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）-2021.9-120页_12mb

Summary of The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators (SDI) Surveys

Core Content

This document presents an analysis of the quality of health and education systems across nine African countries, based on data collected through the Service Delivery Indicators (SDI) surveys over a decade. The SDI surveys are designed to measure the effectiveness of service delivery at the point of contact between citizens and service providers, focusing on primary health care and primary schools. The report emphasizes the importance of human capital in development, highlighting how health and education systems are central to improving productivity, reducing poverty, and fostering social cohesion.

The SDI approach provides a platform for measuring key aspects of service quality, such as provider knowledge, presence, and readiness; availability of infrastructure and resources; and student learning outcomes. These surveys collect data from a representative sample of public and private facilities, using standardized methods to ensure comparability across countries and over time.

Main Points

• Human Capital as a Development Priority: Human capital, defined as the skills and health people accumulate over their lifetime, is essential for economic prosperity and social development. Strong health and education systems are crucial for human capital accumulation and long-term economic success.

• Impact of the Pandemic: The COVID-19 pandemic has exposed the fragility of health and education systems in Africa, with both direct and indirect effects on service delivery. School closures and reduced access to education have exacerbated existing inequalities, while disruptions in health services have affected routine immunizations and maternal and child health outcomes.

• SDI Surveys as a Tool for Reform: SDI surveys provide evidence on the performance of health and education systems, enabling policymakers and stakeholders to identify gaps, benchmark progress, and design targeted interventions. The data have been used to inform public debate and policy action in several African countries.

• Key Findings from SDI Data:

  • Health Systems: Many health facilities lack basic infrastructure, equipment, and essential medicines. Health care providers, especially at lower-level facilities, often have limited diagnostic and treatment skills. Provider absenteeism is high, particularly in public facilities, and the workload per provider is significant, with some seeing up to 23 patients per day.

  • Education Systems: Student learning outcomes are generally low, with less than half of students able to perform basic tasks. Teacher absenteeism is common, and even when present, many are not in the classroom during assigned times. Teacher competencies in content knowledge and pedagogy are also low and not correlated with education level.

• Strategies for Improvement:

  • Enhance provider skills through pre- and in-service training.
  • Improve infrastructure and resource availability, especially in rural areas.
  • Address human resource allocation and management.
  • Learn from high-performing schools and private institutions to improve public education.
  • Strengthen measurement frameworks to support evidence-based policy decisions.

Key Information

• SDI Methodology: The surveys collect data at the facility level, sampling between 250 and 3,000 public and private facilities in urban and rural areas. They use unannounced visits to assess provider presence and performance, and measure student learning outcomes through standardized testing.

• Geographic Scope: The analysis covers nine African countries, including Nigeria, Mozambique, Togo, and Tanzania, among others. These countries represent a range of contexts and development levels.

• Policy Implications: SDI data have been used to guide national reforms, such as teacher absence campaigns in Mozambique and curriculum revisions in Togo. They also support innovation in measurement tools, such as teacher observation tools and patient exit surveys.

• Future Directions: The report suggests that measurement should evolve to reflect the changing nature of health and education services, with a focus on patient-centered care and the broader determinants of service quality.

Conclusion

The SDI surveys provide critical insights into the quality of health and education systems in Africa, revealing persistent gaps and highlighting the need for targeted reforms. As countries recover from the pandemic, leveraging this evidence can help build more resilient systems that deliver better outcomes for citizens and support sustainable, inclusive growth. The report underscores the importance of investing in human capital and using data to drive meaningful change in service delivery.