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Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM

Lund, C.; Alem, A.; Schneider, M.; Hanlon, C.; Ahrens, J.; Bandawe, C.; Bass, J.; Bhana, A.; Burns, J.; Chibanda, D.; Cowan, F.; Davies, T.; Dewey, M.; Fekadu, A.; Freeman, M.; Honikman, S.; Joska, J.; Kagee, A.; Mayston, R.; Medhin, G.; Musisi, S.; Myer,
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
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There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurseled service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second...

Informality and Protection from Health Shocks : Lessons from Yemen

Cho, Yoonyoung
Fonte: Banco Mundial Publicador: Banco Mundial
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The informal sector is generally believed to be more vulnerable to various risks due to limited access to social insurance, but little empirical evidence exists to support this statement. This paper examines the relationship between informality and protection from health risks in Yemen. The formal sector, when defined based on pension coverage, largely overlaps with public employment where the better educated, more experienced, and better informed tend to work. The results indicate that, even after accounting for socio-economic status, water supply and quality conditions, risky behavior patterns, and unobserved heterogeneity, formal sector households have better accessibility and affordability to health service. This may in part explain better health outcomes among formal households, although large heterogeneity across regions (urban/rural) exists. However, the role of the existing health insurance is found to be unclear. The findings reconfirm the importance of policies that promote universal access to health service and a risk pooling avenue delinked from employment types as well as healthy living conditions and lifestyles.

Toward Defining and Measuring the Affordability of Public Utility Services

Kessides, Ioannis; Miniaci, Raffaele; Scarpa, Carlo; Valbonesi, Paola
Fonte: Banco Mundial Publicador: Banco Mundial
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36.7%
This paper reviews the progress made in the literature toward defining and measuring the affordability of utilities. It highlights the relative merits of alternate affordability metrics; the practical challenges to their operationalization, including the underlying data requirements; and their implications for the design, evaluation, and implementation of appropriate affordability programs.

Ageing and Poverty in Africa and the Role of Social Pensions

Kakwani, Nanak; Subbarao, Kalanidhi
Fonte: Washington, DC Publicador: Washington, DC
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In many low income African countries, three factors are placing an undue burden on the elderly. First, the burden on the elderly has enormously increased with the increase in mortality of prime age adults due to HIV AIDS pandemic and regional conflicts. Second, the traditional safety net of the extended family has become ineffective and unreliable for the elderly. Third, in a few countries, the elderly are called upon to shoulder the responsibility of the family as they became the principal breadwinners and caregivers for young children. While a number of studies have examined the welfare consequences of these developments on children, few studies have systematically analyzed the poverty situation among the elderly (relative to other groups) in low income countries Africa, and the role of social pensions. This study aims to fill this gap. Drawing on household survey information, the study profiles the elderly for 15 African countries which include both East and West African countries, and countries with a high and low prevalence of HIV-AIDS pandemic. The findings show much heterogeneity across countries with respect to the proportion of the elderly population, the living arrangements and the composition of households, and household headship. The variations in household types and living arrangements presumably reflect the variations in...

Latin America & the Caribbean - Urban Services Delivery and the Poor : The Case of Three Central American Cities (Vol. 1 of 2) : Service Delivery and Poverty

World Bank
Fonte: Washington, DC Publicador: Washington, DC
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The present study describes, and quantifies the provision of basic urban services to the poor, in three Central American cities in El Salvador, Honduras, and, Panama. It also identifies priority areas for government intervention, using specialized household surveys to quantify current deficits, and to rank households from poor to rich, using aggregate consumption as the measure of welfare. The urban poverty profile is examined in each city, through migration, growth, and mobility patterns, including education and labor characteristics. In terms of land and housing, in all three cities, almost half of the poor who reported being property owners have weak, or no documentation over their properties, and, considerable portions of the poor population, are not connected to the public aqueduct, while few if any, receive help from the government. High dependency on public transportation was reported, e.g., one hundred percent in El Salvador, ninety seven percent in Tegucigalpa. Institutional, and policy issues explain the current situation: in terms of decentralization...

Urban Services Delivery and the Poor : The Case of Three Central American Cities, Volume 2. City Reports

World Bank
Fonte: Washington, DC Publicador: Washington, DC
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The present study describes, and quantifies the provision of basic urban services to the poor, in three Central American cities in El Salvador, Honduras, and, Panama. It also identifies priority areas for government intervention, using specialized household surveys to quantify current deficits, and to rank households from poor to rich, using aggregate consumption as the measure of welfare. The urban poverty profile is examined in each city, through migration, growth, and mobility patterns, including education and labor characteristics. In terms of land and housing, in all three cities, almost half of the poor who reported being property owners have weak, or no documentation over their properties, and, considerable portions of the poor population, are not connected to the public aqueduct, while few if any, receive help from the government. High dependency on public transportation was reported, e.g., one hundred percent in El Salvador, ninety seven percent in Tegucigalpa. Institutional, and policy issues explain the current situation: in terms of decentralization...

