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Poor sanitation is stunting children in Pakistan

Ghazala Mansuri's picture
A nutrition assistant measures 1 year old Gullalay’s mid-upper arm circumference (MUAC) at UNICEF supported nutrition center in Civil Dispensary Kaskoruna, Mardan District, Khyber-Pakhtunkhwa province, Pakistan.
With a stunting rate of 38 percent, Pakistan is still among the group of countries with the highest rates of stunting globally and the pace of decline remains slow and uneven. In Sindh, for example, things have worsened over time, with one in two children now stunted. Credit: UNICEF


More than one in every three children born in Pakistan today is stunted.

Child stunting, measured as low height for age, is associated with numerous health, cognition and productivity risks with potential intergenerational impacts.

With a stunting rate of 38 percent (Demographic & Health Survey 2018), Pakistan is still among the group of countries with the highest rates of stunting globally and the pace of decline remains slow and uneven.

In Sindh, for example, things have worsened over time, with one in two children now stunted!

The policy response to this enormous health crisis has been almost entirely centered on interventions at the household level—reducing open defecation (OD), improving household behaviors like child feeding and care practices and food intake.  

A recent World Bank report, which I co-authored, suggests that a major shift is this policy focus is required for significant progress on child stunting.

The report begins by showing that over the past 15 years Pakistan has made enormous progress in reducing extreme poverty, with the poverty rate falling from 64 percent to just under 25 percent in 2016.

This has improved dietary diversity, even among the poorest, and increased household investment in a range of assets, including toilets within the home.

This has, in turn, led to a major drop in OD, from 29 percent to just 13 percent. Curative care has also expanded, with the mainstreaming of basic health units and the lady health worker program.
 

Toward Great Dhaka: Seize the golden opportunity

Qimiao Fan's picture
Toward Great Dhaka
Read the Full Report
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Originally Appeared on the Daily Star

Had you looked across Shanghai's Huangpu River from west to east in the 1980s, you would mostly have seen farmland dotted with a few scattered buildings. At the time, it was unimaginable that East Shanghai, or Pudong, would one day become a global financial centre; that its futuristic skyline, sleek expressways, and rapid trains would one day be showcased in blockbusters like James Bond and Mission Impossible movies! It was also unimaginable that the Shanghainese would consider living in Pudong.

How wrong that would have been! Pudong is now hosting some of the world's most productive companies, and boosting some of the city's most desirable neighbourhoods. And Shanghai has become China's most important global city, lifting the entire hinterland with it.

The same potential for urban transformation exists in Bangladesh, across the Pragati Sarani Airport Road that divides Dhaka into its west and east. West Dhaka is urban, hosting vibrant centres. East Dhaka remains largely rural, with a vast expanse of farmland. This sharp contrast presents a golden urban development opportunity for Dhaka, one that is not available to other major Asian cities.

Realizing the Promise of a Great Dhaka


Dhaka's population has grown from three million in 1980 to 18 million today and it continues to increase rapidly, which is a clear sign of success. However, Dhaka's development has been mostly spontaneous, with its urban infrastructure not keeping pace with its population growth.

Mapping Afghanistan’s future, one road at a time

Walker Bradley's picture
Also available in: دری | پښتو
Mapping Afghanistan’s future, one road at a time
OpenStreetMap is an open source geospatial data portal built and maintained by a community of mappers. Photo Credit: Taimani Films/ World Bank


In May 2017, the World Bank celebrated its 15 years of reengagement in Afghanistan. Since reengagement, we have helped the government deliver public services to its citizens and, in the process, accumulated a wealth of data on many sectors from health and education to infrastructure.

However, publicly available base data used across sectors – also called ‘foundation’ data-- is still lacking. As it happens, that information is important to design projects and inform policies.

Case in point: while we may have data on vaccines given or babies born, we don’t know much about the roads that lead to the clinic. Similarly, we may get data on school attendance and passing rates of students, but we don’t know how long it takes for students to reach their schools.

These examples highlight how foundation data can help better plan the expansion of healthcare facilities or enhance access to education. After all, each mapped kilometer of a road can help us understand how long Afghan children must walk to get to school or how long it takes sick Afghans to reach a hospital.

Without question, there is a clear need for better foundation data to inform decision making at all levels.

