccination human development systems need to be integrated coverage. The project further supported strength- and their service delivery needs to be resilient. ening the prevention and preparedness capacity Systems without these features risk service delivery to strengthen the disease surveillance information disruptions, compounding the impact of shocks. management system at the decentralized level, For example, when targeting is based on a social and included training for health workers in treating registry that is not dynamic (i.e., a social registry gender-based violence survivors and providing them that is not regularly updated), households newly with psychological support, given the elevated risks exposed to shocks may not receive assistance. of gender-based violence during and postpandemic with strained financing at households. In terms of health systems resilience, it is important to follow the “5s” concept: staff, stuff, space, The Regional Disease Surveillance Systems systems, and social support. To build resilient health Enhancement Project Phase III (REDISSE III) is systems, it is important to (1) build health founda- another example of strengthening the national tions (human resources for health, infrastructure, and regional intersectoral capacities for disease equipment, medicines, etc.) to effectively manage surveillance and epidemic preparedness, and rapid routine demand regardless of shocks; (2) improve response in the event of a health crisis. The project service readiness for continuous service delivery; has supported the government in setting up a One (3) improve health systems and networks (orga- Health platform to promote cooperation between nization of services); (4) collaborate with other environmental, animal, plant, and human health sectors such as disaster risk management and agencies to prevent and control zoonoses. The civil protection agencies; and (5) strengthen basic platform has managed several outbreaks, including infrastructure systems (electricity, transport, water, COVID-19, Rift Valley fever, Crimean-Congo hemor- telecommunications). rhagic fever, avian influenza, and polio. Other major achievements include reinforced capacity of labo- The Mauritanian authorities have made concerted ratories, establishment of a community network in efforts to address weaknesses in the country’s nine regions, setting up sentinel herds for hemor- capacity to deliver primary health services. A rhagic fever surveillance, reinforcement of the Kobo results-based approach is expanding to strengthen toolbox real-time information system, and acqui- health service delivery. The COVID-19 pandemic sition of a mobile veterinary clinic. Additionally, response and the successful vaccination campaign, multidisciplinary rapid response teams were trained. together with the implementation of health-related conditionalities to strengthen the link between the Education systems that ensure that learning can provision of health services and social safety net happen anywhere are more resilient to crises. programs, show the path toward further improve- Building these types of education systems requires ments in the resilience of service provision, with a expanding accessible digital learning platforms at focus on the poor and vulnerable. For example, the schools and investing in information systems to 5  Assessing the strengths and gaps in protecting human capital 71 track the enrollment and retention of at-risk students the implementation process, maximizing investment and engage citizens. In a resilient education system, efficiency, and reducing the vulnerability of infra- teachers need to know how to employ distance structure to future hazard events. learning platforms and tools to reach students in their households. The COVID-19 pandemic offered Better preparing for an opportunity to make the delivery of education increased frequency and more resilient. In response to the pandemic, Mauri- severity of climatic shocks tania introduced distance learning programs through radio and TV broadcasts and digital learning plat- Climate change has already started to deeply affect forms. However, these tools were often inaccessible the livelihoods and economic prospects of the due to the unavailability of the Internet and a lack Mauritanian population. Even through the country of television sets, particularly among poor families. has made progress in building social protection programs that can adapt to climate change, more The authorities need to improve the resilience efforts are needed to integrate these programs into of service delivery infrastructure to ensure it a coherent social protection system. The absence can function despite more frequent and severe of nationally approved and multisectoral standard climate-related shocks. For instance, 15 health facil- operating procedures describing how social protec- ities were severely affected by the 2022 floods in tion programs and delivery mechanisms will be their infrastructure and equipment, which disrupted leveraged in case of emergencies is a major chal- their health service delivery.18 Efforts to improve lenge across Sahel countries. Standard operating resilience include reducing delays in public service procedures need to define (1) triggers for expan- delivery in the aftermath of a disaster (World Bank sion—based on, for instance, information provided 2020b). Enhancing the resilience of infrastructure through early warning systems; (2) agreement on is not limited to improving facilities. It also includes the program(s) to be scaled up or adapted in case developing plans for business continuity, emer- of a shock; (3) transfer amounts to be provided; gency response, and reconstruction. The objective (4) transfer modalities; (5) the targeting methodology is to improve existing facilities to ensure they can and tools (e.g., building on Cadre Harmonisé and support contingency measures included in conti- early warning system data or the social