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El Salvador: small country, giant steps to control tobacco use

Patricio V. Marquez's picture



In a recent visit to El Salvador, the smallest, yet beautiful most densely populated country in Central America, I attended an international event organized by the Secretariat of the Framework Convention on Tobacco Control (FCTC) for the FCTC 2030 project.  During this event, I had the opportunity to learn from government officials and the Solidarity Fund for Health (FOSALUD) team about the significant tobacco control steps taken by the country.  

According to data presented at the event, 1 in 10 adults in El Salvador smoke; the prevalence of current cigarette consumption is 17 percent among men, 2 percent among women, and 10 percent among young people.  Data from the IHME Global Burden of Disease study indicate that, in 2016, of the more than 1,600 tobacco-attributable deaths in El Salvador, almost half of them were premature deaths (before the age of 70 years). This contributed to an estimated 34,000 years of life lost due to tobacco-related premature mortality and disability. Besides these impacts, an assessment done by FOSALUD with the support of the FCTC Secretariat, UNDP and PAHO/WHO, estimates that tobacco use causes significant economic losses, including both health care costs (US$115.6 million) and loss of productivity (US$148 million), amounting to US$264 million or 1 percent of El Salvador’s GDP.

What happens when someone is unable to access health or education? These artworks confront these very questions

Juliana J Biondo's picture
Human Capital exhibition at the World Bank Group Visitor Center in Washington, DC. © Bassam Sebti/World Bank
Human Capital exhibition at the World Bank Group Visitor Center in Washington, DC. © Bassam Sebti/World Bank

What exactly is Human Capital? The phrase itself is only two words: “Capital” refers to an asset that improves one’s ability to be economically productive while “Human” refers to the individual as the very unit in which the asset comes. Taken together however, the phrase transforms to be about that which an individual human can harness within themselves to realize their full potential, and be the best contributor to society they can be. Human Capital is about the economic power which lays ready for realization inside every human; the ideas and talent imbued in every individual.

What can each individual harness to make the most for, and of themselves? This is the question that the contemporary visual art exhibition on view in the Gallery in the World Bank Group Visitor Center seeks to understand.

The World Bank believes that it is the health, knowledge, and skills which people accumulate through their lives that enable them to harness and realize their full potential as productive members of society. But, how can we ensure that every human being has access to those three things? What happens when someone is unable to access health, knowledge, skills - some, or all three? The artworks on view confront these very questions. 

Making Pakistan more equitable for all

Silvia Redaelli's picture
Between 2001 and 2015, approximately 32 million people were lifted out of poverty
Photo: World Bank

This blog is part of a series that discusses findings from the [email protected]: Shaping the Future report, which identifies the changes necessary for Pakistan to become a strong upper middle-income country by the time it turns 100 years old in 2047. 

In recent years, Pakistan has made remarkable progress in reducing poverty. Estimates based on the national poverty line, which was set at Rs3,030.3 per adult equivalent per month based on 2013-14 prices, show a consistent decline over the past two decades.
 
Between 2001 and 2015, approximately 32 million people were lifted out of poverty and the poverty rate was more than halved, going from 64 percent in 2001 to 24pc in 2015. However, a lot is yet to be done.

Not only because 2015 estimates show that approximately one in four Pakistani still does not have enough money to satisfy basic needs, but – even more alarming – progress has been far from equal when looking across the provinces, districts, cities, and rural areas.
 
While poverty declined at a fast pace in Khyber Pakhtunkhwa and, to a lesser extent, in Punjab, progress was less positive in Sindh and Balochistan.
 
Within provinces, poverty has remained stubbornly high in Southern Punjab and Northern Sindh. Similarly, the pace of poverty reduction has been slower in rural areas compared to cities, where the risk of poverty is less than half compared to rural areas.

Inequalities in poverty levels and poverty reduction performance are compounded by substantial inequalities in access to and quality of basic services such as health, education, electricity, water, and sanitation.
 
Being born in one of the country’s lagging areas and/or in a poor family largely predetermines a child’s chances of escaping deprivation and realizing his or her full human capital potential in life.

The dos and don’ts of boosting Pakistan’s human capital

Tazeen Fasih's picture
Photo: World Bank

This blog is part of a series that discusses findings from the [email protected]: Shaping the Future report, which identifies the changes necessary for Pakistan to become a strong upper middle-income country by the time it turns 100 years old in 2047. 

My parents’ gardener has six children – all aged 8 or younger. While his wife is busy taking care of the youngest ones, barely 15 months and 2 months old, he brings the other kids along with him so they don’t wander in the streets.

As I look at the supposedly 8-year-old girl with a dupatta wrapped around her head, looking tiny, probably stunted, suddenly I realize how pervasive all the statistics Yoon and I have been working are – right there, staring at us in our face.

