HEART Talks – Health and Education Advice and Resource Team http://www.heart-resources.org Providing DFID staff and other development actors with health, education and nutrition knowledge and expertise from around the world Fri, 02 Mar 2018 13:10:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.4 Sonali Nag on assessments of foundational literacy skills http://www.heart-resources.org/mmedia/sonali-nag-assessments-foundational-literacy-skills/ http://www.heart-resources.org/mmedia/sonali-nag-assessments-foundational-literacy-skills/#respond Tue, 25 Jul 2017 13:10:18 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29815 Read more]]> In this video, Sonali Nag, Associate Professor of Education and the Developing Child at Oxford University, discusses her recent review of literacy assessments, Assessment of literacy and foundational learning in developing countries.

This review examines the quality and range of tools used to measure literacy and foundational learning in developing countries. It covers the assessment of language and literacy skills in children from age 3 to 14 (or preschool to Grade 8). It also includes assessment tools from studies published between 1990 and 2014, rated as ‘Moderate’ or ‘High’ in methodological quality.

There are 2 main reasons to assess children’s learning and underlying skills:

  • Assessment can monitor educational quality. Communicating test results about what children can do (or cannot do) can improve decision making at every level of the education system. This improves educational quality and thereby lifts children’s attainment.
  • Assessment can inform teaching practice. Teachers who assess well and use test information well, teach better. Towards this aim, the synthesis collates measures that potentially could be part of a teacher’s toolkit.

The reason for assessing literacy skills is to ensure that “children can come to a point where they can read with comprehension and write and express for others to understand.”

Not all assessments are suitable for supporting the decisions that are often made on the basis of the data they produce. Therefore care should be taken to ensure that tests captures students’ level of learning and are sensitive to small differences in attainment. Tests should also be fair: “A good test is one that is considerate to the child’s learning history, child’s cultural background, child’s linguistic assets… A good test tries to not be influenced so much by contextual factors so that you get the child’s level of learning”.

Sonali’s key messages are that funders and researchers should focus on comprehension and understanding through all stages of literacy development and in all areas of test development, analysis. Protocols should be followed to ensure that assessments are appropriate to the local context. Finally she urges transparent and thorough reporting on the cycle of instrument development and the properties of the test (validity, reliability, potential sources of bias, mitigation against bias, etc.)

The main report is supported by an evidence brief and two briefing notes (on contextual issues and what to test and why).

Sonali Nag previously recorded a video for HEART Talks on Literacy, Foundation Learning and Assessment in Developing Countries, which is available to view here.

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Public health surveillance http://www.heart-resources.org/mmedia/public-health-surveillance/ http://www.heart-resources.org/mmedia/public-health-surveillance/#respond Tue, 14 Feb 2017 12:16:42 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29723 Read more]]> Dr Brian McCloskey CBE is the Director of Global Health Security at Public Health England and a Senior Consulting Fellow at the Chatham House Centre for Global Health Security. In this HEART Talks he introduces the HEART Reading Pack he co-authored on public health surveillance.

He explains that public health surveillance is a means to quantify the burden of disease in a community or country. It can be used to measure how the amount of disease is changing over time to understand what is relatively normal, and what is abnormal when something different has happened. It allows us to look at changes over time which helps in evaluating interventions and identify whether targeting is needed. It is also needed to identify unexpected public health events such as Ebola, Zika, and yellow fever to alert people and take actions early.

There are two main systems available. Firstly, health facility-based surveillance uses data already collected by health workers to monitor the normal. Taking this data out is an easy way of doing public health surveillance. Secondly, event-based surveillance which collects information on events as they happen to find the abnormal. There are some global systems for examples Global Public Health Information Network (GPHIN) and ProMED. These are computer-based systems which scan social media and online news looking for anything that might be relevant to public health.