registry); (6) nuity and emergency plans (e.g., providing shelters overview of roles and responsibilities; and (7) ways or relocating classrooms in the case of schools). to scale up human resource capacity where needed. These plans define the decision-making process, Establishing these procedures is important to rein- stakeholders, roles, and resources required during force shock-responsive social protection systems, an emergency or crisis. Reconstruction planning as they can ensure a more agile, efficient, and coor- considers the sector’s capacity to assess the impact dinated response and avoid delays. of disasters, derive evidence-based data from infra- structure failures, and integrate findings into the In Mauritania, the Food Security Monitoring Survey reconstruction strategy. This would ensure that is conducted twice a year and provides first-hand reconstruction planning contributes to accelerating information on the country’s food security situation for planning interventions. However, these surveys are mainly focused on monitoring the cereal produc- The stagnated water throughout the cities and the 18  tion deficit. This limits their effectiveness because absence of a solid and liquid sanitation system further the proportion of households dependent on the elevated risks of waterborne diseases. Cases of Rift Valley fever and Crimean-Congo hemorrhagic fever were external market for food security is larger than the recorded. 72 Mauritania Human Capital Review share of households dependent on agricultural strengthen the integration of risk reduction into production. The timing of surveys is also not ideal sectoral development policies and strategies to to support calibration of the forecast model devel- better understand risks, implement adaptation and/ oped in collaboration with the government and the or reduction measures, and better protect against World Food Programme. Moreover, the Food Secu- future disasters. This will include the development rity Monitoring Survey does not analyze urban of a national disaster risk reduction program; the vulnerability and does not consider livestock, even revision or development of industry codes and stan- though its contribution to food security is very high dards; and ensuring that climate risks are better in Mauritania. taken into account in land use planning, particu- larly urban planning. Finally, it will be useful to set New approaches offer a promising way to strengthen up awareness-raising programs on the risks of the use of data for early warning. The catastrophe floods and droughts, to be disseminated to the risk model developed by Blanchard et al. (2023) can most-vulnerable and exposed populations, local produce fairly accurate food-insecurity predictions authorities, and officials of ministerial departments. for the lean season early in the agricultural season (October–November), which translates to six to eight months before the start of the lean season. Applying Financing mechanisms for this model to estimating the risk of food insecurity at preparedness and response the household level shows that 31 percent of house- to climate-related events holds in rural Mauritania have at least a 50 percent To improve Mauritania’s resilience to future shocks, chance of being food insecure in any given year. The the authorities need to ensure financial instru- accuracy of this new approach represents a clear ments can be deployed rapidly at the onset of a improvement in the existing (largely qualitative) early crisis. These instruments could include contin- warning system used in Mauritania and other coun- gency borrowing, sovereign wealth funds, and other tries in the region. The model could feed into early crisis response vehicles. There is also a need for warning systems to support intervention planning careful fiscal management, including medium-term and inform the design and targeting mechanisms of expenditure frameworks for planning and debt early response programs that prevent the negative sustainability analysis. Beyond direct financial plan- effects of shocks on the vulnerable. ning, adequate preparation could involve regulatory adjustments and national and international cooper- Based on the lessons learned from its shock ation on forward-looking strategic planning. responses, Mauritania can further strengthen its adaptive capacity. At the next stage, it will be The government has taken steps to create innova- important to update and strengthen the legal and tive ways to finance the country’s adaptive social institutional framework for risk management and protection programs. It has been working on oper- emergency response to have effective manage- ationalizing the Shock Response Framework ment and decision-making tools and mechanisms (Dispositif National de Prévention et de Réponse in place. The establishment of a unified legal frame- aux Crises Alimentaires et Nutritionnelles—DCAN) work for disaster preparedness and response will be since it was approved by decree in December particularly sought to ensure a more consolidated 2022. The framework was used for the first time and coordinated response of the various institu- in 2022 to oversee the preparation of the national tions. It will also be important to update outdated response plan for the lean season as well as its contingency plans and develop a new national multi- implementation. The government also adopted the hazard contingency plan. There is also a need to 5  Assessing the strengths and gaps in protecting human capital 73 decree establishing a National Fund to Respond to absorb the costs associated with food-insecurity to Food and Nutritional Insecurity (Fond National crises, the FNRCAN mitigates climate risks within de Réponse aux Crises Alimentaires et Nutrition- the broader fiscal risk management strategy of the nelles—FNRCAN) in May 2022 and is currently government. By acting as a buffer for government working on operationalizing the fund through the expenditure, it helps