Community-based health insurance schemes (Mutuelles) in Rwanda are one of the largest experiments in community based risk-sharing mechanisms in Sub-Saharan Africa for health related problems. This study examines the impact of the program on demand for modern health care, mitigation of out-of-pocket catastrophic health expenditure and social inclusiveness based on a nationally representative household survey using traditional regression approach and matching estimator popular in the evaluation literature. Our findings suggest that Mutuelles have been successful in increasing utilization of modern health care services and reducing catastrophic health related expenditure. According to our preferred method, higher utilization of health care services was found among the insure non-poor than insured poor households, with comparable effect in reducing health-related expenditure shocks.
While agro-chemicals such as pesticides, fungicides, and herbicides are often promoted as inputs that increase agricultural productivity by limiting a range of pre-harvest losses, their use may have negative human health and labor productivity implications. We explore the relationship between agro-chemical use and the value of crop output at the plot level and a range of human health outcomes at the household level using nationally representative panel survey data from four Sub-Saharan African countries where more than ten percent of main season cultivators use agro-chemicals. We find that agro-chemicals use is associated with increased value of harvest, with similar magnitudes across three of the four countries under study, but is also associated with increases in costs associated with human illness, including increased health expenditures related to illness and time lost from work due to sickness in recent past. We motivate our empirical work with a simple dynamic optimization model that clearly shows the role that farmer understanding of these feedbacks can play in optimizing the use of agro-chemicals. The central role of information in determining that optimum underscores the role of agricultural and public health extension as modern input intensification proceeds in the region.
This report reviews the progress made in the health sector in Africa over the last 50 years, in terms of health outcomes, and particularly in the utilization of, and access to, healthcare services. The current challenges faced by the health sector are thoroughly assessed, focusing on the progress made toward the health-related Millennium Development Goals (MDGs), the need to establish more robust health systems, the problems of equity in access to and use of health services, sustainable health financing, and the quality of healthcare service provision. The discussion lays the groundwork for projections regarding the future of healthcare in Africa over the next 50 years. The analysis looks at how the sector is likely to evolve and the emerging trends, the key features of the post-MDG agenda, the future of health financing, and the methods that might be deployed to strengthen the system and human resources.
This report, produced jointly by the Economic Commission for Africa (ECA), the African Union (AU), the African Development Bank (AfDB) and the United Nations Development Programme (UNDP), assesses the progress towards the Millennium Development Goals (MDGs) in Africa.
Africa has seen an acceleration in economic growth, established ambitious social safety nets and designed policies for boosting education and tackling HIV and other diseases. It has also introduced women’s quotas in parliament, leading the way internationally on gender equality, and increased gender parity in primary schools. Although overall poverty rates are still hovering around 48 percent, according to the most recent estimates, most countries have made progress on at least one goal. Much more work lies ahead to ensure living standards improve for all African women and men. While economic growth has been relatively strong, it has not been rapid or inclusive enough to create jobs. Similarly, many countries have managed to achieve access to primary schooling; however, considerable issues of quality and equity need to be addressed.
Gender inequality is costing sub-Saharan Africa on average $US95 billion a year, peaking at US$105 billion in 2014– or six percent of the region’s GDP – jeopardising the continent’s efforts for inclusive human development and economic growth, according to the Africa Human Development Report 2016. The report analyses the political, economic and social drivers that hamper African women’s advancement and proposes policies and concrete actions to close the gender gap. These include addressing the contradiction between legal provisions and practice in gender laws; breaking down harmful social norms and transforming discriminatory institutional settings; and securing women’s economic, social and political participation. Deeply-rooted structural obstacles such as unequal distribution of resources, power and wealth, combined with social institutions and norms that sustain inequality are holding African women, and the rest of the continent, back. The report estimates that a 1 percent increase in gender inequality reduces a country’s human development index by 0.75 percent.
Whilst we recognize that much work has been done in the main-streaming of gender equality in human settlement, UN-Habitat acknowledges that much more is required. This compendium of case studies is designed to bring into one document some of the gender main-streaming initiatives UN-Habitat implemented from 2008 to 2012. The case studies provide the most comprehensive examples of the field implementation of the UN-Habitat Gender Equality Action Plan of 2008 to 2013. The projects and programmes compendium brings recognition to UN-Habitat’s efforts to advance the internationally agreed agenda for Gender Equality and Empowerment of Women. The compendium serves as a good start towards capturing the successful efforts under way to advance the agenda on equality and empowerment of women. In addition, the compendium serves as a learning and resource tool to UN-Habitat and its partners
As a report with joint efforts by China Science Center of International Eurasian Academy of Sciences, China Association of Mayors, Urban Planning Society of China and UN-Habitat, this publication integrates both the guidelines of the Third Plenum of the 18th CPC Central Committee and the Central Urbanization Work Conference and includes new concepts, ideas, measures and innovative cases gathered from various places in China.