International Health Regulations (IHRs) form the framework for disease surveillance around the world, they establish a framework for response, and put in legal requirements for the capacities that people need in their public health system. One of the challenges that came out with Ebola is that money spent on health systems strengthening hasn’t been focussed on public health systems, disease surveillance systems and human resource capacity. The 2005 IHR is a legally binding agreement for 194 member states of the World Health Organization (WHO). It builds on previous IHR’s and was updated because of changing threats. There was a move away from a focus on specific diseases to an ‘all hazards’ approach. It was agreed in coordination with travel and trade organisations. It sets out ‘core capacities’ for member states to deliver IHRs.

All member states must have a National Focal Point for IHRs. There are agreed protocols for risk assessment and reporting to the WHO. There are a number of criteria used to assess whether the WHO declare a Public Health Emergency of International Concern (PHEIC) when binding travel and trade restrictions can be made. All member states were meant to be compliant by 2012 but very few are. There have been four PHEIC since 2005: 1) pandemic flu in 2009; 2) polio became of international concern in 2009 when the decline started to reverse; 3) Ebola in 2014; and 4) Zika in 2015.  There have been in the region of 50,000 events reported to the WHO since 2005. The concern is something important maybe missed between the large number of items reported and the small number declared as PHIEC.

After Ebola IHRs are being revised. What IHRs were set out to do was right, the problem was they weren’t being implemented properly in enough countries. They also weren’t being properly assessed and evaluated. This has prompted a move away from voluntary self-assessment to independent evaluation. A number of countries have challenged the idea of external assessment. Another issue is that assessment is linked to the global security agenda which is seen to be US-led. Formal agreement has yet to be reached on regular assessment on how well countries are reaching IHRs. This assessment is required for targeting countries who need support. This would be in everyone’s best interest.

Improving public health surveillance has many benefits, is an urgent priority, and should be part of health systems strengthening. It is important for the country to get this capacity right. South Korea, for example, lost 0.9% of their GDP in the six months following the outbreak of the Middle East Respiratory Virus (MERS). The health systems strengthening can also benefit, non-communicable disease burdens using the same infrastructure. And also be beneficial maternal and child health. Monitoring trends and identifying what is changing and why can help to target interventions.

Future priorities are:

  • Invest in IHR core capacities
  • Encourage and support independent external evaluation
  • Develop the workforce and the systems
  • Look at IT improvements
  • Look for partners, ie in: agriculture and farming, industry/private sector, and communities.
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Urban Health http://www.heart-resources.org/mmedia/urban-health/ http://www.heart-resources.org/mmedia/urban-health/#respond Tue, 29 Nov 2016 14:54:39 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29705 Read more]]> Dr Helen Elsey is from the Nuffield Centre for International Health and Development, University of Leeds. In this HEART Talks she talks through the urban health HEART reading packs that she has put together with Dr Siddharth Agarwal from the Urban Health Resource Centre in India. The three reading packs are: A) Data and evidence, B) Improving population health – strategies for inter-sectoral action, and C) Interventions and pro-poor service provision.

The world is urbanising. Globally, more people live in urban areas than in rural areas. By 2050, it is expected that 66% of the world’s population will be urbanites. Africa and Asia are urbanising the fastest. By 2050 56% will be urban in Africa and 64% in Asia. There are currently 28 mega-cities (i.e. with a population of 10 million or more). By 2030, the world is projected to have 41 mega-cities. However, the fastest growing urban areas are medium-sized cities and those with less than 1 million inhabitants located in Asia and Africa. UN-Habitat estimates the number of people living in slum conditions is now 863 million; growing from 760 million in 2000 and 650 million in 1990. Cities are at the forefront of ‘disease transition’ with malnutrition and obesity occurring simultaneously. Water and sanitation provision is grossly inadequate in urban slums. Tobacco consumption is a major concern among urban poor men, and increasingly women; a risk factor for both NCDs and TB. There are multi-sector influences on urban health.

