2021-10-31-世界银行-非洲各地卫生和教育系统的质量_来自十年服务提供指标调查的证据（英）_169页_7mb

Summary:

Health and Education Systems Across Africa: Key Findings and Recommendations

This book synthesizes evidence from ten years of Service Delivery Indicators (SDI) surveys conducted across nine African countries (Madagascar, Niger, Mozambique, Nigeria, Sierra Leone, Tanzania, Uganda, Kenya). The SDI initiative measures key aspects of service quality in education and health through nationally representative surveys comparing provider performance, presence, inputs, and student/ patient learning.

Health Service Delivery Observations:

• High rates of provider absence (~20-60% across countries) question availability.
• Outpatient caseloads are often unbalanced (3-23 patients per provider/day).
• Diagnostic and treatment accuracy for common conditions is low (average 40-69% correct), especially at lower-level facilities.
• Essential medicines are unavailable in over half of facilities; basic infrastructure (water, sanitation) is often lacking, particularly in rural areas.

Education Service Delivery Observations:

• Average fourth-grade student learning is low (less than 50% read simple sentences; similar low performance in math).
• Teacher absence is high (~22-57% missing from classrooms), and knowledge and pedagogy skills are generally weak.
• Basic school inputs (blackboards, toilets, textbooks) are often missing, and class sizes are large (average 36 students per teacher).
• Significant heterogeneity exists within and across countries regarding learning outcomes, service inputs, and provider performance.

Conclusions and Implications:

• Despite decades of growth in access, fundamental gaps persist in the quality of basic health and education services across Africa, affecting human capital development.
• Specific levers for improvement include strengthening provider skills (especially frontline staff), optimizing allocation of human resources, improving infrastructure, enhancing teaching learning inputs, and better management practices.
• Case studies from countries like Mozambique and Tanzania show that SDI data effectively catalyzed policy discussions and reforms ("Big Results Now!" initiative).
• The COVID-19 pandemic underscores the urgency of strengthening resilient systems based on high-quality evidence from sources like SDI.
• SDI surveys provide valuable, actionable data for improving service delivery, building local capacity, and informing global measurements of human capital outcomes.

The book highlights that while challenges remain substantial, identifying specific areas for reform offers a path toward significantly enhancing the quality and impact of health and education services across Africa.