safeguard programmed invest- preparation of its operation manual (van der Borght, ments in social sectors from emergency budgetary Ishizawa, and Lefebvre 2023). Prior to the FNRCAN, reallocations. the response to food-insecurity crises was largely financed through ad hoc donor support, with the It is important to deploy and evaluate the results risk of potential overlaps or redundancies in donor of the new financing instrument. The FNRCAN is support. The financial credibility of the FNRCAN planned to be used for the first time during the 2023 relies on its ability to efficiently and transparently lean season; this is expected to provide important channel funds with a measurable impact. technical lessons to expand its use in subsequent years. Further expansions of the FNRCAN manual The new mechanism effectively combines national will consider national response plan activities budget contingency resources and development beyond cash transfers (the focus for the first year), partner contributions within a harmonized frame- including food, nutrition, and livelihood programs. work. By bringing all resources under a unique It will also be important to ensure the appropriate dedicated fund with its own operational manual, coordination of the fund with other financing instru- the FNRCAN provides a clear, rule-based mech- ments, in particular climate-related insurance such anism for allocating, disbursing, monitoring, and as the ARC initiative. auditing funds. The fund also ensures a coordinated multiyear approach among government entities and (inter)national humanitarian and development partners, further reducing transactional costs and improving efficiency. As a separate financing vehicle 6 Conclusions   Mauritania is facing serious challenges in making by the Ministry of Health can incentivize health human capital the main engine of its sustainable workers to serve in rural areas. To improve child inclusive growth. It is not creating enough human health and nutrition, Mauritania should urgently capital, not utilizing what it has, and is losing implement measures targeting undernutrition among some of it because of a lack of protection against children below age five, including by adopting a shocks. Most of the issues identified in this review package of interventions that include cash trans- are cross-sectoral by nature, and overcoming them fers and nutritional supplements. To enhance child will require coordinated multisectoral programming education and development, caregivers need to be and monitoring. empowered to stimulate children’s cognitive and behavioral development. Lessons from the Tekavoul Low and poorly coordinated investments in young program, which has successfully induced behavior children and their mothers produce poor early change and increased parent-child interaction, childhood development outcomes and low learning could inform other national programs. The intro- outcomes. Mauritania’s challenge to build human duction of a package of interventions to improve capital starts with prenatal and postnatal early child- teaching practices and pedagogy is needed to hood. The maternal mortality rate is high: almost urgently address some of the learning deficits. one-third of all deaths of women of reproductive age are due to pregnancy-related complications. Mauritania is not fully utilizing its human capital, Recent estimates suggest that there has been an despite potentially significant returns. Indexes increase in childhood stunting, making malnutri- corrected for utilization are showing that less than tion and stunting a multisectoral priority. Lack of one-half of available human capital is utilized. The cognitive and behavioral development in early child- transition from education to jobs is difficult due to hood leads to low learning outcomes. The education a lack of labor demand and a mismatch between system is not geared toward learning, compounding what is needed in the economy and the competen- the deficit in human capital, and resulting in children cies and qualifications provided by the education who lack fundamental skills. system. Increasing numbers of women decide not to join the labor force, leaving the country with an To better build early childhood human capital, untapped source of development and prosperity. it is essential to address barriers to accessing Those who manage to find employment are not social services, improving service availability fully utilizing their earning potential since they are and quality, and bridging urban-rural disparities. mostly employed in low-productivity precarious jobs Performance-based financing mechanisms adopted in the informal sector. There is a worrying trend of 74 6 Conclusions 75 increasing inactivity and stagnating earnings, leading Important knowledge gaps remain that need to be to the human capital value per capita shrinking and addressed in future work. For example, Mauritania’s losing its role as an engine of growth. Strengthening Human Capital Index is based on data that are obso- ongoing initiatives—for example, reducing the frag- lete and require updating: the data underlying the mentation of labor market programs for youth and harmonized test to assess the quality of education bringing those initiatives to scale based on rigorous date from 2004. Better data will allow for better evaluation—is needed to address underutilization. monitoring of policies. In addition, further work is needed to identify better concrete policy options. Mauritania can better protect its human capital These include the following: from shocks, which are increasingly frequent and severe. About half of Mauritania’s households report ■ A comprehensive job diagnostic. Such a diag- facing shocks on a recurrent basis; extreme climate nostic is needed in order to identify the potential events make close to a million Mauritanians food of job creation in specific sectors, actions insecure every year. The most common coping needed to spur growth, and