The 38 percent stunting rate for the population, the fertility rate of 3.6 births per woman, the 22.6 million children out of school, the dismal learning outcomes for students, these are all here manifested in this family and its future.

What kind of future is awaiting these children? Will they be able to reach their full productive potential? According to the World Bank’s Human Capital Project, Pakistan’s children born today can achieve only 39 percent of their full potential – productivity they could have achieved if they were able to enjoy complete education and full health.

With over 60 percent of Pakistan’s national wealth (measured as the sum of produced capital such as factories and infrastructure; 19 types of natural capital such as oil, minerals, land, and forests; human capital; and net foreign assets) estimated to be coming from Human Capital Wealth, a failure to nurture and utilize this wealth to its full potential can be fatal.

Nonetheless, successive governments have failed to address the human capital challenge. A careful review of policies in Pakistan on human development reveals a myriad of policies over the 70 years of the country – many strategies appearing sound and well-intentioned, some, of course, appearing to be prompted by geopolitical situations of specific eras of the country.

In this context, we highlight some principles in human capital policies.

Ways for Sri Lanka to fix its healthcare

Deepika Attygalle's picture
Ways for Sri Lanka to fix its healthcare
Nurses in Sri Lanka. Photo: World Bank

Today on World Health Day, we can say with confidence that Sri Lanka’s healthcare system has delivered on many of its promises.

This year’s focus on universal health care is a timely reminder that Sri Lanka is still reaping the benefits of far-thinking health policies implemented as early as the 1800s.  

Many of these measures were designed to address what were then considered the key challenges of previous centuries, such as high maternal and child mortality rates and infectious diseases that claimed the health and lives of thousands.
 
Successes in lowering maternal and child mortality rates and introducing effective vaccination programs have made Sri Lanka’s low-cost model one worth emulating in the rest of South Asia.  
 
Sri Lanka’s healthcare faces new challenges
 
However, we can no longer afford to rest on our laurels. Our policies and systems must now evolve to address the country’s urgent concerns.
 
The island must also now contend with a worrying rise in non-communicable diseases such as cardiovascular diseases (CVD), ischemic heart disease and stroke, cancers, diabetes, and respiratory conditions such as asthma.
 
Fertility decline and increasing longevity have resulted in a demographic transition in Sri Lanka and this is taking place while the country is aspiring to become an upper middle-income country. 

Population projections show that the proportion of Sri Lankans above the age of 60 years will increase from 14 percent in 2017 to 22 percent by the year 2037.
 
With such a rapidly aging population in Sri Lanka, it is imperative for policymakers to ensure that social and economic institutions in the country are ready to face the health challenges and social consequences ahead.
 
In response, Sri Lanka is undertaking an ambitious agenda that will strengthen and expand primary healthcare services from the ground up. Documented in Re-Organizing Primary Healthcare in Sri Lanka, preserving our progress preparing our future”   this approach is backed by strong evidence.

The report captures the findings of wide-ranging conversations among hundreds of stakeholders from every level of the country’s healthcare system.

Facilitated by the Ministry of Health, Nutrition and Indigenous Medicine, and supported by the World Bank, the report makes a case for why, and how, Sri Lanka must re-imagine its primary healthcare systems in order to attain the goals of universal healthcare. 

Visualizing Nepal's health progress

Ravi Kumar's picture
Photo: World Bank

Over the last few decades, Nepal has considerably improved the health and wellbeing of its people.

As we mark World Health Day today, here’s an overview of how much health progress Nepal has made in its efforts to meet the Sustainable Development Goals (SDGs), especially the SDG 3 indicators, which focus on healthy lives and wellbeing for all at all ages.

Gender inequality is a major stumbling block to human capital—global health needs to step up

Sonja Tanaka's picture

Today is World Health Day, celebrated this year under the theme of Universal Health Coverage for everyone, everywhere. Gender equalityfrom eliminating the gender pay gap in health workforces to ensuring all people have equal opportunity in accessing health services that meet their needsserves as an essential pillar in achieving universal health coverage. So on this World Health Day, we review where global health organizations themselves lead and lag in advancing equality and call for gender-transformative action.

Globally, women earn less than men. As a result, human capital worldwide is about 20% lower than it ought to be. Much of this deficit is a result of policies and practices that range from the gender-blind to the overtly discriminatory. At the national level, the World Bank reports that 2.7 billion women are still legally barred from having the same choice of jobs as men, and just six countries currently provide women and men equal rights related to work.


 

Shaping a brighter future for Pakistan

Illango Patchamuthu's picture
Pakistan needs to think big on investing in its people
Pakistani girls attending a primary school. Photo: World Bank
This blog is part of a series that discusses findings from the [email protected]: Shaping the Future report, which identifies the changes necessary for Pakistan to become a strong upper middle-income country by the time it turns 100 years old in 2047. 
 
In 28 years, Pakistan will turn 100 years old. The children born this year will be adults then.

