To Accelerate Health And Education Programs

World Bank

Two Projects prepared by the Government of Ghana with the support of the World Bank and which seek to boost significantly access to high impact education and health services will be receiving US$229million from the World Bank. The Maternal and Child Health &Nutrition Improvement Project (US$73 million) and the Ghana Secondary Education Improvement Project (US$156 million) were approved by the Board of Executive Directors of the World Bank Group on May 20, 2014. A third project, the Ghana Social Opportunities Project (US$50 million), to strengthen and expand support to some of Ghana s citizens through expansion of the coverage of LEAP and provision of more resources to labor intensive public works programs to help tide eligible communities over the lean season, while providing needed infrastructure, will be presented to the World Bank Board on May 27, 2014.

We are very delighted to be able to support these timely interventions by the Government of Ghana to save lives and extend opportunities to some of the country s most vulnerable citizens. A development agenda which focuses directly on people and seeks to promote shared wellbeing is surely the right thing to pursue. We do hope that these projects will help to bring about good and tangible results in the form of more rapid reductions in maternal and child mortality, better and equitable educational outcomes as well as an acceleration of the social protection program ,?says World Bank Country Director, Yusupha Crookes.???As the performance and results unfold during implementation, the Bank will consider providing expanded support for the program ,?he adds.

Background:??Ghana has made steady progress in improving health outcomes over the past two decades.??The total fertility rate (TFR) declined significantly over the past 20 years from 6.4 children per woman in 1988 to 4.1 children per woman in 2011 with the country reaching one of the lowest fertility rates in Sub-Saharan Africa.??Ghana has also experienced a marked decline in childhood mortality over the past 20 years, reaching a rate of 78 deaths per 1,000 live births in 2011.??While the Maternal Mortality Ratio (MMR) dropped steeply from a high of roughly 600 per 100,000 live births in 1990 to about 350 by 2010, it still remains high, particularly in relation to countries at similar socio-economic levels.

In spite of the overall progress to improve health outcomes Ghana is lagging in meeting all health related Millennium Development Goals (MDGs) targets.??Three trends are worthwhile noting.???First,?Ghana is considerably off track to attain the maternal mortality MDG?of 160 per 100,000 live births and needs to redouble efforts in this area.???Second, the country?is not likely to meet the 2015 child mortality target?(53 per 1000 live births) even though it is proceeding in the right direction but at a slower pace than needed. Over two-thirds of child deaths occur in the first year of life.??Third,?Ghana is not likely to meet all the child nutrition targets,?especially stunting.

Given this context, there is a strong case for the Bank to invest in this project, which seeks to support the Government s efforts to reduce maternal and child mortality.

Project Development Objective:?The project seeks to improve utilization and effectiveness of community-based health and nutrition services by women of reproductive age, especially pregnant women, and children under the age of two years.????The project will support (i) increasing availability of high impact health and nutrition interventions, and (ii) addressing barriers to access to such high impact services using existing community-based health service delivery strategies and communications channels.

Delivery Mechanisms and Time Lines:?The project will strengthen the functionality of the Community-based Health Planning and Services (CHPS) delivery platform. The Health Results and Innovation Trust Fund will finance the pilot an innovative community performance-based financing approach which builds in rewards for service providers who achieve agreed targets of maternal and child services delivery. The project s expected closing date is June 30, 2020.

Project Components:?The project comprises the following components:
Component 1:???Community-Based Maternal and Child Health &Nutrition Interventions?(estimated cost, US$73 million:??IDA US$68 million, HRITF $5 million).??This component will focus on strengthening supply, creating demand, and increasing ownership and accountability of district level stakeholders, outreach workers, community leaders and household members.

?Component 2:??Institutional Strengthening Capacity Building, Supervision, Monitoring and Evaluation, and Project Management(estimated cost: IDA US$8 million):?This component will support (i) effective inter-sectoral coordination, ownership, and accountability for health and nutrition towards the strengthening of a coherent national community health and nutrition program; (ii) strengthen MoH capacity to provide stewardship and GHS capacity to effectively coordinate, supervise and monitor implementation of the community-based services; and (iii) evaluate the impact of the project.

