The Quality of Health and Education Systems Across Africa
the evidence in this area suggests that more or better resources improve student achievement only if they translate into real changes in children’s daily experiences at school (Ganimian and Murnane 2016). On average, other factors remaining constant, adding one teacher per school and ensuring that every school has a functioning blackboard and private and gendered toilets is associated with an increase of 0.24 of a standard deviation in students’ average test scores (see table A.9 in appendix A).21 Although this evidence does not give insights into the causal pathways for reform, it still points to feasible solutions with clear benefits for the order of magnitude of the impact generated by the most successful interventions to improve test scores at scale (see Glewwe and Muralidharan 2016; McEwan 2015). Some of these improvements, such as the
BOX 3.2 Toilets and handwashing facilities in schools: A key concern during COVID-19 In many respects, the COVID-19 (coronavirus) pandemic has reshaped the way people think about education. Millions of schools have shut down and countries are continuously reassessing whether it is safe to reopen them. An essential condition to allow schools to reopen is ensuring a safe return for students and teachers, which means being able to maintain physical and social distancing as well as implementing public health measures like frequent handwashing. The availability of basic sanitation infrastructure such as clean toilets is essential to prevent or reduce the spread of COVID-19 and other diseases. Some of these features might be difficult to attain in low- and middle-income contexts—such as those in the Service Delivery Indicators (SDI) sample—where basic sanitation infrastructure is already lacking. SDI results provide information on some of the sanitation inputs that have gained importance in the current context. Although some SDIs date back several years, more recent ones— including the 2016 surveys for Madagascar Morocco, and Tanzania—may give policy makers a good indication of what investments are needed to facilitate a safe reopening. In particular, the data allow analysts to look into (1) the availability of toilets for students, (2) the availability of a clean toilet, and (3) the availability of a handwashing facility with soap and water near the toilets. SDI data show that, generally, investments in sanitation infrastructure are needed more
urgently in rural settings, although schools located in urban areas also need support. Although the presence of at least a toilet seems to be the norm in most schools, there are still gaps, and not every school has one. These shortfalls may be largest in rural schools in Madagascar and Morocco, where 68 and 76 percent of schools have at least one toilet, respectively, as figure B3.2.1 shows. However, there is more room for improvement with regard to cleanliness. In the three countries with 2016 SDI surveys, only 65 percent of schools have a toilet assessed as clean. Of increased importance in the setting of COVID-19 is the presence of handwashing stations near these toilets. As shown in figure B3.2.1, this feature was not prioritized in the past. Overall, only 48 percent of schools in the three countries have a handwashing station in proximity to their sanitary facilities. This means that more than 50 percent of students are not able to wash their hands after using the toilet. This inability represents a serious health risk, especially in the current context. Although SDI surveys were not designed with these issues in mind, the richness of the data generated makes it possible to shed some light on this and other characteristics that can help policy makers to make appropriate decisions. As the SDI team continues to revise and enhance its instruments for upcoming surveys, more questions on this front will likely be needed. Chapter 4 explores some future survey plans in greater detail. (Continued)
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