This timely report comes at a decisive moment in history where we can reshape urban environments and health systems for the majority of the world’s population that live in cities. Enabling this transformation are the SDGs, which have reconfigured how governments and the international community need to plan and implement actions to eradicate poverty and inequality, create inclusive economic growth, preserve the planet and improve population health. Central to this quest is to create equitable, healthier cities for sustainable development. A focus on urban health not only recognizes global demographic trends but the inextricable and inter-dependent links between health, economic productivity, social stability and inclusion, climate change and healthy environments, and an enabling built environment and governance. At the core of the dynamic and transformative nature of cities are people – healthy people. In order to pursue this goal and the SDGs, we must ensure that all citizens and communities, regardless of income, social status, or gender, have access to the quality health services they need with sufficient financial protection.
For the last 40 years, UN-Habitat has been working to improve the lives of people in human settlements around the world. As our population has grown, so has the number of people living in cities, towns and villages on all continents. With around 3 billion more people expected to live in urban areas by 2050, it is more critical than ever that we plan and manage the way our cities expand. This publication demonstrates just a snapshot of UN-Habitat's overall portfolio and represents the ways in which, along with their partners, their work positively impacts the quality of life for people around the world. Working together we can, and must, promote economically, socially and environmentally sustainable urbanization and a better urban future for all.
The study analyses how the Philippines’ national Child Friendly Movement, which has engaged government, NGOs, civil society, children and UNICEF, has enhanced the capacity of local governments, communities and young people to fulfil the rights of the poorest children. The study uses participatory methodologies and reflects the viewpoint of children and the community. It reveals that in areas where the Child Friendly Cities strategy was adopted, greater attention is paid to the most excluded and vulnerable groups and interventions are developed on a wider spectrum of children’s rights. Beyond providing insights on concrete ways in which child rights are bring promoted at local level, it provides recommendations on how the fulfilment of child rights can be further enhanced by municipal governments.
Every year, three million girls and women are subjected to genital mutilation/cutting, a dangerous and potentially life-threatening procedure that causes unspeakable pain and suffering. Not only is it practiced among communities in Africa and the Middle East, but also in immigrant communities throughout the world. Moreover, recent data reveal that it occurs on a much larger scale than previously thought. It continues to be one of the most persistent, pervasive and silently endured human rights violations. This Innocenti Digest examines the prevalence of FGM/C and its social dynamics. It provides an explanation as to why the practice persists and of the elements necessary for its abandonment. It also takes stock of progress to date, identifies what works and what does not, and provides direction regarding the most successful strategies to promote the abandonment of FGM/C. Combining concrete field experience with tested academic theory, the Digest provides a practical tool to bring about positive change for girls and women.
This IRC Insight highlights the urgent need to support families and communities to care for children orphaned by HIV/AIDS. The report looks at how the epidemic undermines children's health and schooling, and reinforces marginalization and deprivation. It explores the options for the care of children in communities affected by the AIDS epidemic. Beginning with the premise that the parent-child bond is the basic building block of child development and the family the basic unit of society, the report looks at ways to keep the family together for as long as possible. It then goes on to explore alternative care arrangements beyond the immediate family. Settings range from care by the extended family, to different forms of fostering in the community, through adoption and placement in residential institutions, which should be used as a last resort.
This study addresses one of the greatest challenges of our time: the damage caused by HIV and AIDS to the well-being of children and families. With 38.6 million people affected by HIV in 2006, with HIV prevalence at antenatal clinics exceeding 40 per cent in areas of Botswana and KwaZulu-Natal (South Africa), with nationwide adult prevalence in excess of the critical threshold of 20 per cent in several countries, and with the prospect of a rapid spread of the disease in large swathes of India, China and the Russian Federation, the future of child well-being is seriously threatened. Certainly, in the 50 or so countries affected by the disease, the Millennium Development Goals in the field of child survival, education, poverty and basic rights will be missed, often by a large margin.
The study reviews the implications of climate change for children and future generations, drawing on relevant experiences in different sectors and countries of promoting child rights and well-being. It traces in considerable detail the pathways through which shifts in temperature and precipitation patterns create serious additional barriers to the achievement of the child survival, development and protection goals embraced by the international community. The role of children as vital participants and agents of change emerges as a key theme.
This paper adds a perspective to existing research on child protection by engaging in a debate on intersectional discrimination and its relationship to child protection. The paper has a two-fold objective: (1) to further establish intersectionality as a concept to address discrimination against children; and (2) to illustrate the importance of addressing intersectionality within rights-based programmes of child protection.
