74525 MDGs and Beyond Produced by the Development Prospects Group Issue 3 December 2012 INSIDE Page 2: Human development counts Child marriage and education By Ariel Fiszbein targets Chief Economist, Human Development Network The World Bank Page 3: A GMR 2013: Rural-Urban s the process of international consultations around the post-2015 Mil- Dynamics and the MDGs lennium Development Goals (MDGs) framework advances, it is useful Page 4: to consider the shape that human development goals will take in the Challenge of equity: The case of emerging agenda. The following are some broad themes worth considering. Ghana The MDGs have focused on getting children into school, enshrining quantity of education rather than quality in the targets. This focus is understandable, given that enrolment is the first step toward school-based learning. Unfortunately, CONTACT: there has been insufficient progress in learning achievement. As a result, there Jos Verbeek is now widespread agreement in the international community to prioritize learn- Lead Author ing—meaning, that while we should continue the efforts to get all children into Global Monitoring Report school, we should also make sure that once children are in school, they learn. Development Prospects Group There is growing recognition that the achievement of the health MDGs demand The World Bank improvements in access to affordable health services of adequate quality, and E-mail: gmr@worldbank.org sustainable solutions to the often large inequalities that prevail in many coun- Web: www.worldbank.org/gmr tries. Improvements in access to affordable health services of adequate quality are also important to provide a reasonable level of financial protection, particu- larly to those with low income levels. A number of international health organi- RESOURCES: zations as well as governments from developing countries are exploring the Global Monitoring Report idea of global goals related to the pursuit of universal health coverage as a www.worldbank.org/gmr means of pursuing the aforementioned access goals. Given the high levels of malnutrition that still prevail, particularly in South Blog Asia and Sub-Saharan Africa, the post-2015 goals will need to place the issue MDGs and Beyond 2015 of malnutrition squarely on the agenda as critical, unfinished business. There is growing consensus that stunting is the preferred indicator of child nutrition, as Maquette for MDG Simulations it reflects the cumulative effects of inadequacies of health, diet and care. www.worldbank.org/mams Access to social protection is not a goal under the MDGs and this absence repre- MDGs at the World Bank sents a noticeable gap, given the increasing recognition of the importance of www.worldbank.org/mdgs social protection in the fight against poverty. For many countries, expanded so- cial protection is an important enabler of progress in other key development Health, Nutrition and Population goals: conditional cash transfers have played a significant role in the achieve- Data ment of health and education MDGs; social safety nets have avoided negative http://datatopics.worldbank.org/ impacts of crises on hunger and poverty. Whether as a goal or as a critical instru- hnp/ ment underpinning many goals, social protection will need to be an integral part of the discussions on the post-2015 framework. MDGs and Beyond Child marriage and education targets By Minh Cong Nguyen and Quentin Wodon In a 2009 paper on Bangladesh, Field and Ambrus used The World Bank variation in the timing of menarche (puberty) as the instrumental variable for the age at first marriage, given C hild marriage profoundly affects the life of girls that in that country girls are often not allowed to marry by, amongst other effects, lowering education before reaching puberty. They find that each additional prospects, increasing health complications year of delay in the age of marriage increases schooling (such as vesico-vaginal fistulae, a higher likelihood of by 0.22 year and the likelihood of literacy by 5.6 acquiring HIV/AIDS, and higher levels of infant mor- points. tality with early pregnancies), and raising risks of social In our work, we use as instruments the contemporane- exclusion and violence at home. In other words, child ous and past incidence of child marriage in the area marriage is a cultural practice with major negative ef- where a girl lives. We find that, in Africa, each year of fects on progress towards achieving the MDGs and early marriage reduces the probability of literacy by 5.6 other similar targets. points, and the probability of secondary school comple- How extensive is the practice of child marriage today? tion by 6.5 points. In another paper, we find similar Our estimates, based on data from demographic and effects for India using a different methodology. All health surveys, suggest that in South Asia 45.4 percent these effects are large. of women, born between 1985 and 1989, were married What can be done to deal with issues such as child mar- before the age of 18. Sub-Saharan Africa is next, with riage? Laws can be adopted to forbid marriage below 38.5 percent of girls marrying early. The Middle East 18 years of age, but they are often not enforced. So, and North Africa region comes third, with a child mar- while needed, such laws are not enough. riage incidence of 31.5 percent. There are, however, a number of promising interven- Over the last three decades, the incidence of child mar- tions which could help, including conditional cash riage has declined by 14.8 percentage points in South transfer programs promoting schooling. Other educa- Asia and 14 points in Sub-Saharan Africa (declines tion interventions that may also have positive indirect were lower in other regions). While this is positive, effects on child marriage include improving school progress remains much too slow. proximity (especially for secondary schools), providing To illustrate the impact of child marriage on human public transportation to go to schools, ensuring access development, consider the case of education. Two ap- to water in schools, and, most importantly, enhancing proaches have been used in the literature to try to esti- the quality of schooling so that the benefits for girls to mate the impact of child marriage on education. The enroll are higher. first approach relies on the reasons given by parents in Still another alternative is to provide transfers condi- surveys as to why their children dropped out of school. tional on not getting married, as has been done in rural In a 2008 paper, Lloyd and Mensch found that for girls Ethiopia with the Berhane Hewan pilot program aged 15 to 24, child marriage and pregnancies directly through which a pregnant ewe is presented to the girl account for between 5 percent and 33 percent of drop- and her family at graduation. outs, depending on the country. Using similar data for Yet, beyond such incentives, it is also important to em- Nigeria, we found that child marriage (and, to a lower phasize that reframing the transition of girls to marriage extent, pregnancies) account for 15 to 20 percent of requires a policy dialogue with religious and commu- drop-outs. If child marriage and early pregnancies nity leaders who have a great deal of influence on those could be eliminated, this could reduce by half the gen- practices. der gap in educational attainment in some countries. Child marriage is just one example of cultural (and A second approach to estimate the impact of child mar- often religious) practices that affect education as well riage on education relies on regression techniques with as other human development outcomes. It would be instrumental variables to explain the decision to marry helpful to consider and discuss such practices more early, but not education outcomes conditional on mar- explicitly in the post-MDG agenda. rying early. Development Prospects Group Page 2 MDGs and Beyond GMR 2013: Rural-Urban Dynamics By Jos Verbeek other MDGs. Access to water and sanitation facilities, Lead Author, Global Monitoring Report for example, is typically much lower in rural areas than Development Prospects Group, The World Bank in urban areas. In 2010, 96 percent of urban population had access to safe drinking water compared to 81 per- T cent of the rural population. These disparities are more he upcoming Global Monitoring Report (GMR) th pronounced in access to basic sanitation: 80 percent in of 2013 will mark the 10 edition of the report urban areas compared to 50 percent in rural areas. since its inception in 2004. The GMR continues to provide an annual assessment of progress towards Urban environments not only have the advantage of the Millennium Development Goals (MDGs). This as- providing economies of scale for the delivery of ser- sessment allows the Development Committee of the vices, such as water, sanitation, and education, but their World Bank and the International Monetary Fund density of economic activities allows for faster eco- (IMF), together with the larger international develop- nomic development relative to rural areas (World Bank ment community, to reinforce accountabilities among 2009; Montgomery 2009). As rural dwellers migrate to developing and developed countries and our institu- cities in search of a better livelihood, the shift in popu- tional partners, for attaining the MDGs. lation distribution can be expected to spur progress towards the achievement of the MDGs related to the Besides monitoring progress towards the MDGs, each delivery of services. GMR also has a thematic focus, an aspect of the devel- opment agenda on which the report provides a more in- But urban areas do not provide guarantees. Migrants depth assessment. The theme of GMR 2013, Rural- can find themselves in urban slums where expected Urban Dynamics, is highly relevant not only for assess- improvements in overall service delivery necessary to ing progress within the current MDG framework, but it achieve the MDGs do not ensue. The important point also has the potential to inform discussions about the here is that rural-urban dynamics and the possibility of post-2015 development agenda. urban areas to improve living conditions have implica- tions for progress toward the MDGs. Urbanization matters for the MDGs in several ways. Two main channels by which the goals are impacted With 2015 just around the corner, 2012 has marked the are through the benefits of agglomeration, as cities have start of discussions on a post-2015 development frame- the potential to generate higher living standards for all work and a second generation of MDGs. The findings their residents (not just migrants), and through the of GMR 2013 can inform the discussion of the post- benefits of scale economies, as basic public services 2015 development agenda, not least because they will can be expected to be provided at lower unit cost in point to how countries can reap the benefits of econo- urban areas. mies of scale in service delivery and agglomeration of economic activity and make progress on important de- Overall, urbanization can play a positive role in reach- velopment outcomes as measured by the MDGs. ing both the poverty and service delivery MDGs if these potential benefits of agglomeration and scale There are also regional considerations to be taken into economies are realized. In addition, the official list of account. Sub-Saharan Africa and South Asia, which MDG indicators calls for disaggregating the MDGs by face the most challenging development trajectories, are urban/rural as far as possible. This disaggregation has less urbanized than other regions are and, therefore, the not been addressed so far. lessons articulated in GMR 2013 can help inform pol- icy choices beyond 2015. For