Building Human Capital in

AfricA

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Urgent HUman Development priorities in AfricA

Equipping Africa’s burgeoning youth with the right skills for jobs

Enhancing earning opportunities

Improving educational enrollment and quality at all levels

Getting better human development outcomes for the money invested

Breaking vicious disease cycles that are a drain on societies and economies

Building stronger health systems for lasting results

Developing sustainable, innovative safety nets

Making services work for the poor

Keeping pace With 21st century africa

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Urbanizationthere is widespread urbanization across the continent, reflecting increasing environmental stress, a growing population, and greater competition for land and water resources. traditional family or community-based social safety mechanisms are breaking down as people move away from villages and into towns and cities. many african governments are setting up or extending social protection systems to protect the most vulnerable households from sudden shocks. the need for more social safety nets that can offset poverty or respond to extreme vulnerability has been painfully underlined in many countries during the food, fuel, and financial crises.

Democratizationin the past decade, the number of coups in africa has fallen significantly, and the number of elections has risen. in many countries, the process of democratization is still young, and governance challenges and corruption still remain, but there is an increasing and palpable demand for accountability across africa and for more attention by governments to people’s basic needs. this has strong implications for development. results must be clearly demonstrated and various

africa has been changing at a great pace this century and on a number of fronts—population trends, economic growth, democratization, and technology, to name just a few. the development agenda in the region must keep pace with these changes that are accompanied by different needs and expectations than in the past, as well as by new opportunities and challenges.

Source: 2008 Revision of World Population Prospects, UN Population Division, 2009.

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20.1 − 25

25.1 − 30

30.1 − 35

35.1 − 40

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This map was produced by the Map Design Unit of The World Bank. The boundaries, colors, denominations and any other information shown on this map do not imply, on the part of The World Bank Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries

IBRD 37601 AUGUST 2010

Global Median Age In 2010

A Youth Explosionat current growth rates, africa’s population is likely to double within a generation. no region has ever tried to develop in the face of such rapid population growth. the region is also witnessing a major increase in the population’s share of young people. in fact, as the map below shows, africa is now the “youngest” region in the world. this means that the region now has a unique window of opportunity to help transform an entire generation through the right long-term investments in education and health. tomorrow is too late for africa’s burgeoning youth, who already make up 60 percent of the unemployed in the region. they urgently need the right skills for jobs, and protection from preventable diseases that affect their productivity.

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stakeholders, including civil society, must be frequently consulted. in those areas that are still at high risk of internal or external conflict, delivery of essential health, education, and social protection services remains a particular challenge.

Economic Growth

economic growth has been stronger over the past decade than it was during the 1980s, when it actually declined, and africa has recently been recovering from the effects of the global crisis. Yet about half of the population lives on less than $1.25 a day and most governments remain heavily dependent on foreign aid. the majority of people work in the informal sector or are engaged in subsistence farming. as africa puts in place the agricultural productivity improvements and the industrial upgrading, infrastructure, and technology that will be needed for the region to become a bigger player in the global economy, attention to human capital is more critical than ever. For example, as economies try to diversify and grow less reliant on natural resources, africa needs not just more university graduates, but graduates with the right sets of skills for a changing job market.

An ICT Wave

the information and communication technologies (iCt) wave in the region offers exciting new ways of transforming education, health-care, banking, and more. in education, new technologies may offer affordable large-scale improvements in education delivery, and iCts also open up new job opportunities in it and it-enabled services in africa. in health, iCts have a major role to play in improving health systems. rwanda’s efforts to promote “e-health” or improved health service delivery through a computerized national health-care system and community information systems are an example of how iCts can be put to work for health.

Collective Action

africa’s development has been hindered by its economic geography: many small, landlocked countries with thick economic borders. there is great potential for africa to overcome some of these disadvantages

by developing better mechanisms for regional and collective action. governments and citizens alike realize that there can be enormous benefits from pooled arrangements such as those for research, and from greater labor mobility, such as that within the east african Community. this presents a strong opportunity for development and knowledge sharing across borders.

The World Bank’s Rolerecognizing these forces of change at work in africa, the World Bank’s evolving role in helping the region’s governments build human capital is focused on results and reform in three areas: strengthening health systems; improving the quantity and quality of education at all levels from primary to tertiary; and extending adequate social protection to the poorest and most vulnerable people. the World Bank’s refreshed response in africa is driven first and foremost by countries’ development needs, which are articulated in Country assistance strategies and informed by a number of constituents, including governments, donors, and civil society.

in the wake of the global crisis, governments face shrinking revenues, and donors’ budgets are stretched. the World Bank is helping governments make their money work better—in other words, deliver better human development outcomes for the money invested and more efficient progress towards the millennium Development goals (mDgs).

