The politics and finance of progress in health and education

Lenhardt, Amanda; Engel, Jakob; Prizzon, Annalisa (2014). 'The politics and finance of progress in health and education' Paper presented at the annual conference of the HDCA, 2-5 September 2014, Athens, Greece.

Paper Title: Progress in Political Voice and Improved Service Delivery in Ghana

Authors: Amanda Lenhardt, Jakob Engel, Alina Rocha Menocal, Kojo Asante, Vitus Azeem, Sebastien Hine

Over the past 20 years Ghana has achieved remarkable progress in multiple dimensions of human development while undergoing one of Africa's most successful and stable transitions to multi-party democracy. It stands as a stark contrast to most countries in the West Africa region and to many struggling democracies more generally. As such, Ghana is a compelling case to explore what factors have contributed to progress in both the provision of basic services (notably in health and education) and increased political voice and democracy more broadly. The case of Ghana also allows for an analysis of the links and common drivers between progress in human development and greater (political) voice, and to address the critical question of whether democracy can deliver for its citizens. A variety of different factors enabled progress in service delivery and increased political voice/democracy separately, however some factors are broadly similar and include: state-society relations and the social contract these have engendered; the role of political leadership and elites with a unified sense of a 'Ghanaian identity', broader developmental vision; economic growth (and in the case of voice in particular a highly educated middle class); rising incomes and international support.  Acceleration of human development in the last 10 years is indicative of a mutually reinforcing relationship with increased voice and opened political space. We find that in Ghana there are numerous plausible ways through which increased political voice has likely impacted both access to and the quality of social services (though not the only way). This is mediated through a complex series of institutional factors and processes including: the 1992 constitution enshrining the right to health and education; electoral processes; increased civil society activism on issues related to service provision; an active and responsive media. The case of Ghana shows that voice can help to focus on outputs – but this is not done on the basis of idealised models, rather it is complex and not necessarily always pretty. Progress is gradual and takes time, and it is essential to be realistic about what can be expected of a young democracy like Ghana - which from this perspective seems to be doing remarkably well – despite the many challenges.

Keywords: political voice, basic service delivery, democratic transition

Paper Title: Nepal's Story: Improvements in Maternal Health

Authors: Jakob Engel, Jonathan Glennie, Shiva Raj Adhikari, Sanju Wagle  Bhattarai, Devi Prasad Prasai  and Fiona Samuels

Nepal achieved a striking reduction in maternal mortality during the 1990s and early 2000s.  According to data from Nepal Demographic and Health Surveys (NDHSs), the country's maternal mortality ratio (MMR) fell by 47% between 1996 and 2006. More recent survey data support this downward trend. Despite difficult terrain, conflict and political upheaval, it is one of the few countries likely to meet Millennium Development Goal 5 on maternal health. A consistent policy focus and sustained financial commitment by the government and donors throughout the past two decades, including substantial increases in funding for maternal health since the early 1990s, has allowed for widespread improvements in access to medical services, particularly in remote areas.MMR improvements have further been facilitated by behavioural and economic changes at the household level, driven by increased empowerment and education of women and greater awareness of how to mitigate pregnancy-related risks. Together with a sustained rise in incomes, these factors have combined to create what appears to be a virtuous cycle, with national policy and implementation reinforcing changes occurring at the household level. Nepal's experience can provide important lessons for other countries struggling to address high levels of maternal mortality and morbidity, especially within a context of difficult terrain and high poverty rates. Despite these improvements, numerous systemic challenges remain. These include addressing inequalities, increasing community mobilisation to improve accountability, building more effectively on inter-sectoral synergies and, most importantly, maintaining political and financial commitment  to safer motherhood.

Key words: Maternal health, MDG goal 5, post-conflict

Paper Title: From decline to recovery: post-primary education in Mongolia

Authors: Jakob Engel and Annalisa Prizzon with Gerelmaa Amgaabazar

Building off of almost full enrolment at primary level, secondary school and university, enrolment rates in Mongolia have now recovered from their precipitous decline following the transition to a market economy and electoral democracy in the early 1990s, now surpassing those in most other Central Asian transition economies. This case study examines Mongolia's progress in post-primary education. Enabling access to relevant and high-quality schooling and training beyond primary school (and increasingly secondary school) is growing as a policy priority throughout the developing world. Low-income countries are seeing rapid growth in primary completion rates and increasing demand for post-primary education; middle income countries are increasingly focused on improving the quality and relevance of post-primary education. Parents throughout the world are increasingly convinced that attending at least secondary school is a prerequisite for formal employment. In post-transition Mongolia, recovery was driven by the high cultural and economic value attributed to post-primary education, particularly within the context of changing economy. Second, government investment and incentives to further education helped expand enrolment. Third, expanding provision addressed supply-side constraints to access. Finally, the Mongolian government's success at leveraging the financial and technical engagement of donors further accelerated the recovery in post-primary enrolment. Two decades of reforms in the education sector have led to successes, though new challenges have become visible, including continued barriers to access for the most marginalised students and very limited improvements in learning outcomes. Nonetheless, Mongolia provides an important example of a country adapting to changing social and economic demands within a context of strong environmental pressures, a demographic transition and rapid urbanisation.

Key Words: post-primary education, post-transition Mongolia, economic crisis


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