Local governments are key to coordinating inter-sectoral action. Donors are increasingly working with local government to strengthen capacity to plan, manage services, link with sector ministries, enforce public health legislation and establish local level governance structures.

There is a need to coordinate health services between local government and health ministries. The urban public health service is woefully inadequate. There has been underinvestment due to years of the perceived ‘urban advantage’. Responsibilities for staff, their training, equipment/drugs, and facilities often fall between the Ministry of Health (MOH) and the Municipality. The poor are left with little option but to use meagre resources on private facilities resulting in high levels of catastrophic health expenditure. There are poor referral mechanisms due to the plethora of NGO and private providers. There is a need for monitoring and enforcement of quality standards among providers and pharmacies. Secondary care is insufficient with maternity hospitals not open all hours and weak services. Tertiary hospitals are overloaded and not easy to access for the poor.

Public Private Partnerships (PPPs)
There are challenges with different forms of PPPs, private for-profit and not-for profit forms. For-profit PPPs have no incentive to reach out to the urban poor. They are not keen to partner for outreach care which is the key to preventative healthcare and the most crucial for urban deprived communities. Non-profit agencies tend to have few resources. Bangladesh’s Urban Primary Healthcare Programme uses partnerships with NGOs, private clinics and government health centres to expand services to slum and vulnerable communities. There are still challenges with monitoring, quality, and referrals between providers which covered in some detail by in the reading packs.

Health promotion
Helping people remain healthy and not in need of health services is a fundamental goal of any urban health strategy. There is a lack of evidence on which health promotion approaches are likely to be effective in changing ‘lifestyle behaviours’ such as tobacco use, diet, and exercise among the urban poor. Encouraging waist measurement, desired diet, physical activity and mental wellbeing at community level; peer education approaches to nutrition, physical activity, and promoting optimal behaviours in schools have shown some success. Community healthworkers (CHWs) have been effective at changing behaviours in Bangladesh, India, and Ethiopia. CHW and slum women’s groups promoting peer-to-peer health promotion shows promise. Mass media through mobile phones, print, radio and television have wide audience reach in urban centres, but it is hard to compete in the cluttered media environment. Instant messaging for skilled birth attendants is more effective in urban areas. There has been increases in zinc treatment awareness following TV, radio, and newspaper media campaign in urban areas.

Water, sanitation and hygiene (WASH)
WASH needs to be promoted in households and schools to improve, health, nutrition and education. The three interventions of the WASH sector (hand-washing, food storage, garbage disposal) – depend on one another for full realisation of their benefits. For example most sanitation systems cannot function without water. School WASH impacts education outcomes, especially for girls. Menstrual hygiene and girl friendly toilets in schools affect school attendance of girls and reproductive tract infections. Hand-washing with soap and water and other personal hygiene practices have the potential to substantially reduce within household transmission of diarrhoea and improve nutrition. Promoting practices such as hand-washing with soap and water, and safe disposal of child faeces benefit health and nutrition and can be incorporated in a wide range of public health strategies at low cost.

Participatory neighbourhood mapping
Participatory mapping has been used in India to expand the reach of urban services. Slum women’s groups use hand drawn maps to ensure that no family is left out from municipal/NGO lists used for housing, sewage systems, toilets, and entitlements. They are also used to track access to health services eg. immunisation, antenatal care,  and delivery. The maps help identify recent migrants for linkage to services and entitlements. Gentle negotiation is occurring through collective petitions. Inclusive urbanisation requires disadvantaged communities to actively participate in governance.

Healthy places
Pressure from real estate developers, poor governance and corruption undermines local government’s role in controlling urban development to keep healthy places within the city. Access to green spaces reduces mental illness and has been shown to reduce inequities in cardio vascular disease and all-cause mortality in high income countries. Green spaces are rarely considered in controlled and uncontrolled expansion of urban areas. Urban agriculture can make an important contribution to household food security, especially in times of food crisis or food shortages. This needs support and regulation so food is grown in healthy environments.