africa’s human Development challenge

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Education

africa faces broad challenges on the education front. the region must ensure universal primary education—not just enrollment but also good learning outcomes—to ensure better completion rates and more efficient use of resources. and it must simultaneously improve opportunities for secondary, higher, and vocational education, as all these levels need to expand and improve to cater to africa’s huge youth population and enormous skills deficit. For example: the region needs approximately a million primary teachers by 2015. it also needs doctors, nurses, lawyers, engineers, scientists and other professionals. education intersects with other sectors such as infrastructure and

health. For instance, schools need enough physical classroom space, and should be in convenient locations and with facilities that make it easier and safer for girls to attend. also, proper nutrition, stimulation, and overall health in early childhood have a great influence on learning outcomes, making development interventions that extend from the pre-natal stage to age eight very important. While africa has seen clear progress in enrollment in many countries, such as ethiopia, tanzania, nigeria, mozambique, Kenya, and madagascar, there is still need for rapid and holistic action at various levels throughout the education sector in order to improve relevance and quality of services.

Health

For decades, parts of africa have remained trapped in a vicious cycle of poverty, hunger, and disease. Better health outcomes for everyone, including the poorest people, depend largely on access to quality health-care and stronger health systems. too often, there are simply not enough health facilities and health-care workers; drugs and other essential supplies do not reach people on time; and the quality of services is poor. to establish sustainable, long-term solutions for health and to break out of disease traps, countries and partners need to take coordinated actions to strengthen health systems and increase equitable access to effective health-care. this includes access to modern methods of contraception and to pre-natal care, to bring down the region’s exceptionally high fertility rate, and reduce maternal mortality. many countries have shown extraordinary progress—such as through results-based financing for frontline health facilities in rwanda; community-based nutrition programs in senegal; and better access to health-care among the poorest people in tanzania. such efforts need to be replicated and scaled up across the region.

africa faces daunting human development challenges. on current trends, most countries in the region are off-track on most of the millennium Development goals. However, a look beneath this aggregate record reveals that much progress has happened in many countries which started from a low base; and that there have been examples of extraordinary progress in a short time. if successes could be quickly scaled up based on evidence of what works, africa can reach the goals—if not by 2015, then in the not-too-distant future.

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As Africa confronts profound human development challenges...

n 200 million people chronically malnourished and 43% of under-5 children stunted because of malnutrition

n 38% of region’s adults illiterate; 37% of children will not complete primary school; just 5% of the relevant age group in university

n youth make up 60% of the total unemployed in the region

n 51% of the population lives on $1.25/day or less, leaving households highly vulnerable

n With the financial crisis, 30,000-50,000 more infants, mostly girls, may have died here in 2009

n 90% of the world’s malaria deaths occur here; malaria responsible for about 1 in every 6 under-5 deaths

n over 22 million people live with hiv/aiDs

...The World Bank is helping countries invest in human capital

Strengthening health systems for better results: children in Zambia get lifesaving malaria drugs on time via an improved supply chain.

Equipping youth to be successful adults: girls in nigeria get cash transfers to encourage them to move into secondary school.

Helping countries extend safety nets: During the global crisis, over 10 million people in ethiopia get additional cash and food transfers.

Social Protection

in a rapidly changing africa that is vulnerable to various types of shocks, social protection extends security to the poorest people, enabling them to protect, or even build, both their human and physical capital in times of crisis or vulnerability. it can protect them from hunger and malnutrition; and sustains their access to education and other basic services.

vulnerability is experienced in a number of areas—failure of crops, variable weather, keeping children back from school or cutting down nutrition due to income shocks; as well as a number of issues related to labor markets,

land distribution, property rights, and contract enforcement. as the global crisis has shown, when government revenues shrink and donor budgets are constrained, poor people stand to lose their already limited access to basic education and health services. african governments have recently struggled to sustain existing services at the very same time that demand for these services has increased with the effects of the food, fuel, and financial crises.

there are good examples of social protection at work throughout africa, such as in ethiopia, where over 10 million people received additional cash and food transfers during the global crisis. nevertheless, much remains to be done at the regional level.

our WorK: Key themes across sectors

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the World Bank’s work in human development in africa covers health, education, and social protection; with an emphasis on innovation, results, and improvements in governance and accountability. the Bank helps governments provide basic needs during the all-important early childhood years, equip young people with the right skills for jobs, and expand opportunities for girls. it also facilitates the development of regional programs that cut across groups of countries.

Early Childhood Developmentacross africa, 71 million children do not reach their full potential due to poverty and poor health, nutrition, and care. that is why early childhood development (eCD)— physical, cognitive, linguistic, and socio-emotional development from the prenatal stage up to age eight—is so important. proper health, nutrition, and early stimulation during this period play a critical role for brain development and child well-being. Without access to high-quality eCD, poor children often fall behind their more advantaged peers before they even begin school. as they get older, the gap widens. Quality eCD programs improve outcomes by providing critical health and nutrition inputs, better access to and retention in primary school, improved gender equity in education, lower repetition rates, and higher achievement in education. through its donor partner-financed trust funds, the World Bank provides technical and financial support on eCD to several countries (guinea, liberia, malawi, mali, mozambique, niger, nigeria, senegal, tanzania, and Zambia).

