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Why The First 1,000 Days Matter Most

Roger Thurow's picture



This blog first appeared in the New York Times on June 20, 2016.

Nutrition is not only fundamental to an individual’s cognitive and physical growth, it is also the cornerstone of all development efforts, whether improving education, health, income or equality, at home or abroad. And the most important time for good nutrition is in the 1,000 days from the beginning of a woman’s pregnancy to the second birthday of her child. What happens in those first days determines to a large extent the course of a child’s life – his or her ability to grow, learn, work, succeed – and, by extension, the long-term health, stability and prosperity of the society in which that child lives.

3 steps to improve rural sanitation in India - a pathway to scale and sustainability

Joep Verhagen's picture
Child using a latrine in Rajasthan. 
Photo credit: World Bank

Almost 600 million Indians living in rural areas defecate in the open. To meet the ambitious targets of the Indian government’s Swachh Bharat Mission Grameen (SBM (G)) – the rural clean India mission – plans to eliminate open defecation by 2019. SBM (G) is time-bound with a stronger results orientation, targeting the monitoring of both outputs (access to sanitation) and outcomes (usage). There is also a stronger focus on behavior change interventions and states have been accorded greater flexibility to adopt their own delivery mechanisms. 
 
The World Bank has provided India with a US$1.5 billion loan and embarked on a technical assistance program to support the strengthening of SBM-G program delivery institutions at the national level, and in select states in planning, implementing and monitoring of the program.

Fecal sludge management is the elephant in the room, but we have developed tools to help

Peter Hawkins's picture

Recently developed Fecal Sludge Management tools to help address this important, but often-ignored, urban sanitation issue.

A global challenge

In the rapidly expanding cities of the developing world, sanitation is of ever growing importance – more people mean more exposure to fecal pollution, and therefore a greater risk to public health.  The widely accepted solution, taught to sanitary engineers worldwide, is to flush human waste into sewers which take it to large, centralized treatment facilities. 

This requires expensive infrastructure, a plentiful water supply, skilled operators and a substantial and reliable stream of operating funds. This means that in most low- and middle-income country cities, the sewerage service is only available to a small and decreasing proportion of the population, as investments cannot keep up with the explosive urban growth.

Reading ICAI’s review of DFID WASH results

Suvojit Chattopadhyay's picture

The Independent Commission for Aid Impact (ICAI), UK’s aid watch dog, today, released its review of DFID’s programming and results in water sanitation and hygiene (WASH). In this impact review, they take a close look at the results DFID reported in its 2015 Annual Report; results that cost £ 713 million between 2010 – 2014. 

Do read the full report here.

Some thoughts on the areas of concern in the report:

  • The focus on ‘leaving no one behind’ is spot on. It is easy to stack up impressive WASH numbers if one ignores the poorest and the most vulnerable in communities. Safe sanitation and hygiene need to be universal for health benefits to accrue to communities. Within WASH, sanitation is specifically complex, sometimes also called a ‘wicked problem’ – a challenge foremost, of inducing lasting behaviour change. The very nature of careful social engineering required to bring about this behaviour change seems to run contrary to some of the factors that make an intervention scalable – an ability to standardise inputs and break programme components down to easily replicable bits.
  • Within the broad basket of ‘service delivery’ interventions, WASH is one of the trickier sectors when it comes to measuring sustained impact, especially at scale. Naturally then, ICAI find that while DFID’s claims of having reached 62.9 million people are broadly correct, it is very hard to establish if the benefits are sustained. Therefore, the results reported remain at the ‘output’ level and that is what ICAI ends up assessing, even though what they set out to do is an ‘impact’ review. While the report speculates on sustaining benefits beyond the 2011-15 period, I wonder whether those that accessed the programme in 2011-12 continued to experience any benefits in 2015.
  • The link with government systems, in terms of implementation, monitoring and sustenance remains unclear: another typical WASH issue. Barring say, India, (and this is true especially in sub-Saharan countries, government WASH budgets are highly inadequate. A lot of the work that happens is funded by donors and this implies that monitoring and maintenance happens outside the official system. Achieving local ownership in such a context is a challenge.
  • ICAI finds it difficult to assess value for money (VfM) in DFID’s WASH programmes. On one hand, it finds that there isn’t enough competitive procurement, but also there is a lack of established metrics and benchmarks to analyse VfM. Following DFID’s own 3Es framework, an Economy and Efficiency analysis should be possile across the portfolio, and as far as I can tell, is rapidly being developed in the sector, and within DFID. However, partly as a consequence of the lack of ‘outcome/impact’ data, cost-effectiveness studies are likely to remain a challenge. This work by an OPM-led consortium should be particularly relevant in improving VfM analysis across the sector.