the gaps in human strategy reported by households is selling assets or capital to fully capture this potential. reducing food intake—compromising future recovery and human capital investments. Mauritania has ■ Political economy analysis or sectoral analysis created foundations of an effective and compre- (health, education). Given the complex institu- hensive adaptive social protection system that can tional landscape of each sector, it is necessary protect households from shocks. To further enhance to better understand incentives of service the protection of human capital, human develop- providers in order to achieve better perfor- ment–related service delivery needs to become mance. more adaptive and resilient; this will require further ■ In-depth diagnostics on human capital and investments in data and information, such as early climate change adaptation. Given that Mauri- warning systems, delivery platforms, tools, and tania is one of the countries most affected by coordination. Testing the effectiveness of the inno- climate change, it is necessary to understand vative financing mechanism that was recently put in the factors of resilience in the provision of action will be needed to strengthen its future role. services, and the role of human capital in better This human capital review provides a broad over- adaptation and in capturing the potential of the view of the issues pertaining to building, utilizing, green economy in generating jobs. and protecting human capital—however, it should only be seen as the first analytical piece. Table 6.1 offers concrete actions for the key issues identified in this review to be implemented in the short run (next year) to medium run (next two to five years). 76 Mauritania Human Capital Review Table 6.1  Operationalizing the policy recommendations Proposed lead Time frame for Key issue Concrete next action agency implementation Increase the availability and Ministry of Short to High maternal mortality quality of health services through Health medium term rate and poor maternal performance-based financing health outcomes Political economy analysis or Short to sectoral analysis (health, education) medium term Building Ministry of human Consider direct provision of Poor child health and Health, Taazour Short to capital nutritional supplements to nutrition outcomes (for safety net medium term malnourished children beneficiaries) ■ Offer Tekavoul social and behavioral change messages to wider population Ministry of Low learning outcomes Short term ■ Introduce package of integrated Education interventions to improve teaching practices and pedagogy Define registration options for Child protection ANRPTS Short term children not born at health facilities Consider using the cloud-based Transition from education management information system of Short term to work the Youth Employability Project (PEJ) as a platform for intermediation Utilizing human Underutilization of human capital capital by prime-age workers Gender disparities in terms Conduct a jobs diagnostic Short term of access to opportunities and distribution of care responsibilities Conduct more work on implications Underutilization of older of Mauritania’s aging labor force and Medium term cohorts’ skills suitable policy solutions Expand the universal health High vulnerability to coverage scheme and increase Ministry of Short to health-related idiosyncratic coverage to reduce out-of-pocket Health medium term shocks spending Protecting Improve early warning systems and human ensure they are integrated with Short to capital emergency response protocols and medium term Increased frequency and financing instruments to effectively severity of climatic shocks respond to emergencies Conduct in-depth diagnostics on Short to human capital and climate change medium term adaptation Complete the first transition in and Prevalence of negative out of the Tekavoul program and Short to Taazour coping strategies expand its productive economic medium term inclusion elements Note: ANRPTS = National Agency for the Population Register and Secure Documents (Agence nationale du registre des populations et des titres sécurisés). APPENDIX A Utilization-Adjusted Human Capital Index A main limitation of the Human Capital Index (HCI) ■ The basic UHCI captures the income gains is that it implicitly assumes that when today’s child from employing all potential workers. The becomes a potential worker, she will be able to find a basic utilization measure is the employment to job—which may not be the case in countries with low working-age population ratio. The basic UHCI employment rates. Moreover, even if today’s child has the advantage of simplicity, and ease of is able to find employment in the future, she may construction and measurement. not be in a job where she can fully use her skills and cognitive abilities to increase her productivity. ■ The full UHCI also takes account of the income In these cases, human capital can be consid- gains from moving workers to jobs where they ered underutilized, because it is not being used to can better use their human capital to increase increase productivity to the extent it could be. productivity (“better” employment). The full UHCI is a weighted average of the HCI score To account for the limitations of the HCI, a for those in the better employment (who are as complementary index was developed: the productive as their human capital allows), and Utilization-Adjusted Human Capital Index (UHCI). the theoretical minimum HCI for the rest of the While the HCI is an index of supply of a factor of working-age population (who are underutilizing production (in the future), the UHCI is a hybrid their human capital): between an index of factor supply (capturing invest- ment in human capital) and a productivity index UHCI (full measure) = (capturing how efficiently that human capital is used BER × HCI + (1 − BER) × (minimum HCI) in production). 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