Youth, Jobs, and Skillsafrica’s youth number around 200 million—over 20 percent of the population. to meet their needs, education systems need to focus more on developing skills needed in the job market and on strong public-private partnerships. africa will need to act now to not only provide quality primary education for all, but also more and better vocational and higher education. the World Bank is helping by supporting youth employment and broadening learning and training opportunities. For example, the growth and employment project in nigeria supports sectors that are predominantly

youth driven, such as iCts, music, entertainment and hospitality. the World Bank is helping governments expand and improve tertiary education and link training closely with market demand in areas ranging from technical expertise in science and technology to general workplace skills. Comprehensive training for girls, another focus area, is provided through the adolescent girls initiative interventions in liberia, rwanda, and south sudan.

Results-Based Financing

results-based financing (rBF) is a financing mechanism that allows strong and effective emphasis on accountability and results in development. For

example, in health, it can take the form of a payment to a public service provider (such as a rural health facility) on condition that pre-agreed, measurable results have been demonstrated in priority areas. rBF helps build stronger, better-functioning

health systems that deliver much-needed services on time to key groups like mothers and children. recent research has shown that incentives are important, and work better than simply increasing available resources. success in rwanda with the rBF approach holds many ideas and lessons for other low-income countries in africa faced with huge challenges in the provision of basic services. With support from the World Bank, rBF is now expanding to several countries in africa, including Benin, Burundi, Cameroon, the Democratic republic of Congo, and Zambia. Burundi became the second african country to implement rBF in the health sector on a national scale in april 2010, and the early signs are encouraging, with utilization levels of key basic health services already increasing. Burundi is on a similar track with support from the Bank and other donors.

“Youth, not oil, will be the country’s most valuable resource in the twenty-first century.”

– Nigeria: The Next Generation Report, British Council, Harvard School of Public Health, 2010

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Stepping up progress toward the Millennium Development Goals

Governance and Accountabilityacross africa, the Bank promotes governance and accountability across sectors, through collaboration and partnership among stakeholders. this approach addresses the traditional problems of dysfunctional state institutions; and also the corruption and poor governance that can undermine economic and social progress. Weak public sector management, corruption, and poor governance stifle economic growth, and tend to affect the poor disproportionately by increasing the price for public services and restricting poor people’s access to education, and health care and social services. Key public sector areas which have proven relevant in the social sectors to enhance access and quality of service delivery are the management of public expenditure, performance, and sectoral human resources; as well as customized institutional strengthening.

Regional Programsin addition to in-country efforts, the World Bank facilitates projects that cut across groups of countries which face shared challenges. an example is the recently launched laboratory networking project in four countries in east africa. this project is helping to strengthen diagnostic and surveillance capacities across national borders, to eventually deliver better results against diseases through more rapid and accurate diagnosis, especially of patients suffering from tuberculosis and tB-Hiv co-infections. another example is the intergovernmental authority for african Development’s regional Hiv & aiDs partnership programme (irapp), motivated by a shared readiness to develop inter-country collaboration to fight epidemics, with grant funding administered by the World Bank.

A special push towards the human development goalssome key areas that will need a special push between 2010 and 2015 fall within education, health, and social protection. major challenges in these areas include:

n strengthening social safety nets in countries with poor populations exposed to risks such as climate change and higher food prices

n Quickly scaling up highly effective nutrition interventions for children under age two and for pregnant women

n providing more equitable access to better-quality education and health-care

n strengthening health systems—a key factor in progress towards the maternal and child health goals, as well as in the fight against both communicable and non-communicable diseases

n improving monitoring and evaluation by expanding statistical capacity in countries

n coordinating the international response in conflict and post-conflict situations

How the World Bank is helping governmentsn improving nutrition policy and expanding community nutrition

programs, such as in senegaln increasing lending for social protection in response to the

financial crisisn contributing to the accelerated pace of primary school enrollment

seen in many countries including ethiopia, tanzania, nigeria, mozambique, Kenya, and madagascar

n helping countries meet unmet family planning needs, a major cause of maternal and child mortality in low-income countries with very high fertility rates

n strengthening health systems and making strategic interventions such as bed nets to protect against malaria (45 million treated bed nets funded by the World Bank to date)

n leading, with the World health organization, the international health partnership—which has joined forces with the catalytic initiative and the global campaign for the health mDgs—to ensure coordinated support from the major agencies

africa’s performance on the mDgs will determine, to a large extent, how the world fares on these global targets. What is now required is a major effort to replicate successes and scale up progress across the region.