اهمیت نقشه برداری برای اینده افغانستان، اما یک سرک در یک وقت

Walker Bradley's picture
Also available in: English | پښتو
Mapping Afghanistan’s future, one road at a time
اوپن ستريت مپ يک منبع رایگان معلومات جغرافيايی است که توسط یک گروهی از متخصصان  نقشه برداری بميان آمده و فعالیت می نماید. عکس: تایمنی فلم/ بانک جهانی

بانک جهانی در ماه می سال ۲۰۱۷، از پانزدهمین  سالگرد از سرگیری فعالیت هایش در افغانستان تجليل نمود.  این در حالیست که طی این ۱۵ سال گذشته بانک جهانی حمایت لازم را برای دولت افغانستان غرض فراهم آوری خدمات عامه به افغانها فراهم نموده است. در اين فرایند، مشترکاً با دولت افغانستان ما توانستیم معلومات و آمار بسیاری را در بخش های صحت، معارف و هم چنان زیربنا ها جمع آوری نمايیم.

با آنکه معلومات در عرصه های مختلف بصورت پراگنده و غیر هماهنگ در دسترس عام قرار دارد اما این معلومات هنوز هم کافی نیست تا افغانها و همکاران انکشافی را در طرح ریزی برنامه ها و تدوین پاليسی ها که نقش کلیدی دارند، کمک نماید. به طور مثال ما در حاليکه آمار تطبيق واکسين و اطفال نوزاد را داريم، اما در مورد سرک ها ییکه به مراکز صحی منتهی میشوند آگاهی نداریم. به همین ترتیب، ممکن است در رابطه به میزان حاضری شاگردان در مکاتب و شاگردانيکه در امتحانات کامياب ميشوند بدانیم، اما  در مورد اینکه آیا چه زمانی را در برمیگیرد، تا شاگردان به مکتب برسند، معلومات کافی در دست نداريم.

این مثال ها نشان دهنده این است که چگونه  معلومات و آمار اساسی و دقیق ميتواند در گسترش پلانگذاری تسهيلات و خدمات صحی کمک نماید  و يا هم چگونه میتوانیم با دسترسی به این آمار دسترسی معارف را تقويت بخشیم. در نهایت امر، نقشه برداری هرکيلومتر سرک به ما کمک مينماید، تا بدانیم که اطفال بعد از طی چه مصافتی به مکتب میرسند، یا چه زمانی نیاز است، تا یک بیمار به شفاخانه برسد. بدون شک، دسترسی به آمار اساسی و دقیق یک نياز شمرده می شود، تا در روشنی آن مسوولین ذیربط در تمام سطوح از آن استفاده نمایند. 

د افغانستان راتلونکی نقشه کول، هرځل یو سړک

Walker Bradley's picture
Also available in: English | دری
Mapping Afghanistan’s future, one road at a time
اوپن سټريټ مپ د جغرافيايي معلوماتو يوه وړيا منبع ده چې د کارپوهو نقشه اخيستونکو يوې ډلې رامنځته کړې او فعاله يې ساتي.  انځور: ټایمني/نړیوال بانک

د ۲۰۱۷ کال په مې مياشت کې نړیوال بانک په افغانستان د خپلو فعاليتونو د بيا پيل ۱۵ مه کليزه ونمانځله. دا په داسې حال کې ده چې د دغو ۱۵ کلو په اوږدو کې نړیوال بانک افغان دولت ته اړينې مرستې برابرې کړي او دولت يې افغانانو ته د عامه خدمتونو رسولو جوګه کړی. په دې بهير کې مو له دولت سره په ګډه د روغتيا، پوهنې او زېربناوو په برخو کې ګڼې شمېرې او معلومات راټول کړي.

سره له دې چې په بېلابېلو سکتورونو کې معلومات په خوره وره او ګډه وډه بڼه په عام ډول د لاسرسي وړ دي، خو دا معلومات لا دومره نه دي چې له افغانانو او پراختيايي ملګرو سره د پروژو په طرحه او پاليسي جوړولو کې، چې کليدي ونډه لري، مرسته وکړي. د بېلګي په ډول: موږ په داسې حال کې چې د واکسينو د تطبيق او د نویو زېږېدلو کوچنیانو شمېرې لرو، د هغو سړکونو په اړه چې صحي مرکزونو ته ورغلي معلومات نه لرو. همدا راز، موږ ښايي په ښوونځيو کې د زده کوونکو د حاضرۍ او د هغو زده کوونکو چې په ازموينو کې کاميابېږي د شمېرو په اړه معلومات ولرو، خو په دې اړه چې زده کوونکي په څومره وخت کې ښوونځي ته رسېږي، کافي معلومات نلرو.

