Linking Women s Empowerment and the Demographic Dividend

Transcription

1 Linking Women s Empowerment and the Demographic Dividend Margareta Harrit and Christophe Lemiere

2 ABOUT THIS EXPERT INSIGHT Margareta Harrit is a Health, Nutrition, and Population Specialist at the World Bank with extensive experience working across global health systems. Since joining the World Bank in January 2011, Margareta has contributed to the development of the World Bank Group s private sector roadmap and is the Task Team Leader for the World Bank s engagement with HANSHEP. She also works on the Sahel Women's Empowerment and Demographic Dividend Project with Christophe Lemiere, a Senior Health Specialist and Task Team Leader for the SWEDD. Women play a key role in economic development. There are several potential benefits of investing in girls and women s education and empowerment, including healthier and better nourished children, increased household earnings and GDP growth.. In this interview, the Hub asked Margareta to reflect on the link between women s economic prosperity and reproductive health and family planning, and to introduce the Hub community to a new project that the World Bank is spearheading at the intersection of gender, livelihoods and health. For this expert insight, Margareta invited her colleague Christophe Lemiere, to add to the discussion. For more Expert Insights and quality resources on health systems specially selected for policymakers, practitioners and researchers, visit Powered by HANSHEP: 1

3 Linking Women s Empowerment and the Demographic Dividend Margareta Harrit Partnership Specialist, Health, Nutrition, and Population and the World Bank In partnership with Christophe Lemiere, Senior Health Specialist at the World Bank QUESTION ONE You ve both worked in the Health, Nutrition and Population Global Practice (HNP GP) at the World Bank for several years now. Can you tell us about yourselves and the types of projects you ve worked on over the years? Both of us came to the World Bank with experience from the private sector. Christophe was a former Hospital Director in France as well as in various consulting companies and I (Margareta) launched with a handful of partners McKinsey & Company s health systems global practice. Since joining the Bank, we both have been involved in many different projects, including, recently: The preparation with IFC colleagues a hospital PPP operation in Benin (Christophe) The development of the World Bank Group s private sector roadmap team and the Bank s engagement with the HANSHEP partnership. (Margareta) QUESTION TWO You are currently working on a project on Women Empowerment and the Demographic Dividend in the Sahel region of West Africa. What does that mean? The demographic dividend is characterized by a period in a country s demographic transition when the proportion of working age population is higher compared to the number of dependents. This period can correspond to an extra economic boost through increased savings and private investments. Triggering such a demographic dividend requires two ingredients: i) a decreased dependency ratio which is made possible only when fertility declines more rapidly than mortality ii) adequate policies to foster human capital, employment and investments to ensure that the additional working-age population can get good jobs. In the Sahel, while the demographic transition has started with remarkable declines in child mortality in the past decade, the key trigger of rapidly declining fertility has yet to be achieved. QUESTION THREE What are some of the main bottlenecks today? Triggering such a demographic dividend requires two ingredients Despite encouraging trends in mortality, fertility remains high in the Sahel. Demand-side issues play a major role in explaining the low modern contraception rates in the Sahel. Women s desire to space or limit births has been slow to increase. Early marriage and childbearing are common and contribute to overall high fertility rates. The Sahel region has low levels of education (especially for girls), a cornerstone of building human capital and a key driver of demand for contraception. On the supply side, frequent stock-outs of contraceptives, especially in rural areas are also an obstacle for effective birth control. 2

