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Promoting better nutrition in Bhutan

Izabela Leao's picture
 Izabela Leao / World Bank
School children singing and dancing in Samtse Dzongkhag. Photo Credit: Izabela Leao / World Bank

Bhutan is no ordinary place.

A landlocked Himalayan kingdom tucked in a mostly rugged mountainous terrain between India and China, it measures prosperity by assessing its citizens’ level of happiness by way of a Gross National Happiness index.

Equally striking, Bhutan’s constitution mandates that 60 percent of its national land be preserved under forest cover, making Bhutan the world’s only carbon-negative country.

Bhutan’s geography – with land rises ranging from 200 meters in the southern foothills to 7,000 meters in the high northern mountains – consists of three major agro-ecological zones that allow for a rich biodiversity and seasonal foods.

This natural wealth, however, comes with its caveats as Bhutanese living in isolated rural areas can’t access a reliable diverse diet throughout the year.

"Many families in rural Bhutan practice two meals rather than three meals a day," reports Ms. Kinley Bidha, Tarayana Foundation Field Officer in Samtse Dzongkhag. "Some for cultural reasons, others due to a shortage of food, others due to a shortage of land too farm," she adds.

Overall socio-economic development in the last three decades has led to a rapid improvement in health and nutrition outcomes in Bhutan – the country’s infant mortality rate declined to 30 per 1,000 live births in 2012 down from 90 per 1,000 in 1990; while the rate of stunting in children under 5 years declined 24 percent from 1986 levels.

Nonetheless, the lack of variety of foods in diet remains a key concern, especially for pregnant and nursing women as well as young children. And while most families feed their children complementary food, fewer than a quarter of parents provide them nutritious meals essential to their health.

In addition, 67 percent of Bhutanese adults consume less than the recommended five servings (or 400 grams) of fruits and/or vegetables per person a day [National Nutrition Survey (NNS) 2015].

When consumed, vegetables consist for the most part of two national staples, potatoes and chilies, which hardly provide essential vitamins and minerals.

Keeping regional variations in mind, between 16 and 34 percent of children under 5 are stunted—or too short for their age—seven percent of children are underweight, 35 percent of children of age 6-59 months and 44 percent of women of reproductive age are either anemic or iron deficient. Exclusive breastfeeding rates for six-month-old children remain at a low 50 percent (NNS, 2015).  

Damages caused by malnutrition during pregnancy and the first years of a child’s life are irreversible and contribute to stunting and lower immunological and cognitive development, and predispose to adult-onset diseases (including metabolic syndrome).

Thankfully, the negative impact of malnutrition on Bhutan’s economy is now better understood and has become a priority to promote its national development.

Inclusive transport will be critical to women’s empowerment—and to development as a whole

Nato Kurshitashvili's picture
Also available in: Español
Photo: WRI Brasil Cidades Sustentáveis/Flickr
Does separating women on public transport tackle the wider problem of sexual harassment and assault, or does it merely move the problem around? How can governments combat sexual harassment on public transport without segregating transport by gender? Does the employment of women in the sector contribute to designing better solutions to improve women’s personal security in public transport and enhance their mobility? Experts on both sides of the issue debated these and other questions at a recent event on “Women as Transport Users and Transport Services Providers – What Works and What Doesn’t” hosted by the World Bank’s transport team. Data reveals that while a significant share of women all over the world experience sexual harassment on public transport, often in pandemic proportions, the majority of cases goes unreported.
 
The session was conceived to explore development implications of women-only transport; highlight why laws matter for women in the transport sector; and better prepare World Bank staff to discuss these two topics with their respective clients.
 
The women-only transport concept regularly catches the media’s attention and has been debated before. Those who favor providing women with the option of gender segregated transport say it provides much-needed safety for women and facilitates their access to income-earning opportunities and various services. Those against segregation say it further reinforces gender inequalities and entrenches sexist attitudes.

Wenchuan Earthquake, ten years on: Building back stronger

Yi Shi's picture
Photo:Mara Warwick/World Bank

It’s been ten years since the Wenchuan Earthquake struck China, leaving an everlasting scar on ravaged land, but also revealing the strong and unyielding will of the Chinese people.

Growing or fading? The long-run impacts of educational interventions

David Evans's picture
Also available in: Français

Many education investments focus on the first years of primary education or – even before that – early child education. The logic behind this is intuitive: Without a solid foundation, it’s hard for children and youth to gain later skills that use those foundations. If you can’t decipher letters, then it’s going to be tough to learn from a science textbook. Or even a math textbook. But it’s important to remember that for most “investors” (whether governments or parents or the children themselves), the most basic skills aren’t the ultimate goal. The objective is better life outcomes. Most of the justification for these early interventions are that they will translate into better lives once these children grow up.

The School Leadership Crisis Part 2: From Administrators to Instructional Leaders

Tracy Wilichowski's picture

How can a school principal be transformed into an instructional leader who provides meaningful feedback and targeted coaching? In this blog, the second in a two-part series, we explore how principals can use observation and feedback to support teachers.

Face to face with Country Director for India, Junaid Ahmad

Nandita Roy's picture

The Lighthouse India is a platform to facilitate knowledge flows across states within India and to create strategic partnerships with other countries to share and transfer knowledge and experience, which would inform development policies, scale up good practices and innovations. We caught with our Country Director, Junaid Ahmad, for an in-depth understanding of this initiative of the World Bank.

What is Lighthouse India?