various measures of human development that can be disaggregated between urban and rural areas, people But the findings of the report certainly will not be lim- living in urban areas typically fare better than those in ited to certain regions. Urbanization is a long-term rural areas. For example, Ravallion, Chen, and San- worldwide trend that is still very much underway, and graula (2007) find that the global rural poverty head- the implications of a more urbanized global population count index stood at 29.3 in 2002 while the same global will be felt for decades into the future. How countries measure for urban areas stood at 12.8 for the same year. manage urbanization will be a key part of making pro- Similar observations can be made in the data related to gress on the international development agenda. Development Prospects Group Page 3 MDGs and Beyond Challenge of equity: The case of Ghana By Peter Darvas years, meaning that nearly one million primary school- Senior Education Economist aged children are not in school. Students facing these Africa Human Development, The World Bank inequities are disproportionately from poor households, from rural or marginalized areas or language groups G hana has experienced rapid growth and change (including the three northern regions) or living in situa- which have transformed the economic, political tions of fosterage. Instead of compensating for depriva- and social landscape of the country. In the last tion, public expenditures appear to exacerbate inequality two decades, the population in Ghana has increased by by allocating fewer resources per child to regions where nearly 70 percent to 25 million and the number of people the majority of deprived districts are located. living in urban areas has doubled. In the past decade Inequitable distribution of inputs creates a negatively alone, GDP has increased five-fold and the incidence of reinforcing loop where children with the greatest need extreme poverty has been halved. These changes have receive the fewest resources and opportunities. Such a brought with them better access to modern amenities, system perpetuates poverty and inequality. This picture including government education and health services. of inequity is mirrored in data on primary learning out- Changes in basic education mirror these recent transfor- comes, primary completion and access to senior high mations, especially in terms of access and financing. school. Notably, while several equity-improving initia- Enrollment in basic education has nearly doubled in the tives have been introduced by the Ministry of Education, past 15 years to seven million pupils in 2011 and gov- challenges in program design, targeting and implementa- ernment expenditure on basic education in the past dec- tion show that these initiatives often end up dispropor- ade has more than tripled in real terms. More children tionately benefitting individuals from wealthier popula- are accessing basic education, graduating from junior tions. For example, compared to its neighbors, Ghana’s high school and enrolling in senior high school than at allocation of teachers is one of the least equitable. any time in Ghana’s history. Persistent inequity negatively influences country pro- However, even as access to basic education has im- gress toward basic education quality, efficiency and ac- proved, managing the delivery of basic education has countability goals. Put simply, large numbers of children become more complex and subject to increasing public are not in school; large numbers of students leave pri- expectations and influences. mary school having not become proficient in English or mathematics, and education inputs (e.g. teachers, text- As Ghana has moved closer to meeting the Millennium books) are not distributed equitably. Importantly, stu- Development Goals (MDGs) in education, sustaining dents and populations who may require the most support progress has become more difficult to realize. Increasing to meet expected outcomes (e.g. learning, primary com- the primary net enrolment ratio (NER) from 90 to 95 pletion, access to secondary), receive, on average, dis- percent is more difficult than increasing it from 50 to 60 proportionately fewer resources (e.g. trained teachers, percent. Measures aimed to boost demand, such as the textbooks, etc.) from the government than their peers. capitation grant scheme (which aimed to compensate for the eliminated school fees), caused a one-time bump in Efficiency improvements in the use of money, human access. However, improving age-in-grade and reaching and physical resources and time could help Ghana real- vulnerable and marginalized groups often require more ize improved learning outcomes within the same budget targeted and context-specific interventions. Further, as envelope. The education sector accounts for over 20 old problems are solved, new priorities emerge: provid- percent of government expenditures, equivalent to 6 ing remedial learning support to pupils from poor house- percent of GDP. Over the past decade, education expen- holds, improving girls’ retention in upper primary, and ditures have surpassed enrollment growth by a ratio of 3 reinvigorating efforts to recruit, equitably deploy and to 2. Efficiency improvements in the deployment and retain qualified teachers. utilization of teachers (e.g. more equitable distribution and reduced absenteeism) and improving time on task Despite Ghana’s achievements in access to basic educa- (i.e. the amount of time used for learning during the tion, inequity remains a persistent feature of education school day) could help the Ministry of Education and the service delivery and the most critical challenge. Primary Ghana Education Service improve learning outcomes at NER has remained close to 80 percent over the past five no additional cost. Development Prospects Group Page 4