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eDucation: high staKes for africa

the World Bank, which is the leading multilateral donor to education in africa, helps governments provide basic education to millions of children, while also finding efficient ways to provide secondary, vocational, and tertiary education. it assists in the holistic development of the education sector, using different approaches depending on the country context.

Primary across the continent, only about two-thirds of those who enter primary school reach the final primary grade. of them, only half master the required skills. nearly half of all children out of school globally live in sub-saharan africa. strong population growth means that pressure on enrollment will only increase, making quantity and quality of education equally important targets. also, recent gains, however promising, remain heavily dependent on foreign aid—despite impressive increases in national education budgets. Quality, inclusion, and financing are major challenges ahead for the primary subsector.

the World Bank has strongly supported universal primary education— through sector-specific international Development association (iDa) and trust fund operations, general budget support and infrastructure programs for school construction; as well as by managing six multi-donor trust funds for education in conflict zones, and most of the Fast track initiative (Fti) Catalytic Fund operations (this is a multi-donor trust fund which aims to help countries address primary education). For the foreseeable future, the Bank will remain actively involved, given the enormous pressures still faced at the primary level. major new Fti programs have recently been started in liberia, malawi, togo, and ethiopia. primary level efforts are being linked to other key interventions such as school feeding programs, early childhood development, household income security, and female literacy.

Unleashing the hidden potential of girlseducation for girls—especially through the secondary level—is critical in africa because of the enormous potential gains for development, for families, and for women. it is the fastest way to bring about a shift to

smaller, healthier, and better-educated families—gains that begin almost immediately as girls delay marriage to attend school. recent research shows that in uganda, if girls with only a primary education finished secondary school, they would contribute economic benefits to their country equivalent to one-third of current year gross domestic product (gDp) over their working lives (chabaan/cunningham, forthcoming).What it will take to put more girls through school effectively:n reduced cost to parents of educating their daughtersn safely and conveniently located schools with strong

community tiesn all-girl schools, depending on the cultural contextn girl-friendly infrastructure such as a school lavatoryn more trained women teachersn Better quality of education, including in math and sciencethe bottom line is that parents are reluctant to make a long-term commitment to education if they think that the school will fall apart in a few years, and if the teacher is often absent.

the past decade has seen plenty of progress in africa’s education systems, especially at the primary level. more than 90 percent of children in the region now enter grade 1. this is a remarkable achievement, but it is not enough. actual attendance is weak, as is actual learning. many never complete primary school, among them the most vulnerable children—such as aiDs orphans, girls, and children in conflict zones. vast numbers of unemployed youth reflect the burning need for more higher education that delivers skilled, employable graduates. and rapid urban migration raises new challenges in education delivery.

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World Bank and Fti efforts have already contributed to growing enrollments in several countries. Between 2000 and 2007, primary enrollments more than doubled in ethiopia (from 5.8 million to over 12 million), and nearly doubled in tanzania, mozambique, and madagascar. in ethiopia, the general education Quality improvement program (a collaborative effort between the government, the World Bank, and various donors) has also helped lower the cost and complexity associated with coordinating individual donor efforts, allowing the government to focus on improving education quality.

Secondaryin 2007, africa’s gross enrollment ratio at the secondary level was just 34 percent, although this varies considerably across countries. the World Bank has supported african governments that are succeeding at the primary level to plan and finance the expansion of secondary education. one of the key focus areas is getting more girls into secondary school, an objective that deserves much higher priority in africa. a World Bank-supported project that pursues this objective in Kano, nigeria is using cash transfers as incentives for girls to attend secondary school. notably, a July 2010 study in malawi showed that such ‘conditional’ cash transfers not only worked to keep more girls in school; a group of girls receiving the transfer also had lower Hiv prevalence than a similar group that did not.

Tertiarythe key to economic success in a globalized world increasingly lies in how effectively a country can assimilate knowledge and build comparative advantage in selected areas. sustained, strong, and diversified economic growth depends partly on tertiary education that is attuned to the needs of the job market. relevant tertiary education will also help africa to respond effectively to challenges arising from climate change, population growth,

and uncontrolled diseases. Yet, in an africa where youth make up 37 percent of the working-age population—and 60 percent of the unemployed—just 5 percent of the tertiary age group is enrolled in tertiary

institutions. Compare this to the world average of 25 percent.

the World Bank supports public-private partnerships at the tertiary level; and financing mechanisms such as competitive financing that stimulate the development of university faculties and ensure that graduates have skills that are in demand (used in mozambique, nigeria, Uganda, and ghana very effectively). it invests in private-sector development, business incubation, and improving the regulatory environment and investment climate, ultimately to improve economic growth and employment.

“In the Gambia, we went for thirty years after independence without a university. We are facing a huge resource gap, and we cannot emphasize enough the role of higher education in development. Higher education policies of today will determine our society of tomorrow.”