دا بېلګې روښانوي چې څنګه دقیق لومړني معلومات او شمېرې را سره د صحي مرکزونو او خدماتو په غځولو کې مرسته کوي او يا څنګه ښوونې ته لاسرسی پياوړی کولای شو. د هر کيلومتر سړک نقشه اخيستنه موږ ته راښوولای شي چې کوچنيان تر ښوونځي څومره پلي ځي‌، او يا يو ناروغ په څومره وخت کې تر روغتونه رسېږي. بې له شکه چې لومړنیو معلوماتو او شمېرو ته څرګنده اړتيا ليدل کېږي، چې په رڼا کې يې اړوند چارواکي په هر پاټکي کې له دې ګټه واخلي.

Transforming Sri Lanka’s Cities to be More Livable and Prosperous

Ede Ijjasz-Vasquez's picture

Sri Lanka night lights
 
Sri Lanka is in many ways a development success story.

Growth of income per person in Sri Lanka has averaged a little more than 7 percent a year over the past five years. That follows average growth of just over 5 percent a year in the preceding nine years. Among the six largest South Asian countries, Sri Lanka has the highest level of economic output per person. With sustained high growth, Sri Lanka has largely eradicated extreme poverty.

All this success has helped propel the country towards middle-income status. Going forward, how successfully Sri Lanka manages its cities will determine how quickly and efficiently the country moves to higher middle-income status and beyond. Every high-income economy has achieved this status through urbanization.

What can South Asian cities learn from Colombia's Medellin?

Sangmoo Kim's picture
Cable Car in Medellin
The Metro Cable in Medellin has facilitated greater access to mobility, services, and opportunities through connecting poorer neighborhoods with facilities and services throughout the city. Joe Qian/World Bank
Cities are created for human experiences and not for satellites in the sky. So why are there so many cities that while look impressive on a map, exclude so many of their residents from enjoying the full extent of their benefits? The key may be that details matter for inclusion of cities.
                                                                                               
Inclusion means that all people and communities have access to rights, opportunities, and resources. Urbanization provides cities the potential to increase prosperity and livability. However, many suffer from poor environments, social instability, inequality, and concentrated pockets of poverty that create exclusion. In South Asia, as in other regions, segregation within cities cause poorer areas to suffer from the lack of access to facilities and services that exacerbate misery and crime.

Medellin, Colombia was once the most dangerous city on the planet with astounding gaps between the wealthy and the poor, vastly different access to services, and the highest homicide rate in the world. Its turnaround has been impressive. Much of the progress has been attributed to the thoughtfulness of its planning to ensure greater inclusion. What can South Asian cities learn from this South American city?

Planning policies and action have often been concentrated on the broad structures and functions of cities. However, drilling down the details can realize an inclusive urban environment that improves life for all in public spaces. In our definition, inclusive cities provide:                                                                              
  • Mobility: A high level of movement between different neighborhoods that provide opportunities for jobs, education, and culture;
  • Services: All neighborhoods have a basic level of facilities and affordable necesities such as housing, water, and sanitation;
  • Accessibility: Urban spaces are designed so that everyone can easily and safety enjoy public spaces. 
 Social inclusion requires greater planning at a micro scale
Scale matters: Inclusion requires greater planning at a micro scale. Sangmoo Kim/World Bank

What happened in Medellin, Colombia? Medellin offers an inspiring example of how improved planning and sound implementation can increase social inclusion. Two decades ago, Medellin was the homicide capital of the world. Illicit drugs were a major export and hillside slums were particularly affected by violence. In response, the government created public facilities inclusive of libraries and schools, public transportation links, and recreational spaces in the poorest neighborhoods; and connecting them with the city’s commercial and industrial centers. As a result of a planning model that seeks to serve all residents, the city has become safer, healthier, more educated and equitable.