Taxing ‘public bads’ and investing in ‘public goods’: Constructive tax policies can help prevent harm and help promote progress

Christopher Colford's picture
To tax, or not to tax? That is the question that preoccupied a thought-provoking panel at a recent World Bank Group conference on “Winning the Tax Wars” – along with such pragmatic policy questions as: What products and behaviors should be taxed, aiming to discourage their use? How heavily should taxes be imposed to penalize socially destructive behaviors? If far-sighted, behavior-nudging taxes are indeed adopted, where should the resulting public revenue be spent?

Before memories start to fade about a stellar springtime conference – at which several of the Bank Group’s Global Practices (including those focusing on Governance and on Health, Nutrition and Population) assembled some of the world's foremost authorities on tax policy – it’s well worthwhile to recall the rigorous reasoning that emerged from one of the year’s most synapse-snapping scholarly symposia at the Bank.

Subtitled “Protecting Developing Countries from Global Tax Base Erosion,” the conference focused mainly on the international tax-avoidance scourge of Base Erosion and Profit-Shifting (BEPS). Coming just one week after a major conference in London of global leaders – an anti-corruption effort convened by Prime Minister David Cameron of the United Kingdom – the two-day forum in the Preston Auditorium built on the fair-taxation momentum generated by the recent Panama Papers disclosures. Those leaks about international tax-evasion strategies dominated the global policy debate this spring, when they exposed the rampant financial conniving and misconduct by high-net-worth individuals and multinational corporations seeking to avoid or evade paying their fair share of taxes.
 
The Bank Group conference, however, explored tax-policy issues that ranged far beyond the headline-grabbing disclosures about the scheming of rogue law firms and accounting firms, like the now-infamous Panama-based Mossack Fonseca and other outposts of the tax-dodging financial-industrial complex. Conference-goers also heard intriguing analyses about how society can levy taxes on “public ‘bads’ ” to promote investment in “public ‘goods’ ” – as part of the broader quest for broad-scale tax fairness.
 
"Winning The Tax Wars" via revenue-raising strategies

Blog post of the month: The 2016 Multidimensional Poverty Index was launched last week. What does it say?

Duncan Green's picture

Each month People, Spaces, Deliberation shares the blog post that generated the most interest and discussion. In June 2016, the featured blog post is "The 2016 Multidimensional Poverty Index was launched last week. What does it say?" by Duncan Green.


This is at the geeky, number-crunching end of my spectrum, but I think it’s worth a look (and anyway, they asked nicely). The 2016 Multi-Dimensional Poverty Indexwas published yesterday. It now covers 102 countries in total, including 75 per cent of the world’s population, or 5.2 billion people. Of this proportion, 30 per cent of people (1.6 billion) are identified as multidimensionally poor.

The Global MPI has 3 dimensions and 10 indicators (for details see here and the graphic, right). A person is identified as multidimensionally poor (or ‘MPI poor’) if they are deprived in at least one third of the dimensions. The MPI is calculated by multiplying the incidence of poverty (the percentage of people identified as MPI poor) by the average intensity of poverty across the poor. So it reflects both the share of people in poverty and the degree to which they are deprived.

The MPI increasingly digs down below national level, giving separate results for 962 sub-national regions, which range from having 0% to 100% of people poor (see African map, below). It is also disaggregated by rural-urban areas for nearly all countries as well as by age.

Five ways to increase citizen participation in local waste services

Silpa Kaza's picture
ICT services offered by I Got Garbage in Bangalore
Web platforms, apps, and citizen surveys are changing how solid waste management services are conducted globally and showing that waste infrastructure alone is simply not enough. These interactive platforms provide incentives, quantify actions, and increase pressure on service providers, and thereby improve waste management with greater citizen engagement.
 
The World Bank recently hosted five individuals representing organizations and projects that use information and communications technology (ICT) to engage citizens with local waste services. Their varied approaches reveal incentive models that effectively lead to strategic behavior change.

Arab reality show tests humanity and empathy

Bassam Sebti's picture


It’s Ramadan and the Arabic TV channels are festooned with shows that vary from recurring popular soap operas, cooking and competition shows — but one has become the talk of the town.

Al Sadma, or The Shock, the Arabic version of the popular American show What Would You Do, is a reality TV prank show. But it’s not like many other tasteless reality shows that invoke fright and even terror, it is a show that invokes morality and examines humanity.

Globally, periods are causing girls to be absent from school

Oni Lusk-Stover's picture
Student at primary school in Freetown Sierra Leone. Photo © Dominic Chavez/World Bank

A United Nations Children's Fund report estimates that one in ten girls in Sub-Saharan Africa misses school during their menstrual cycle. By some estimates, this equals as much as twenty percent of a given school year.

Many girls drop out of school altogether once they begin menstruating. Should young women miss twenty percent of school days in a given year due to a lack of facilities or a lack of information or a lack of sanitary products?


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