Development is best catalyzed when people learn by doing. The notion of lighthouse is that you are a beacon for someone. An Indian state innovating on how local government programs are run, say in West Bengal, can be a source of information for other states, say Madhya Pradesh or Karnataka, which are also trying to figure out how to strengthen local governments. In a federal system like India, the potential for learning from each other is vast especially where innovation is constantly happening. The problem is that the lessons from these innovations and the information about them is not moving smoothly across borders. Lighthouse India is based on the Bank's unique position to facilitate these exchanges and link them to actual implementation.

It is not only about exchanges between states in India. As India moves along the development trajectory towards high middle income, the nation itself is transforming. The lessons of this transformation are going to be critical for other countries. The Bank can also proactively broker these exchanges between India and other countries as India acts as a “lighthouse” for others.

It is important to stress that Lighthouse India is not just a passive exchange of best practices. It is an active exchange of practices and approaches where the expertise and experiences of India can be leveraged by another country. And as always, these exchanges are never one way: as India shares, it will gain from the development experiences of others.

Importantly, Lighthouse India will change the way we do analytical and advisory services.  The latter will be built around operational issues and offer the analysis to understand better implementation challenges.

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How is Lighthouse India important for Bank’s strategy in engaging with India?

First, Lighthouse India is essential in supporting the strategy of scaling up development impact. Let me take the example of livelihood programs. We’ve been working in Andhra Pradesh, Bihar, Odisha supporting the creation of self-help groups of women and facilitating their access to micro credit and economic activities. We could respond to every state that requests our assistance for this kind of activity. On the other hand, if we have worked in three or four States, we can then leverage their expertise and experience to support others. In this context, the World Bank can act as a broker of exchanges where states learn from the experience of each other. And this could be in any area such as local government strengthening or in solar power generation.

Second, Lighthouse India will play an important role in the delivery of global goods. For example, in the case of climate change, if we support the collective efforts of nations to de-carbonize their growth path, we may be able to achieve the objectives set out in COP18 in Paris. India has set for itself the aspiration of delivering 175GW of renewable energy in the coming years. Not only will India’s energy strategy help in delivering the global goal of sustainable development, its experience with scaling up renewable energy and energy efficiency will support the collective efforts of other countries to achieve their own objectives in the energy sector. This is where Lighthouse India can play an important role of leveraging India in the achievement of global goods.

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The latest poverty numbers for Afghanistan: a call to action, not a reason for despair

Shubham Chaudhuri's picture

The just-released Afghanistan Living Conditions Survey (ALCS) paints a stark picture of the reality facing Afghanistan today. More than half the Afghan population lives below the national poverty line, indicating a sharp deterioration in welfare since 2011-12.[1]  The release of these new ALCS figures is timely and important. These figures are the first estimates of the welfare of the Afghan people since the transition of security responsibilities from international troops to the Afghan National Security Forces (ANSF) in 2014.

While stark, the findings are not a surprise

Given what Afghanistan has gone through in the last five years, the significant increase in poverty over this period is not unexpected. The high poverty rates represent the combined effect of stagnating economic growth, increasing demographic pressures, and a deteriorating security situation in the context of an already impoverished economy and society where human capital and livelihoods have been eroded by decades of conflict and instability.

The withdrawal of international troops starting in 2012, and the associated decline in aid, both security and civilian, led to a sharp decline in domestic demand and much lower levels of economic activity. The deterioration in security since 2012, which drove down consumer and investor confidence, magnified this economic shock. Not surprisingly, Afghanistan’s average annual rate of economic growth fell from 9.4 percent in the period 2003-2012 to only 2.1 percent between 2013 and 2016. With the population continuing to grow more than 3 percent a year, per capita GDP has steadily declined since 2012, and in 2016 stood $100 below its 2012 level. Even during Afghanistan’s years of high economic growth, poverty rates failed to drop, as growth was not pro-poor. In recent years, as population growth outstripped economic growth, an increase in poverty was inevitable.

The School Leadership Crisis Part 1: Making Principals Work for Schools

Ezequiel Molina's picture
Worldwide, hundreds of millions of children reach young adulthood without acquiring even the most basic skills – a phenomenon dubbed "the global learning crisis." Concurrently, few of the principals who oversee these schools exercise strong management practices, which include setting learning targets, using data to guide instruction, observing classrooms, and providing feedback to teachers.

Madagascar, a Country of a Thousand Hopes, a Country of a Thousand Vulnerabilities

Claudia Navalonirina Raobelina's picture



In 2018, Madagascar is said to be one of the poorest countries in the world. Antananarivo is said to be the third dirtiest capital. Some diseases like the plague persist in the country, even in 2017. Moreover, more than 35% of adult Malagasy people are still illiterate. One can witness corruption on every level. Every morning, a new political scandal can be read through newspapers’ headlines.

Can Ghana’s extreme poor be graduated?

Suleiman Namara's picture
A stronger focus on human capital investments of children from these households with a particular focus on skills for future jobs will be key. (Photo: Arne Hoel / World Bank)


Ghana was the first country in Sub-Saharan Africa to meet the Millennium Development Goal (MDG1) target of halving extreme poverty by 2015. A share of the population living in poverty decreased from 52% in 1991 to 24% in 2012. Ghana is eager to lead the way in Africa again, but this time to graduate extreme poor households, out of poverty. The current policy debates are around graduating in about three to four years some 8.4 % of households living in extreme poverty. But to what occupations?


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