Health and safe places for children
Urban poor women are more likely to work outside the home than other women in urban or rural settings. Working outside the home provides opportunities to improve income and increase self-esteem and gender equity. However, there is a lack of childcare and supervision for children. This could be solved with early childhood development opportunities. An NGO mobile crèche run day care centres in partnership with government’s National Creche scheme and with support funding agencies in India. Day care centres operate in coordination with builders and contractors near construction sites.

Transport and communications
10 billion trips are made every day in urban centres around the world. An increasing proportion of urban trips are using high carbon and energy-intensive private motorised vehicles. The urban poorest are disproportionately affected by key negative externalities generated by transport, including road accidents, air pollution and displacement when transport developments are occuring. Regulation to improve road safety can make a substantial difference to accidents. For example regulation of ‘matatus’ (mini-buses) in Kenya was introduced where drivers had to increase their driving and safety skills. This legislation resulted in a 73% reduction in accidents. Keeping cities compact, with opportunities for walking, cycling and public transport reduces emissions and support public health.

All of these issues and more are covered in the reading packs which point out key resources.

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Health responses to humanitarian crises http://www.heart-resources.org/mmedia/chris-lewis-presentation-health-responses-humanitarian-crises/ http://www.heart-resources.org/mmedia/chris-lewis-presentation-health-responses-humanitarian-crises/#respond Mon, 24 Oct 2016 17:29:53 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29457 Read more]]> This HEART Talks is a presentation from a humanitarian health seminar held at DFID 29th July 2016. In the video below DFID health adviser Chris Lewis talks about two of the HEART reading packs. The first is Health Responses to Humanitarian Crises and the second is Humanitarian Overview From Principles to Coordination.

Humanitarian crises are important as they contribute to 60% of all preventable maternal deaths. They also contribute to 53% of under 5 deaths, as well as 45% of neonatal deaths. The most common causes of mortality in emergencies are pneumonia, diarrhoea and malaria. As well as the initial response  to a crisis, it is important to consider the long-term impacts. Water borne diseases tend to emerge a week or two after a crisis. Vector borne diseases emerge after one or two months. In the video, Chris summarises the impact of crises on health systems.

Different types of monitoring are required for different post-crisis periods. Chris outlines how the initial assessment should be carried out in the first 72 hours. In weeks one to two field assessments shout be carried, and from week three onwards more health specific assessments should be conducted. Details of health assessment methods for each health topic are available in the reading pack. Key response activities for different diseases and health areas are presented.

Chris states that it is important to be aware of the opportunities for health system reform. The end of a crisis may be an opportunity to implement effective reform. Chris outlines the principles and conventions that exist within humanitarian response, which one of the reading packs is about. There are 11 clusters in the humanitarian system to be aware of. They have different roles and responsibilities that are outlined in the pack.

WHO global health cluster update

A recent WHO global health cluster update describes areas of crisis response planning that still require attention. More thought must be given to coordination efforts across the different support mechanisms. Chris describes humanitarian response as a continuum from humanitarian relief to sustainable development. Humanitarian advisers must consider the opportunities to strengthen health systems after a crisis.

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Health financing for universal primary healthcare (UPH) http://www.heart-resources.org/mmedia/health-financing-universal-primary-healthcare-uph/ http://www.heart-resources.org/mmedia/health-financing-universal-primary-healthcare-uph/#respond Fri, 30 Sep 2016 10:02:49 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29393 Read more]]> These HEART talks videos were recorded at a seminar on health financing for UPH. The seminar was held at Oxford Policy Management (OPM) on June 17th 2016.  It was the first in a series of health financing seminars inviting reflection and discussion from decision-makers, academics and technical specialists on how the global Universal Health Coverage (UHC) financing discourse can pragmatically translate into country-level decisions and implementation.