Connection Charges and Electricity Access in Sub-Saharan Africa

Golumbeanu, Raluca; Barnes, Douglas
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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Sub-Saharan Africa trails other regions in providing access to electricity for poor urban and rural residents. This poor performance can be linked to various factors, including political interference in utility policy, higher investment costs and lower profitability of extending service to rural areas. But a major obstacle to wider access is the high charges consumers must pay to connect to the electricity network. The connection charges in Sub-Saharan Africa are among the highest in the world, which has resulted in low rates of electrification in many countries. This paper reviews ways to improve electrification rates by addressing the issue of high connection charges. Essential to the success of such efforts is concurrent political commitment to identify, examine, and implement various low-cost electrification approaches and financing solutions as part of a broad plan to improve access. Electricity companies can lower their connection-related costs, and thus consumer charges, by using a variety of low-cost technologies and materials in distribution networks and household connections; making bulk purchases of materials; and adjusting technical standards to reflect the lower loads of households that use a minimum amount of electricity. Strategies for lowering connection charges may also include spreading charges over a reasonable period...

Improving Energy Access to the Urban Poor in Developing Countries

The Energy and Resources Institute
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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The case studies documented in this report aim to inform the energy access community (including practitioners, civil society groups, project planners, end users) about best practices of successful energy access initiatives targeted at slum dwellers. Eight case studies focusing on electrification and household energy were selected from India, Bangladesh, Colombia and Brazil, all countries that have had varying success in providing access to modern energy services for slum dwellers. The cases had to meet all or some of the following criteria: 1) limited to developing countries; 2) demonstrate innovative methods of improving energy access, including collaborative stakeholder engagement; 3) at least one example of small local energy service providers; 4) contributed to community development by promoting local skill development and income generation; and 5) representative of electricity and different sources of household energy. The case studies describe the existing conditions in the slum, type of energy service provided...

Maldives Development Update, April 2014

Gomez Osorio, Camilo; Abeygunawardana, Kishan; Subasinghe, Shalika; Sun, Changqing
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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Real GDP growth in Maldives stood at 3.7 percent in 2013 and its outlook is positive at 4.5 percent for 2014. The tourism demand is slowly picking up and has a positive impact on growth in the non- tourism sectors. Chinese tourists continue to compensate for the weaker demand from Europe, but overall the length of stay has declined, as well as spending per tourist. Growth while dynamic was less inclusive, as the tourism industry is operating on an enclave model of development. The share of GDP from the primary sector, agriculture, mining and fisheries that employ the largest share of Maldivians in the outer atolls, was less than 0.3 percent of GDP in 2013. Loose fiscal policy in a context of moderating economic growth has led to rising macroeconomic imbalances. While revenue collection has been strong, over the past five years the gap between revenues and expenditures has widened, financed through unsustainable levels of public debt at increasing interest rates. The 2014 Budget comes with a record high envelope of MVR 17.95 billion (around 50 percent of GDP)...

Braving the Storm

World Bank; Agency for Statistics of Bosnia and Herzegovina; FBiH Institute for Statistics; RS Institute for Statistics; AGe
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Relatório
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This note describes the trends in, and composition of, absolute poverty based on household expenditures, and is thus concerned, as a matter of policy objectives, with access of the population to a particular minimum standard of living. This should be viewed as complementary to the companion note on social exclusion based on Europe 2020 indicators including the relative at-risk-of-poverty (AROP) rate, focuses on low income in relation to other residents in a given country. In addition to the analysis of absolute poverty, the note also presents an analysis of inclusive growth, aimed at assessing whether income growth (losses) benefit (impact) differentially the lowest part (here, bottom forty percent) of the distribution. Other approaches, such as those including measures of poverty based on current income, or self-reported measures of affordability, or approached that differ in the way they set the poverty threshold exist. The choice of World Bank’s methodology for purposes of this report is primarily on pragmatic grounds: (i) it allows for the analysis of trends during 2007-2011; (ii) the same methodology was adopted in the previous report (World Bank 2009) to analyze poverty trends during 2004-2007...