This paper reviews the published evidence of pathways and impacts of global climate change on child health. The review was occasioned by the recognition that most of the work to date on climate change and health lacks clear focus on the children's dimension, while the climate change and children literature tends to be brief or imprecise on the complex health aspects. Based upon scientific and policy research conducted to date there is found to be substantial evidence of disproportionate vulnerability of children in response to climate change. The diseases likely to be potentiated by climate change are already the primary causes of child morbidity and mortality, including vector-borne diseases, water-borne diseases and air-borne diseases. For this reason further research, assessment and monitoring of child health in respect to climate change is critical. Proposals are made for governments to integrate environmental health indicators into data collection in order to accurately assess the state of child health in relation to other age groups and its sensitivity to climate change.
This UNICEF-Innocenti Insight examines the social dynamics of the abandonment of female genital mutilation/cutting (FGM/C) in five countries - Egypt, Ethiopia, Kenya, Senegal and the Sudan - and seeks to inform policies and programmes aimed at ending the practice. The experiences from the five countries documented in this Innocenti Insight provide evidence that the abandonment of FGM/C is possible when programmes and policies address the complex social dynamics associated with the practice and challenge established gender relationships and existing assumptions and stereotypes. This publication concludes with reflections on the remaining challenges of FGM/C abandonment and offers recommendations for future research and programme interventions.
Each year the Office of Research-Innocenti reviews submissions for the best research being published across all UNICEF offices: country programmes, National Committees, Regional Offices and headquarters divisions. The purpose of this activity is to showcase and recognize high-quality, high-impact research being done in the organization. At the end of the process each year the Office of Research-Innocenti issues a publication containing summaries of the papers considered to be of particular merit. In 2014, the summaries cover issues concerning child protection, cash transfers, ECD, maternal health, inclusive education, and WASH.
In addition to recognizing high quality research, the Best of UNICEF Research process aims to share findings with UNICEF colleagues and with the wider community concerned with achieving child rights. This year the competition received 99 applications With global reach, the 12 projects in the final selection cover many of the ‘traditional’ areas of UNICEF work (health, nutrition, sanitation and education), while also highlighting issues that have more recently gained prominence within the global policy agenda, such as social transfers, violence against children and school bullying, and various forms of inequality or exclusion. This publication provides summaries of these research projects, including methodology and results.
The Best of UNICEF competition identifies a number of studies that are assessed to be of particular merit on a number of criteria: in terms of the relevance and interest of the topic and findings; the rigour of their methodology; and the potential for impact, including lessons that could inform programmes elsewhere, or the capacity for replication or scaling up. Issues covered include health, education, WASH, child protection and social inclusion. There was also a strong emphasis on qualitative and mixed methods research, demonstrating the value of rigorous qualitative studies. A number of studies selected as of special merit in 2016 involved research directly with children and there is an increasing recognition that children’s perspectives are of primary importance. There was also a welcome attention to gender in some of the studies, including research with both adolescent boys and girls.
Over the past decade, early childhood development and education (ECDE) has received increasing attention. This has led to an influx of scientific, macroeconomic, and rights-based evidence, supporting the importance of equitably implementing quality ECDE programmes and services. Despite the increase in evidence, young children in the developing world still bear the greatest burden of poverty, disease, violence, and risk factors. Recent research suggests that equitable access to quality early childhood services (ECS) can reduce the impact of risk factors and improve outcomes.
ICTs are not a technical sphere detached from the complex realities of children’s lives. They are increasingly woven into the very fabric of life, in income-rich and increasingly in income-poor countries. It is clear that if there is no targeted engagement with these socio-technical innovations, they are likely to reinforce existing inequalities. It follows that a focus on children and on greater equity leads to an active and reflective engagement with the potential and challenges of ICT for development, targeting in particular marginalized children. This report serves as a key contribution on which to build informed dialogue and decision making, developed jointly between research, policy and practice.
This paper aims to provide a comprehensive overview of the impacts of cash transfer programmes on the immediate and underlying determinants of child nutrition, including the most recent evidence from impact evaluations across sub-Saharan Africa. It adopts the UNICEF extended model of care conceptual framework of child nutrition and highlights evidence on the main elements of the framework – food security, care and health care. It finds that several key gaps should be addressed in future including cash transfer impacts on more proximate nutrition-related outcomes such as children’s dietary diversity, as well as caregiver behaviours, intra-household violence, and stress, all of which have implications for child health and well-being.
This report presents data and analysis evaluating the progress towards achieving the Millennium Development Goals (MDGs). It proves that, with targeted interventions, sound strategies, adequate resources and political will, even the poorest countries can make dramatic and unprecedented progress. The report also acknowledges uneven achievements and shortfalls in many areas. The work is not complete, and it must continue in the new development era.
This report undertakes an assessment of the Ebola virus disease (EVD) for each of the 15 West African countries, breaking away from the tradition of focusing on the three epicentre countries. It assesses the impact of EVD on poverty incidence and food security in both the three epicentre countries and other non-West African countries. The report concludes by offering a set of policy recommendations.