Sophie Witter introduces, affirming that UHC is now embedded in the health agenda and what we need to do next is work out the how. It is hugely ambitious and requires local interpretation. The WHO are proposing a strategy to categorise services by priority: expanding high priority services and ensuring priority groups are not left behind. Public finance is important in achieving UHC as is a move towards mandatory pre-payment systems. Out-of-pocket payments must be reduced.

There has to be strategising at the national level to operationalise the ambitious goal of UHC. One way is to use national health financing strategies. These strategies should be based on diagnosis of problems, focus on the whole population, prioritise actions and set a time period. This should be based on hypotheses that can be tested through an evaluation strategy. Realistic objectives need to be set around resource mobilisation, risk pooling, purchasing, and governance/public financial management. Organisation needs to be planned: prioritisation and sequencing, capacity building measures, management and implementation, and monitoring of results. Costings are needed to identify optimum levels of spend.

Tim Ensor presents OPM’s experience with health service costing. The dynamic health system environment must be accounted for in costing. This will mean accounting for changes in coverage and population changes. This may be done using an accounting approach making assumptions about how cost structures will react. Or it may be modelled based on actual experience if sufficient samples are available.

Changes in the way services are provided must be considered; technologies and treatments etc. Cost estimates must also beware of incorporating unnecessary inefficiencies in provision; for example, inappropriate treatments or low volumes leading to high overhead costs. Modelling data from different facilities can help account for this. The second way of dealing with this is to look in detail at what facilities are doing and then consult with experts on what the difference might be if a service was run based on the best evidence. Use of routine data is important in costing studies and this should be developed into the future.

Mark Blecher of the National Treasury of South Africa talks about the country’s recent experiences in health service costing and it links to approaches to fiscal space and revenue raising. Costing is a centrally important skill and tool for budgeting.  There are shortages in trained staff to carry out costings. Limited routine data collection is another hindrance.

He talks about the primary health care costing study carried out in South Africa. With the Department of Health he is trying to get different unit costs and total programme costs for different programme areas.

Investment cases have been used as a way of developing a budget bid. This starts with a wide set of potential interventions. Workshops are then run to discuss these with different groups. Models come out of this process providing best overall life years saved. These are put together with a costing model to give incremental cost-effectiveness ratios. This has been a useful tool.

He talks about National Health Insurance (NHI) costing. Three costing models were used which all came to a similar result. He describes the models in some detail. Actuaries are involved in some of the costings as they are skilled at modelling.

Creating fiscal space is a challenge in South Africa. Reprioritisation towards health is required which means making decisions to make cuts in other areas. Taxes have been increased to improve fiscal space, including a sugar tax. The tax policy section of the government came up with options for raising revenues large enough to cover UHC: payroll tax, surcharge on personal income tax, or an increase in VAT. Starting new taxes needs to be linked to readiness to implement new arrangements.

Tomas Lievens of OPM shares key learnings on fiscal space modelling. Outlining OPM’s experiences, he provides an overview of the four-step process adopted in approaching fiscal space that looks at resource needs, resource gaps, funding options, and further funding gaps.

What OPM have learned is that capturing the imagination of Ministries of Health is required to address lack of knowledge of the fiscal space concept and budgeting processes. This can be done using the ‘fiscal space diamond’ and gap analysis, as described in the presentation (see also HEART OPM paper: Fiscal space for health). It should also be made clear that fiscal policy is a choice, not an imposed budget ceiling. OPM found that Ministries of Finance are more likely to accept findings from their own models rather than models imposed on them. Financial programming frameworks are often used by Ministries of Finance. These frameworks should be populated with jointly agreed IMF Article IV data.

OPM also found that the process is as important as the findings in fiscal space modelling. Ministries of Health and Finance should be involved from the start. Relationships should be built for future policy reform and budget discussions. Fiscal space analyses should be embedded in comprehensive health financing analysis. It is important to distinguish between planning and advocacy.