Public Expenditure Review of the Education Sector in the Democratic Republic of Congo; Revue des dépenses publiques du secteur de l’éducation en République Démocratique du Congo : une analyse d’efficience, d’efficacité, et d’équité; An Efficiency, Effectiveness, and Equity Analysis

World Bank Group
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Report; Economic & Sector Work :: Public Expenditure Review; Economic & Sector Work
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A sound education sector is fundamental for the economic, social, and political transformation of the Democratic Republic of Congo (DRC). The DRC has achieved significant progress in its education sector over the last decade, demonstrating strong resilience following a particularly violent period in its history. The DRC’s development trajectory will depend on its ability to reap the benefits of it resource-rich territory, which will require large investments in human capital to transition to an economy based on improved productivity, innovation, and technology. The DRC’s population has a very large youth cohort and reaping the benefits of the demographic dividend requires ensuring that sufficient funding is allocated to address priority issues at all levels of education. The three tenets of education investments can be summarized as follows: invest early, invest smartly, and invest for all. This report is organized into following sections: section one gives introduction, section two discusses the country context in terms of demographic dividends and available fiscal space for increasing social sector demand. Section three provides an overview of the education sector context including a chronological order of education sector policies...

Jobs and Land Use within Cities; A Survey of Theory, Evidence, and Policy

Goswami, Arti Grover; Lall, Somik V.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Working Paper; Publications & Research :: Policy Research Working Paper; Publications & Research
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Over the last century, the urban spatial structure of cities has transformed dramatically from the traditional monocentric configuration to varying forms of decentralized organization. This paper reviews the theory and empirical evidence to understand the urban morphology of jobs and land use within a city. This survey highlights four broad insights: (i) The evolution of monocentric to polycentric centers has been accompanied by structural changes in the city. (ii) The internal geography of a city is an outcome of the trade-off between the pull from agglomeration economies and the push from congestion. (iii) The presence of externalities implies that the equilibrium spatial organization achieved by profit-maximizing firms may not necessarily be optimal. This justifies the role of public policy in addressing the associated market failures. (iv) The productive edge and competitiveness of a city can be enhanced by introducing policies that increase the overall connectivity to take advantage of economic opportunities across the metropolitan area. The survey also puts together a wide range of policy instruments that are useful in closing the gap between equilibrium urban spatial structure and the optimal outcome.

Cambodia - Sharing growth : Equity and Development in Cambodia, Equity Report 2007

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Poverty Study; Economic & Sector Work
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Cambodia's changing distribution of income-related outcomes is consistent with the process of transition from a planned to an open market economy, and the accompanying growth of incomes. This transformation has promoted better resource reallocation, expanded the spectrum of gainful activities, and widened the distribution of earnings. Aided by robust economic growth and improved capacity for implementing public policies, Cambodia has seen most other welfare outcomes (notably health and education indicators) become more equal over time. While a radical shift of development strategy is not necessary, improvements in public spending and selected interventions can further promote equality of opportunity, and public policies can promote an expansion of private investment opportunities. The findings of the report point to the following sets of government actions: (i) continuing economic reform to promote investments and sustain growth; (ii) protecting land tenure through systemic titling, and addressing landlessness related poverty through various measures (e.g....

Outage : Investment Shortfalls in the Power Sector in Eastern Europe and Central Asia

Balabanyan, Ani; Vrenezi, Edon; Pierce, Lauren; Hankinson, Denzel
Fonte: World Bank Publicador: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
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Before the onset of the global financial crisis in late 2008, countries in Eastern Europe and Central Asia (ECA) experienced strong economic growth. Demand for electricity increased steadily with gross domestic product (GDP). GDP grew, on average, 6.5 percent between 2000 and 2007, and electricity consumption per capita grew 2.75 percent. Meanwhile, energy security and supply reliability were a growing concern for policymakers and planners. Despite increased access to financing through the opening of international financial markets, under-maintenance of old soviet-era power sector infrastructure created a backlog of critical investments threatening the stability of the sector. As a result, a gap between demand and available supply capacity was beginning to emerge. This report analyzes the impacts of the financial crisis on power sectors in the ECA region through the experience of five countries (the study countries); Armenia, the Kyrgyz Republic, Romania, Serbia, and Ukraine. The report's objective is to help policymakers in the region plan and prioritize electricity sector investments in the wake of the financial crisis...

Cote d’Ivoire Urbanization Review; Diversified Urbanization

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Report; Economic & Sector Work :: Other Urban Study; Economic & Sector Work
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Well-managed urbanization can accelerate Cote d’Ivoire’s ascendance to middle incomes. Such a large gap in gross national income (GNI) per capita means that the underlining economic drivers of urbanization are not being fully harnessed in Cote d’Ivoire. Small cities at low urbanization level facilitate internal scale economies, such as hosting a large firm transforming local agricultural products. Secondary cities at intermediate urbanization level facilitate localization economies by enabling linkages between firms operating in the same sector. Large cities at advanced urbanization level facilitate urbanization economies through a diverse economic base nurturing innovation. Drawing on the findings of the World Development Report 2009 applied to the Ivorian context, the authors identify three types of cities in the country: global connector cities generating urbanization economies needed for innovation, increasing return to scale activities, and global competitiveness; regional connector cities generating localization economies needed for efficient regional trade and transport; and domestic connector cities generating internal scale economies needed to unleash the agricultural potential of regions. Cote d’Ivoire’s small cities and market towns can be anchors generating scale economies for agribusiness. While southwest regions strongly contribute to the production and export of cash crops...