4 QUESTION FOUR Could you tell us more about the project's goals and objectives? What are the main strategies to achieve those goals? The World Bank has approved US$ 205 million IDA financing toward six project countries (Burkina Faso, Chad, Cote d Ivoire, Mauritania, Mali and Niger) with the objective to expedite the fertility transition in the Sahel. Interventions will be organized through three main strategies: 1). Generate demand for Reproductive, Maternal, Neonatal, Child and Adolescent Health and Nutrition commodities and services, by promoting social and behavioral change and empowering women and adolescents; 2). Strengthen regional capacity to improve supply of commodities and qualified personnel; 3). Strengthen capacity and accountability of policy makers. The project design builds on powerful success stories from programs focused on empowering adolescent girls, most of which combine multisectoral interventions, including social and behavior change communication about health, with life skills and job skills training. For example, in Liberia, girls who participated in job or business skills training, combined with life skills and job placement or start-up support, earned an average of 80 percent more than non-participants. A low-cost program implemented by BRAC in Uganda combining a safe social space, life skills training, livelihoods training, and savings and microfinance resulted in a 26 percent decline in fertility, 27 percent increase in condom use, and a dramatic 76 percent drop in girls reporting having had sex against their will. QUESTION FIVE What role can the private sector play in this context? For example, in Liberia, girls who participated in job or business skills training, combined with life skills and job placement or start-up support, earned an average of 80 percent more than nonparticipants. The governments of the project countries play a critical enabling role for women empowerment in the region. There are also several current and potential roles for the private sector in the implementation of the three main strategies. Interventions for women empowerment (component 1) and last mile delivery (component 2) will be identified through regional calls for proposals, developed by various ministries in the project countries. Many of those interventions will rely on CSOs and other private sector stakeholders in the design and implementation phase. Furthermore, Social and Behavior Change Communication and social marketing strategies have been more effective when developed in partnership with NGOs and the private sector. The private sector also plays a role in the training of health professionals. QUESTION SIX What do you see as the role of women in driving sustainable growth? Women play a key role in economic development. There are several potential benefits of investing in girls and women s education and empowerment. Evidence suggests that spaced births can lead to better reproductive health outcomes, which in turn can lead to healthier and better nourished children. With additional years of education, children, and especially girls, are likely to achieve increased earnings (10-20% increased wages by extra year of education). With each additional year of schooling, GDP growth rates would be boosted by 0.58 percentage points per year. Furthermore, a regional analysis indicates that 3

5 every US$1 invested in family planning saves US$3 in other development sectors that contribute to achieving the MDGs (education, vaccinations, water and sanitation, maternal health, and malaria treatment). Women empowerment is thus a key enabler for accelerating progress toward the demographic dividend. QUESTION SEVEN What are key aspects for success for this project? The multidimensional aspects of both challenges and potential solutions will require extensive collaboration and coordination between all stakeholders involved; the governments, the private sector, CSOs, religious leaders, women and girls, as well as their families and development partners working in the areas of HNP, gender, education and social protection to name a few. The project design will allow for innovation and new evidence on what works in the region a through a combination of resources and stakeholders, sustainable progress can be made. QUESTION EIGHT How has the World Bank s engagement with the private sector in health evolved over the past years? Over the years, the World Bank has assisted governments leverage the private sector to achieve HNP goals assessment through initiatives such as Health in Africa, through IDA and IBRD lending projects, as well as through advisory services and training programs. The World Bank Group s private sector arm, the IFC (International Finance Corporation) also has a long We have seen demand for assistance on how to leverage the private sector grow significantly over the past years history of assisting the private sector directly through investments and in providing advisory services to governments on Public Private Partnerships. We have seen demand for assistance on how to leverage the private sector grow significantly over the past years. As a result of growing demand, President Kim asked a joint WBG team to develop a Roadmap for harnessing the private sector in health for the WBG. The research undertaken by the team highlighted the extreme heterogeneity in role of private sector within and across countries, across types of services and across disease areas. Private sector engagement means different things in different contexts, however, in most countries the private sector does play arole, including in serving the poor. The Roadmap concluded that in order for us to meet our goals of UHC, we need an integrated health systems approach that looks for the best solution, regardless of whether it comes from the public or private sector. The Roadmap called for both the World Bank and the IFC to significantly scale up their support to leveraging the private sector in health. The Bank will assemble a dedicated team that will focus on helping clients harness the private sector in its operations and knowledge services. The Bank s engagement will complement existing initiatives and focus on areas that leverage the WBG s comparative advantages. REFERENCES Sahel Women s Empowerment and Demographic Project (2014) 4