Adrian Gheorghe of OPM talks on fiscal space modelling. He provides insight into the overlaps between advocacy and planning, the importance of country ownership, and the need to look ahead towards a methodological consensus. Looking ahead at implementation, it is important to look at how fiscal space models actually influence resource allocations and how best to operationalise efficiency gains. He suggests that tools should integrate health needs, costs and macroeconomic parameters and try to add allocative efficiency.

See also Adrian Gheorghe’s Lancet Global Health blog on fiscal space which is based on discussions from the event: Fiscal space analysis for health: friend or foe?

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Birte Snilstveit on improving learning outcomes and access to education http://www.heart-resources.org/mmedia/birte-snilstveit-improving-learning-outcomes-access-education/ http://www.heart-resources.org/mmedia/birte-snilstveit-improving-learning-outcomes-access-education/#respond Mon, 15 Aug 2016 11:24:22 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29371 Read more]]> Birte Snilstveit, 3ie’s Evaluation Specialist, presented findings on 14th April 2016 from 3ie’s systematic review on education effectiveness, Interventions for improving learning outcomes and access to education in low- and middle-income countries: a systematic review.

The Sustainable Development Goals (SDGs) on education aim to ensure inclusive and equitable quality education and promote lifelong learning. In this context, there is a need for evidence on the effects of education interventions for informing decisions about how limited funding can be best used to achieve quality education for all children. The review identifies, assesses and synthesises evidence on the effects of education interventions on children’s access to education and learning in low- and middle-income countries (LMICs). It synthesises findings from 238 studies evaluating the effects of a range of different education programmes in 52 LMICs.

The review finds that programmes have improved either school participation or learning outcomes, but not both. Cash transfer programmes have the largest and most consistent positive effects on school participation outcomes, but they do not typically improve learning outcomes. Structured pedagogy on the other hand have the largest and most consistent positive effects on learning outcomes, but the studies that measure participation outcomes do not suggest a positive effect.

Other panellists for the session on education effectiveness and the SDGs include Chris Berry, Head of Profession for Education, DFID, and Elizabeth King, 3ie Board of Commissioners who spoke about tailoring educational materials to local contexts and the relevance of considering contextual factors when making policy recommendations.

A video of the session can be seen here.

This session formed part of the 3ie London Evidence Week Conference. The full day’s event on ‘Meeting local and global development goals: how rigorous evidence can help’ can be found here.


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Muriel Dunbar on defining skills http://www.heart-resources.org/mmedia/muriel-dunbar-defining-skills/ http://www.heart-resources.org/mmedia/muriel-dunbar-defining-skills/#respond Fri, 29 Jul 2016 15:48:10 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29336 Read more]]> Muriel Dunbar, Senior Skills Adviser at Cambridge Education, provides a definition of skills and looks at how widely this extends in terms of educational backgrounds, types of skill, range of ages and range of sectors.

She defines skills as: ‘the combination of technical, cognitive and behavioural competences which enable a worker to acquire and retain decent work’. It is important to remember that there is also a need for entrepreneurship and business skills. The type and location of work is changing which affects thinking about skills. Technology has taken away some low-skilled jobs available and medium skilled routine jobs. This affects what skills should be taught. The urban drift should also be taken in to account. In many countries, young people do not complete primary schooling or are only educated to this level. Secondary education or higher is needed to be employed in the formal sector.

The breadth of skills development is reflected in a variety of ways: 1) variation in education backgrounds; 2) range of types of skill; 3) range of ages; 4) range of sectors.  These each require different needs.

There is a need for in-country DFID staff to know their labour market and which level of the market the skills development being put in place is aiming at, ie. local, regional, national, international. This will determine which skills are taught, what employment services are required to support graduates, what the links with employers needs to be, whether there is a need for language teaching over and above the local language and whether there is a need for recognised qualifications. Training institutions must become more entrepreneurial so that they are aware of the labour market that they are training learners for.