– Mamadou Tangara, Minister of Education, The Gambia

the World Bank’s Medium Term Program in Tertiary Education boosts both lending and analytical support to several countries to improve the quality and scope of their tertiary systems to better respond to industry demand. also, its New Economy Skills for Africa Program is tapping into the power

of icts both to improve education delivery as well as to open up new job opportunities in it and it-enabled services. african governments already allocate a large share of public resources—on average 4.5 percent of gDp—to education. many are not in a position to increase this support. the Bank is assisting governments to identify financial mechanisms that could work in a resource-constrained world. a recent report, Financing Higher Education in Africa, proposes ways to regulate student flow, mobilize private resources, reduce costs, and improve governance and management at the system and institutional levels (see page 14).

health: stronger systems for Better results

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the World Bank’s work on health in africa focuses on strengthening health systems, making use of its comparative advantage in this area. Hubs in Dakar and nairobi provide technical and analytical support to countries on demand. the Bank also helps with high-impact interventions against diseases, and with increasing financial risk coverage related to health. Further, it supports important activities in other sectors that help improve health outcomes; including investments in girls’ education, improved access to clean water and better sanitation, new infrastructure, and the supply of electricity, among others.

More and Better Health for the Money

Despite its disproportionately high burden of disease, annual health spending in africa is the lowest compared to any other region. the World Bank supports the ‘africa investment Case’ put forward by Harmonization for Health in africa (a consortium of major health agencies).

low-cost, high-impact interventions need to be scaled up to benefit the poorest people. simultaneously, better health for the money can be achieved by:

n Coordinating external resources to support a single national strategy n strengthening evidence-based planning and budgeting in national

strategy developmentn Using private spending effectively through risk pooling mechanismsn ensuring accountability and pushing for results

Human Resources for Healththe World Bank has been helping to improve baseline data and information on Human resources (Hr) for health, an area where there are huge shortages in africa.

a well-functioning national health system underpins the delivery of key health services to the poorest people and helps improve results in the fight against diseases. to serve poor people well, health systems should have adequately trained and motivated health workers, strong supply chains for pharmaceuticals, adequate financing, good governance, enough infrastructure (including iCt-based systems), and efficient service delivery. With these fundamentals in place, africa has a much stronger chance of breaking out of its vicious disease and poverty traps and of making faster progress towards several of the millennium Development goals.

Results-based financing goes a long way in Rwanda

after the 1994 conflict, which took a great toll on its health sector, rwanda entered the 21st century with one of the weakest health systems in the world. yet today it shows some very strong health results. assisted childbirths rose from

39 percent in 2005 to 52 percent in 2008; while under-5 mortality fell by a third, from 152 deaths per 1,000 live births in 2005 to 103 in 2008. and the use of modern contraception has increased from 10 percent to 27 percent in just three years. these successes can be attributed to rwanda’s innovative health sector reforms, particularly its results-based financing for health facilities and more decentralized decision-making.

the World Bank has supported the government of rwanda’s strong commitment to these reforms. a rigorous evaluation has shown that results-based financing—a type of financing through which health facilities receive performance bonuses based on services provided, for example, the number of children immunized—has made a large contribution to improving health service delivery.

n in Zambia, rwanda, ethiopia, and mali, an analysis of Hr for health n in ghana, an analysis of all aspects of the health labor market n in sierra leone, an assessment of Hr constraints related to free health-caren in liberia, design and implementation of a health worker censusn in tanzania, a study of health worker performance quality

health: stronger systems for Better results

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Disease Control: Malaria, HIV/AIDS, Tuberculosisthe World Bank’s Disease Control program in africa has a consolidated approach to disease prevention, control, and preparedness. the program includes both communicable diseases (such as malaria, tB, Hiv/aiDs, and H1n1) and non-communicable diseases. it provides strategic guidance and technical support to operations, engages in analytical work, and promotes strategic partnerships. it is at the forefront of efforts to achieve better outcomes by interfacing with health systems strengthening work at the country and regional level. the World Bank supports strategic high-impact interventions such as assisting countries to purchase insecticide-treated bed nets to protect against malaria and in carrying out critical Hiv/aiDs prevention, treatment, and mitigation work. the Bank’s malaria Booster program helps countries and the region employ effective malaria-control interventions and treatment strategies while addressing their health systems issues. other projects now under preparation will support national Hiv/aiDs programs and health systems in swaziland, niger, and Kenya. the recently approved east africa public Health laboratory networking project strengthens diagnostic capacity in laboratories—a key weakness in health systems and national disease control programs—and will help diagnose tB-Hiv co-infections, among others.

Population and Reproductive Health rapid population growth exacerbates africa’s economic and social challenges. addressing high fertility rates and weak nutrition is central to keeping more mothers and children alive. the World Bank has a new reproductive Health action plan (2010-2015), which envisages a health systems strengthening approach to improve reproductive health outcomes. it emphasizes reaching youth through improved access to services and information that will motivate young people to delay pregnancy and childbearing and achieve higher levels of education and training; and working with partners including civil society organizations to support country-led health system strengthening strategies to increase utilization of reproductive health services.