I wonder what they will see when they look around. Will they see a country teeming with opportunity? Or will they be in a country that does not offer enough jobs and does not provide the needed skills to compete?

Some of them may well be new parents at 28. Will they be able to look at their own children, and see a brighter future for them?

Pakistan has some important decisions to make if it wants to give its children the future they deserve.

If the country can make the right decisions now, Pakistan can accelerate and sustain growth to become a confident upper middle-income by the time it turns 100. It’s ambitious but possible.

Other countries –South Korea, China, and Malaysia – have transformed their economies within a generation, and there is no reason why Pakistan cannot achieve the same.

The alternative is not inspiring. If the country fails to accelerate and sustain growth as well as control population growth, by 2047 income levels will be close to where they are today and with challenges similar to what they are today.

I like to imagine another Pakistan, in which stunting and malnutrition are gone, in which family background does not determine what job you can get, women compete equally with men, businesses thrive, and Pakistan competes with the likes of Shanghai or Singapore as a trading hub.

Last month we launched a report, [email protected]: Shaping the Future, which looks at some of the reforms needed to accelerate and sustain growth and transform Pakistan’s economy.

Now is the time to come together and see what needs to be done to achieve this goal. A growth narrative for Pakistan needs to rest on these four elements: investing in people; using resources more efficiently; caring for the environment; and finally, improving how Pakistan is run to support growth and the implementation of difficult reforms.

Pakistan needs to think big on investing in its people.

Paving the way for better lives in Bangladesh: A human capital story

Muneeza Mehmood Alam's picture
Bangladesh: Better roads for Better Lives

After improvements were made to a local road, Swapna Akhter, a Community Woman in Kalmakanda, Netrokona, can take patients more conveniently to the nearby hospital. Similarly, Ibrahim Talukder, Chairman of a Union Parishad in Fatikchari, Chittagong, has found that the cost of getting to the local health complex has substantially reduced after the paving of a local road.  

These stories demonstrate the intrinsic link between transport and human capital development. This connection is perhaps most obvious in rural areas, where improved mobility has transformed countless lives by unlocking economic opportunities and expanding access to essential services like healthcare or education.

The ongoing Second Rural Transport Improvement Project (RTIP-II) in Bangladesh is a case in point. We talked to several beneficiaries of the project—which supports road expansion and upgrading, and rural market development in 26 districts across the country, and the dredging of local waterways on a pilot basis—to understand how better connectivity had impacted their lives.

In Bangladesh, new latrines meet a tested business model

Shilpa Banerji's picture
Shamila Hakim outside her home in Gazipur district's Shinglab village, Dhaka
Shamela Hakeem outside her home in Gazipur district's Shinglab village, Dhaka. Photo: World Bank

In a tiny hamlet called Shinglab in Gazipur district, around 2 hours from Dhaka, you can see a cluster of homes made of varying materials depending on the household income.

Shamela Hakeem, 40, lives in a functional mud hut with a tin roof. A widow with no children, she makes around BDT 300 ($3.50) daily as a sweeper at a local factory.

Last year, she decided to upgrade her sanitation facilities and purchased a BDT 10,000 ($118) toilet from a local entrepreneur. She is due to pay off her final installment within the next month.

But why did she decide to invest in a toilet?
                                                                                                                                                                                      
A three-way street

Bangladesh has nearly eliminated the practice of open defecation, but many latrines are poorly constructed and unhygienic, which can be harm­ful to the environment and the user.

Only 32 percent of the rural population have access to a safely managed sanitation service.  The government is helping rural households shift to better sanitation. However, many poor rural households are often discouraged by the upfront cost.

The country also has a history of micro-finance institutions (MFIs) who have effectively worked with rural households. But MFIs have had little experience in investing in non-productive assets such as toilets.

In 2016, a $3 million World Bank grant helped scale up MFIs lending for improved rural sanitation in Bangladesh. An additional $23.7 million in seed money was mobilized from MFIs for the installation of latrines.

Small-scale sanitation entrepreneurs received technical assistance to build good quality, affordable models of hygienic latrines for low-income households. Finally, an agreement was reached with the Palli Karma-Sahayak Foundation (PKSF) to work with retail MFIs and local entrepreneurs (LEs).

Interest-free loans were extended to households using their own capital ($22) of PKSF and their MFI partners plus business loans to entrepreneurs with market rate interest. Across 42 districts, household borrowers could choose from a range of standard design ‘set price’ latrines installed by LEs. Another arrangement was reached between MFIs, LEs, and customers who accessed the sanitation loan from MFIs and placed an order with LEs to construct the latrine.

Households could pay off the loan over a period of 50 weeks without interest. “We started off with 143 latrines in 2017, but now the market is more developed, and entrepreneurs are motivated,” said Gazi Md. Salahuddin, general manager of Resource Integration Centre, an MFI based in Narayanganj district.


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