For more on skills see Muriel’s HEART Reading Pack: Skills provision and private sector demand. See also the HEART topic guide on skills; the reading pack Skills for Development: Thinking about System Reform Options; and a HEART talks from Simon McGrath taken at the same event that Muriel was filmed at.

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Simon McGrath on transforming skills development http://www.heart-resources.org/mmedia/simon-mcgrath-transforming-skills-development/ http://www.heart-resources.org/mmedia/simon-mcgrath-transforming-skills-development/#respond Wed, 27 Jul 2016 18:15:35 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29330 Read more]]> Simon McGrath, Professor of International Education and Development, University of Nottingham, talks about transforming skills development in relation to two key opportunities – the introduction of the Sustainable Development Goals (SDGs) in 2015 and the new UNESCO technical and vocational training (TVET) strategy.

Although TVET and youth employment is mentioned specifically in the SDGs, Simon argues that you can see skills elements across the goals. For example an energy goal talks about training people to install certain systems. What the UNESCO strategy does is use three lenses for thinking about skills: youth unemployment, equity (which includes a strong focus on gender equality), and sustainability. A lot of work has focussed on youth unemployment so Simon concentrates on the other two here.

On human development he critiques that there has not been enough efforts made to listen to young people to find out what they actually want. They want jobs for a number of reasons. Simon emphasises the need to work on converting the aspirations of young people into achievements.

The SDGs help to focus thinking on providing sustainable work. Not just employability but decent jobs. Also there is a need to build skills for work that builds wellbeing rather than undermining it. And there is a need to focus on gendered division of labour.

Skills are not just about supply and demand. Evidence points to the importance of cultures and institutional regimes that set up skills. Sequencing of reform is also an important issue. The interface between being pro-poor and being green needs to be considered, ie. low carbon.

Simon reflects on the skills for oil and gas in Africa (SOGA) programme for which DFID is one of the funders. This project has highlighted the need to ensure that skills are being developed for local and marginalised people. It also raises questions around whether corporate involvement in skills for the poor can be more than corporate social responsibility.

See Muriel Dunbar’s HEART talks for a discussion on defining skills. For more on skills development see the HEART topic guide. There are also two HEART reading packs on this area: Skills provision and private sector demand and Skills for Development: Thinking about System Reform Options.

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Joanna Härmä on low-fee private schooling in Maputo, Mozambique http://www.heart-resources.org/mmedia/joanna-harma-low-fee-private-schooling-maputo-mozambique/ http://www.heart-resources.org/mmedia/joanna-harma-low-fee-private-schooling-maputo-mozambique/#comments Tue, 26 Jul 2016 11:43:11 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29328 Read more]]> In this video Joanna Härmä, visiting Research Fellow at the Centre for International Education, University of Sussex, talks about research she undertook for DFID in Autumn 2015 on non-state provision of education in low-income areas of Maputo, Mozambique.

In many developing countries governments struggle to provide education that is accessible to all and of good quality. This has led to individuals starting their own small private schools in low-income areas serving the community. There is considerable controversy surrounding fee paying provision for poor communities – are they run as a business or a community school.

Arguments for these schools are that they are affordable, better quality, and providing a pro-poor solution. The arguments against are that they increase stratification in society, that they are unaffordable to the poor and that quality is not particularly good. Joanna finds that the truth is somewhere in between. Research on learning outcomes does tend to show private schools produce better test scores. However, when socio-economic background is taken into account the private school advantage tends to disappear. Private schooling is not affordable to the poorest 20-40% of society.

Joanna carried out a study for DFID to find out what non-state schools exist in low-income areas of Maputo, Mozambique. The status of education in this area is low. There is no government provision at pre-primary level and extreme under-provision at secondary level. There is a lack of schooling material in state provided primary schools. Absenteeism is very high amongst teachers and pupils.