Nutritionmaternal and child under-nutrition is a major cause of child mortality in africa. the World Bank is supporting a number of community-based nutrition

projects in africa (madagascar, senegal, ethiopia, Burkina Faso) which aim to reduce the prevalence of stunting and underweight and improve maternal nutrition. the Bank also provides analytical support and technical assistance to several countries to guide their policies and programs for sustained reduction of maternal and child malnutrition. in addition, a school feeding partnership between the Bank and the World Food programme has helped catalyze an evidence-based approach to school feeding in africa.

How stronger supply chains can save thousands of lives

there is less malaria in Zambia today than there was only a few years ago, thanks to large-scale efforts such as distributing insecticide-treated bed nets. But even with these advances

in prevention, the disease is still a leading cause of death in the country, especially of children. recognizing that access to proper treatment needed to be stepped up, the World Bank, the united Kingdom’s Department for international Development, and the united states agency for international Development joined forces to try out new drug distribution methods in 16 districts in Zambia.

the results from this pilot are exceptionally encouraging. simple but smart steps to strengthen the supply chain for lifesaving drugs—including hiring district-level planners to help manage orders—have proved very effective. pediatric malaria drugs, so essential to save children’s lives, became much more widely available in the pilot districts than in the control districts. if the pilot is scaled up and supply chains are strengthened nationwide, thousands of children could be saved from malaria-related deaths in Zambia by 2015. this could significantly reduce the country’s child mortality from malaria, effectively complementing prevention efforts.

social protection: safety nets for the vulneraBle

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social protection aims to reduce poverty, manage individual risks, and promote equitable and sustainable growth. it does so through prevention that provides security for the vulnerable, protection that provides adequate support for the poor, and promotion that expands opportunities for higher productivity and incomes. the World Bank’s social protection work in africa has a conceptual framework based on risk management; an understanding of the context, challenges, and choices in each country; knowledge of global public practices; and its own experience in social protection within africa. the Bank assists countries with a range of instruments that reduce, mitigate, and cope with different types of income risks that are especially relevant for poor households.

Labor Market Policies and Programs For many people in developing countries, the ability to work is their main asset. labor market policies and programs can contribute to development and poverty reduction by fostering a flexible formal labor market that rewards labor productivity and allows labor to be allocated to its most efficient use, facilitating the creation of more and better jobs, reducing the risks individuals face, helping workers manage risks and facilitate labor market transitions, and ensuring proper working conditions. active labor market policies and public works programs can also include measures to train workers in accordance with labor market demands. informal sector activities claim a significant, sometimes dominant share of their respective markets, spanning mining, manufacturing, commerce, finance, and other sectors. as the informal sector is the engine of employment and incomes in both rural and urban areas in the region, efforts to increase the rate of growth of jobs need to be complemented by policies and programs to

While there is wide diversity across africa, most countries in the region face serious challenges when it comes to achieving adequate living standards for the majority of their populations. about half the region’s population lives on $1.25 a day or less, leaving millions of households extremely vulnerable. in many places, unemployment (especially among urban youth) is pervasive, and Hiv/aiDs has contributed to rising numbers of orphans and households headed by women, children, and the elderly. in this context, raising children to healthy and educated adulthood, maintaining adequate opportunities for productive employment or self-employment among working-age people, and facilitating the effective functioning of families and households within a supportive community structure and an expanding economy represent major challenges for communities, policy makers, and governments alike. these challenges have been painfully underlined by the food, fuel, and global crises.

Ethiopia’s Productive Safety Net Program

this safety net program helps address the needs of millions of chronically food insecure households in ethiopia through an effective and affordable rural safety net in a very low-income country. the government launched the program in 2005

in response to the growing consensus on the need to reform a costly and unreliable emergency food aid system that for over 20 years dominated responses to food insecurity in ethiopia.

the program provides predictable and timely cash and food transfers to households. it combines both a public works component for those households with labor as well as unconditional cash transfers for those who cannot work. the public works program is focused on creating sustainable community assets that contribute to the rehabilitation of severely environmentally degraded areas, which are a major cause of food insecurity themselves.

improve the profitability of informal and household enterprises; and broaden skills development, especially for those who do not complete secondary school.

Social Safety Netsto the extent that governments are not able to reduce the systemic risks that households face or to mitigate the impact that shocks can have on households, social safety net programs can be effective risk-coping

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mechanisms. these programs include cash transfers (with built-in work incentives), in-kind benefits, services and subsidies (including food distribution or subsidy programs). they allow the state to reduce the impact of a negative income shock or persistent low income by assisting families to deal with the consequences. in June 2010, the Bank cosponsored a forum on making public Works Work in arusha, tanzania, for 200 delegates from 40 countries, to review experience with the design, performance, and potential of programs such as safety nets.