Expected Results

?a.????????Proportion of pregnant women making first antenatal visit in the first trimester (target of 55% from baseline of 44%)

  1. Births attended by skilled health personnel (target of 450,000 from baseline of 180,000)
  2. Proportion of children under 2 attending community growth promotion activities (target of 75%)
  3. Proportion of children 0-6 months exclusively breastfed in the past 24 hours (target of 54% from baseline of 46%)
  4. Proportion of new acceptors of modern contraceptives (target of 35% from baseline of 25%)
  5. Number of direct project beneficiaries (target of 5 million).
  6. Percentage of direct project beneficiaries that are female (target of 80%)


Background:??With access to primary education becoming almost universal in Ghana, new priorities are emerging at the post-basic level where the demand for secondary education is fast increasing and the supply of Senior High School (SHS) has not kept pace. Ghana s middle income status will require more SHS graduates with the relevant skills and abilities to continue their education or enter the labor market. The Government s education strategy aims to rapidly expand access to and quality of secondary education, making it gradually universal and also progressively free.

Currently there is significant social and geographical inequity in terms of successful completion of basic education and entry into SHS. About 75% of the youth typically do not have physical access to SHS or do not have adequate qualification to enter SHS. In response, the Government intends to scale up programs that support students from low income families, especially girls, who have less access to post-basic education. In addition, the quality of SHS programs shows large disparities between the best performing schools and the rest of the sector. The SEIP supports a policy framework for more equitable, relevant and efficient senior secondary education by targeting investments including construction of new schools and rehabilitation of old schools in underserved areas, providing incentives for improvements in quality and introducing demand side support which includes??scholarships for girls. Research and analytical studies will further elaborate the secondary education strategy for Ghana, lay the groundwork for policy reforms, and finance the piloting and evaluation of innovative approaches like ICT for schools.

?Project Development Objectives:?The Project seeks to increase access to senior secondary education in underserved districts and improve quality in low-performing senior high schools (SHS) in Ghana.

Delivery Mechanism and Time Lines:?The US$156 million Project, to be implemented within five years, is expected to become effective October 1, 2014 and closes on?30 November 2019.??It will use a results-based financing approach. This approach will be based on the Bank providing pre-agreed amounts to support the government s implementation of its program subject to the achievement of performance benchmarks and results that have been defined by the government.

?Project Components:?The project comprises the following components:
Component 1😕Support to Increase Access with Equity and Quality in Senior High Schools?(estimated cost US$140.1 million): This component will use a results-based financing approach which will seek to increase access with equity and quality in SHS. The first results area would expand space through the construction of approximately 23 new SHS in underserved areas, rehabilitation and expansion of existing low performing schools and through support for SHS attainment of disadvantaged students (e.g. scholarships to students from low income families, especially girls). The second results area focuses on improving the quality of education in selected low-performing SHS through: (i) strengthened school management and accountability; (ii) mathematics and science teaching and learning; (iii) information and communication technology expansion and connectivity in schools.

Component 2:?Management, Research and Monitoring and Evaluation?(estimated cost US$15.9 million):?It will finance technical assistance, management, research and monitoring and evaluation for effective project implementation.


Expected Results

?a.????????The project is expected to benefit approximately 30,000 new students in secondary education programs, 150,000 students in low performing schools, 2000 senior high school teachers, head teachers, in addition to education officials.

  1. Increase in Transition Rates from JHS3 to SHS1 in targeted districts (to be determined based on objective and transparent criteria for underserved districts)
  2. Increase in SHS educational attainment within two poorest quintiles in targeted districts (disaggregated by gender)
  3. WASSCE achievement of 6 credits and above?within beneficiary schools (disaggregated by gender)
  4. Increase in new seats for SHS students in under-served districts
  5. Increase in seats in existing selected low-performing schools
  6. Increased enrolment in selected SHS for students from low-income families, especially girls
  7. Annual publication of School Performance Report
  8. Improved learning outcomes in targeted selected schools


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