Fieldwork for the study found 53 non-state schools and 55 government schools. Non-state schools were smaller. 36 of the 53 were serving the pre-primary level only. Many of the 53 non-state schools identified were not owned by a private individual but were community schools. These schools were established by a group of community members or community members got together and asked a religious leader to start a school as an alternative to the government system. 5 of the community schools receive teachers posted from the government and those schools did not charge fees at higher level.

Only 21 of the non-state schools were fully private. There is no major sub-sector of unregistered schools as there is in Nigeria and India so the government is able to keep better track of what is happening. Teachers in the non-state schools identified were relatively well prepared and most at primary and secondary levels are certified as teachers. Pay in non-state schools was found to be around one third of the pay that a civil service teacher receives. The cost of the schools works out to be around 35-40% of the pay of a low-level formal sector employee. Therefore the vast majority of these schools do not serve poor families, pupils tend to be from middle class families. Proprietors of these schools say that the reason that the low-fee private school sector hasn’t flourished in Maputo is people’s clear inability to pay.

Some have claimed that where government are failing to provide sufficiently good quality schools and number of seats a thriving private school sector will exist but this was not found to be the case in Maputo. The research also concludes that poverty is the main barrier to people being able to afford private schooling and to the growth of this sector. The private sector is, however, providing in areas where the government is not providing at all such as pre-primary. However, the poor are not likely to be able to access these.

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Jo Ailwood and Stephanie Bengtsson on integrating early childhood services through care http://www.heart-resources.org/mmedia/jo-ailwood-stephanie-bengtsson-integrating-early-childhood-services-care/ http://www.heart-resources.org/mmedia/jo-ailwood-stephanie-bengtsson-integrating-early-childhood-services-care/#respond Fri, 20 May 2016 10:33:33 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29032 Read more]]> Dr Stephanie Bengtsson and Dr Jo Ailwood have been involved in a teacher training research project in Zimbabwe since 2013. This talk looks at how the concept of care can be used to integrate early childhood services.

A mapping of age phases across sectors is presented and the meaning of the word ‘care’ is discussed. School can be a centre for care, particularly in vulnerable communities. The speakers were working in partnership with Children in the Wilderness, a non-profit organisation facilitating sustainable conservation through leadership development and education of rural children in Africa to support a school in western Zimbabwe. In 2014 it was quite early on in the school’s rehabilitation period. Typical of a rural school in Zimbabwe, the school faced a shortage of qualified teachers and was lacking in physical equipment and supplies. After two years of rehabilitation work there has been significant development at the school.

A number of activities which constitute care work in the school were observed by the research. This includes:

  • Water, sanitation and hygiene structures and life-skills practices with a deep and clean water hole, handwashing facilities (using drums and ‘tippy tappy’), and Blair toilets. Teaching children to care for themselves starts with pre-school age children.
  • In terms of health: vaccines were delivered through the school; teachers deliver a curriculum around HIV/AIDS and other health issues; appointment of a teacher to act as a dedicated health and nutrition officer.
  • For nutrition there is a deworming and micro-nutrients programme; a school-feeding programme with community involvement; agriculture curriculum and a school garden; and hygiene rituals around school meals.
  • In terms of education the school provides care through qualified (or qualifying) teachers for early childhood development and primary years 1-3. Play and teacher led learning provide social interaction, and cognitive and physical development.
  • The school as a hub supports social protection and community functions such as birth registration, eco-clubs, leadership camps, School Management Team, and orphan response.

In this case, care represents an effective means of integration and cohesion across the early years of schooling and also serves community and school members outside of those years. It is helpful to relate the school’s experience to Tronto’s three P’s of care: purpose, power, and participation. The purpose of school is education, but the school must also be purposive about providing caring relationships with the family and the community. The school has the power of authority in information and can become a site for gathering, meetings, vaccinations etc. Finally, participation through community care and engagement gets cemented around the school setting. Through a care-based approach, the case study school is beginning to feel more robust than in 2014.

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