Decentralized Service Delivery many african countries are decentralizing responsibilities for basic service delivery to local levels, but local authorities often lack the capacity and resources to scale up service delivery for poor and vulnerable people, and improve the quality of services. a new style of project, pioneered in ethiopia, channels World Bank resources to local governments in parallel with government financing to support local delivery of education, health, agriculture, water supply and sanitation, and rural roads. the resources are complemented with significant support to deepen transparency and local accountability in service delivery, monitor fiduciary performance, and build local capacity. the ethiopia protection of Basic services program is now in its second phase. the approach has been replicated in sierra leone, where the first phase of the Decentralized service Delivery program is underway.

Children and YouthChildren and youth need their families, and access to health-care and education. But these are not enough. each year, the transition of youth to formal and informal labor markets is marked by periods of unemployment or underemployment. Young people need training, skills development, formal and informal employment opportunities, and investment-led economic growth that could in turn spur labor market reforms. girls face a heightened need for opportunities. also crucial are evaluation systems to show what programs for youth have the most impact. a recent example of a social protection program targeting youth is the Kenya Youth empowerment project (a $60 million iDa credit approved in may 2010) to support the government’s efforts to increase access to youth-targeted temporary employment programs and improve youth employability. Working with the Kenya private sector alliance, among others, this project provides disadvantaged unemployed youth with opportunities to acquire training, apprenticeships, and short-term jobs.

Scaling up social protection during crises

the Bank has substantially scaled up its social protection operations in africa to respond to the food, fuel, and financial crises, and to ongoing climate shocks. highlights include responding quickly to crisis-driven needs; supporting governments to set up

effective and sustainable social safety net systems; and promoting skills and employment opportunities, especially among youth. funding in these areas nearly tripled between 2008 and 2009. existing initiatives such as the ethiopia third productive safety net project, the tanzania social fund for Development ii project and the malawi social action fund have been scaled up. new operations include the madagascar emergency food security and reconstruction project and the comoros emergency global crisis response project. a review of the resilience of social protection systems is also underway in several countries, including mauritius, Burkina faso, mali ,and cameroon. recognizing the huge challenge of unemployed youth in the world’s “youngest” region, the Bank is increasingly shifting from small-scale interventions financed by grants to larger stand-alone operations with a focus on youth employment and employability. innovative projects are being prepared in Kenya, togo, liberia, sierra leone, and nigeria.

Fragile and Conflict-Affected Statessub-saharan africa has the highest concentration of fragile and conflict-affected states. given their redistributive mechanisms, social assistance programs can contribute to stability, reconciliation, and economic growth. Community-driven projects have been particularly successfully in this context. these have been supported by significant World Bank resources with the intention of mobilizing communities in the reconstruction effort, creating a strong implementation agency in the absence of the state, and ring-fencing activities from political capture and governance concerns. in liberia, sierra leone, Comoros, togo, and sudan, the World Bank is actively engaged in social protection emergency operations, including youth- and labor-intensive public works projects which have become an integral part of the reconstruction and stabilization strategies of some of these countries.

the “KnoWleDge” BanK

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Recent reports Financing Higher Education in Africa

institutions of higher education in sub-saharan africa must balance the need to raise educational quality with increasing social demand for access to education. as funding these institutions becomes more difficult and the youth population continues to grow, countries need to devise financing approaches that enable them to meet the higher education challenge. this report examines current practices in financing higher education in africa, and concludes that enrollment

in higher education has grown faster than financing capabilities in most of the region’s countries. the lack of resources has led to a severe decline in instruction quality and in the capacity to reorient focus and to innovate. public funding in most countries is already overstretched.

However, the report also carries an encouraging message—a full range of options do exist and some african countries and institutions have started implementing them. private higher education is experiencing spectacular growth in africa. Cost-sharing programs are being implemented in many universities, accompanied by student loans and financial aid for low-income students. Higher education is being diversified to offer lower cost and more effective delivery alternatives. in a few cases, impressive reforms to improve internal efficiency have been implemented, and governments are increasingly adopting more effective budget management practices. this report makes the case for a comprehensive approach that combines various tools according to each country context.

Designing and Implementing a Rural Safety Net in a Low-Income Setting

Despite the growing international consensus that national social protection systems are a key component of poverty reduction strategies, developing rural safety nets in low-income countries remains a challenge. this paper contributes to the growing body of experience on how to

Besides financial assistance, african countries also seek the World Bank’s development expertise. more than ever, in-depth analysis of local challenges and practical experience gathered both from africa and around the world pave the way for sustainable development. the Bank offers knowledge in the form of technical assistance, reports, data and analytical tools, conferences and workshops, and the internet.

