The Quality of Health and Education Systems Across Africa
Health and education are deeply intertwined in the process of human capital accumulation, and they are mutually reinforcing. For example, low-quality maternal, infant, and child health services put a child at risk for poor developmental outcomes, potentially leading to reduced learning and overall educational attainment, as well as worse health later in life (Currie 2009). Similarly, improvements in education, especially among women, have long been shown to boost health in families and communities. Reinforcing the evidence base on how schooling and health systems can work synergistically may accelerate human capital accumulation.
Learning from the Service Delivery Indicators surveys There are many dimensions to health and education systems, including policies and guidelines, workforce recruitment and training, and incentives and pay.1 Fundamental to system performance are the frontline settings where services meet citizens: at local schools, in clinics, and in hospitals. Comprehensive measurement of health and education services at the point of delivery can help to uncover bottlenecks to quality of care and education and, in turn, to human capital accumulation. To advance this measurement agenda, a decade ago, the World Bank launched the Service Delivery Indicators (SDI) surveys. SDI surveys are nationally representative facility surveys that directly measure whether teachers know the material they are supposed to teach, whether health care providers are able to diagnose and treat common diseases, and whether schools and clinics have basic inputs like textbooks and stethoscopes (box 1.1). By documenting the competence and behavior of providers and the availability of inputs, SDI surveys offer a unique window into the quality of schooling and health care. Implemented systematically and with a core of comparable questions across countries and over time, SDI surveys allow cross-country benchmarking while speaking to the specificity of country contexts. The surveys are consistent in spirit with exercises like global indexes, which leverage competition across countries to trigger virtuous circles of debate and reform. Together with other international measurement initiatives, SDI surveys create a factual platform for dialogue around health and education reforms that engages a broad set of stakeholders, including governments, trade unions, parents, and patients. As the SDI initiative continues to expand, this publication takes stock of more than a decade of SDI surveys in Africa. The SDI initiative began in 2008, when researchers and practitioners at the World Bank Group, in partnership with the African Economic Research Consortium and later supported by the
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