Access to Information

the World Bank policy on access to information sets forth a groundbreaking change in how the institution makes information available to the public. now the public can get more information than ever before—about projects under preparation, projects under implementation, analytic and advisory activities, and Board proceedings. underlying the new policy is the principle that the World Bank will disclose any information in its possession that is not on a list of exceptions.

find out more at: www.worldbank.org/wbaccess

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The Open Data Platform

as a knowledge institution, the World Bank’s first step is to share its knowledge freely and openly.

statistics are a key part of that knowledge and are now easily accessible on the web for all users. the World Bank provides free and open access to a comprehensive set of data about development in countries around the globe, including in africa. the World Bank’s Data web site is meant to provide all users with improved access to development data at www.worldbank.org/data

design and implement effective and affordable rural safety nets. it draws on the lessons learned from the design and operation of ethiopia’s productive safety net program (the largest in sub-saharan africa) and creates a “how to” reference for countries that are in the process of designing or implementing—or considering the adoption of—a rural safety net program.

these lessons apply to several contexts beyond ethiopia, especially the following:

n large-scale safety nets in low-income settings n safety nets in drought-prone areas n shifting from food aid to cash n productive and pro-growth impacts of social safety nets

Incentives and Dynamics in the Ethiopian Health Worker Labor Market

this book is useful for researchers and policy analysts with an interest in understanding and improving the allocation of human resources for health in the developing world. it presents the case of ethiopia, where, by international standards, the supply of health workers is tiny. in addition, those who do enter the profession and remain in the country disproportionately live and work in the capital, addis ababa. this story is

repeated across sub-saharan africa, where shortages of health workers are deemed chronic. increasing the supply of health workers, and improving their geographic distribution, requires an understanding of their responsiveness to changes in the incentives and constraints they face, and the efficacy with which labor markets can be expected to allocate scarce human resources for health.

this book presents evidence on these and other related issues from a new survey of ethiopian health workers. Detailed data help answer three sets

of questions: (i) how compensation levels vary with location, training, experience, etc.; (ii) what kinds of incentive packages are potentially most effective in attracting workers to under-served rural areas; and (iii) what we can learn about the health worker labor market from ethiopia’s method of assigning new graduates to their first jobs (via a lottery). the policy issues that can be addressed with these data are broad in scope.

What We’re Doing

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This map was produced by the Map Design Unit of The World Bank. The boundaries, colors, denominations and any other information shown on this map do not imply, on the part of The World Bank Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries.

IBRD 37618 SEPTEMBER 2010 to JUNE 2011

TYPES OF COMMITMENT: EDUCATION HEALTH SOCIAL PROTECTION

Regional Programs –

n as of June 2011, the World Bank’s africa region Human Development Department portfolio consists of over 136 projects totaling approximately $ 8.2 billion (evenly distributed across three sectors: education, health, and social protection). the average size of an operation is $60 million.

n Commitments have increased sharply over the past five years, doubling since 2006, with a recent spike in response to the various global crises that have adversely affected the region.

n notably, World Bank projects are increasingly designed and implemented as joint efforts with other donors, raising the need for close collaboration and harmonization at all stages.

What We’re Doing contact usRitva Reinikka, Director, Human Development, Africa Regionrreinikka@worldbank.org

Peter N. Materu, Acting Sector Manager, Educationpmateru@worldbank.org

Lynne Sherburne-Benz, Sector Manager, Social Protectionlsherburnebenz@worldbank.org

Eva Jarawan, Sector Manager, Health, Nutrition & Populationejarawan@worldbank.org

Tawhid Nawaz, Operations Advisertnawaz@worldbank.org

Maureen Lewis, Economic Advisermlewis1@worldbank.org

Kaliope Azzi-Huck, Operations OfficerKazzi-huck@worldbank.org

Kavita Watsa, Communications Officeremail: Kwatsa@worldbank.org

www.worldbank.org/afr/hd

www.facebook.com/WorldBankAfrica

www.twitter.com/WorldBankAfrica

AFRICA REGIONHUMAN DEVELOPMENThealth . education . social protection

photo credits: cover images 1 & 2, arne hoel; cover image 3, commissioned photo/Zambia; cover image 4, Jonathan ernst; inside cover, Jonathan ernst; page 1, image 3, hogg; all other photos arne hoel; pages 2 & 3, arne hoel; pages 4 & 5, top image, Jonathan ernst; page 4, arne hoel; page 5, commissioned photo/Zambia, shwetlena sabarwal, from the ethiopia psnp archive; pages 6, 7 & 8, arne hoel; page 9, Jonathan ernst; pages 10 &11, top image, arne hoel; page 10, arne hoel; page 11, commissioned photo/Zambia; pages 12 &13, top image, arne hoel; page 12, from the ethiopia psnp archive; pages 13, 14 &15, arne hoel; inside back cover and back cover, arne hoel.

africa region – human Developmentthe World BankWashington, D.c. 20433

www.worldbank.org/afr/hd