Cameroon Economic Update, January 2014, Issue No. 7; Reexaminer les sources de la croissance : la qualite de l'education de base

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Economic Updates and Modeling
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The Cameroon economic updates aim at sharing knowledge and stimulating debate among those interested in improving the economic management of Cameroon and unleashing its enormous potential. The notes thereby offer another voice on economic issues in Cameroon, and an additional platform for engagement, learning, and exchange. The average observed economic growth rate from 2010 to 2013 is a mere four percent, one percentage point below the vision 2035 targets. Achieving the official objectives set for 2020 will require Cameroon to move to double digit annual growth rates over the 2014-2020 period, compared to the 4.8 to 5.4 percent projected by the World Bank. This report looks at the quality of basic education to ensure that the right investments are made in people to build human capital, a key ingredient for sustainable economic growth. Cameroon has achieved significant progress over the last decade in expanding access to basic education. The number of students completing primary school, the primary completion rate...

Azerbaijan : Living Conditions Assessment Report

World Bank
Fonte: World Bank Publicador: World Bank
Tipo: Economic & Sector Work :: Other Poverty Study
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Azerbaijan saw a substantial reduction in poverty during the 2000s, owing to significant economic growth and policies and programs that improved the distribution of wealth. Seizing the opportunity afforded by the oil boom, Azerbaijan initiated large public sector investment programs and supportive policies to increase wages and social protection transfers to the population, and institutional reforms aimed at modernizing the economy. These efforts translated into double-digit growth and an impressive reduction in poverty. The report underscores that the government's targeted social assistance program has been successful in channeling public transfers to the most needy. On the other hand, high dependence on oil revenues, compounded by the current global economic crisis, presents challenges to maintaining growth and could jeopardize the gains made in poverty reduction. Moreover, while Azerbaijan has made significant progress in building capacity to redistribute the benefits of growth, significant challenges remain in developing the human capital of the population to participate actively in future growth and to close the productivity gap with its comparators in the post crisis world.

Cambodia Economic Update, April 2014 : Coping with Domestic Pressures and Gaining from a Strengthened Global Economy

World Bank
Fonte: Phnom Penh Publicador: Phnom Penh
Tipo: Economic & Sector Work :: Economic Updates and Modeling
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Cambodia's economy has withstood domestic pressures and managed to sustain its high growth driven by its usual engines of growth. The external sector improved as a result of slower imports due to dampened domestic demand. The post-election adverse effects slowed down the demand for imports, while export growth advanced. Inflation rose to 4.7 percent year-on-year at the end of 2013, up from 2.5 percent at the end of 2012. Inflation is projected to remain in mid-single-digits over the short term. Financial deepening continues but the gap between credit and deposit growth rates has widened, reducing bank liquidity. Government revenue growth has moderated, resulting in an increase in the fiscal deficit. The latest joint World Bank and International Monetary Fund (IMF) debt-sustainability analysis (DSA) conducted in 2013 shows that Cambodia's debt-distress rating remains low, with all debt-burden indicators projected to be below respective thresholds. The prospects for sustaining high growth appear favorable...

Financing Energy Efficiency Measures for Residential Building Stock : Scaling Up Energy Efficiency in Buildings in the Western Balkans

Kalkum, Bernd
Fonte: World Bank Group, Washington, DC Publicador: World Bank Group, Washington, DC
Tipo: Publications & Research; Publications & Research :: Working Paper
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Within the Western Balkans region, a secure energy supply is critical to sustaining economic growth. Currently, the region relies heavily on imported hydrocarbons and maintains high energy intensity relative to Gross Domestic Product, or GDP. This places a huge burden on companies, which require affordable and reliable infrastructure services to be competitive; the public sector, which spends significant budgetary resources on energy; and households, which have to pay a high portion of their income for energy services. As energy pricing is further rationalized, a higher burden will be placed on all sectors, especially poorer households. The residential sector is a significant energy consumer. Its share of total final energy consumption ranges from 28 percent to 32 percent (compared with the EU average of 27 percent). Fairly simple renovations such as insulation, heating system upgrades, and improvements to windows and lighting could reduce consumption in this sector by some 9 percent, with payback periods generally less than 8 years. Such improvements could help ease the impact of future tariff increases while helping reduce the region's projected energy supply and demand gap.

The Growing Price Gap between More and Less Healthy Foods: Analysis of a Novel Longitudinal UK Dataset

Jones, Nicholas R. V.; Conklin, Annalijn I.; Suhrcke, Marc; Monsivais, Pablo
Fonte: PLOS Publicador: PLOS
Tipo: Article; published version
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This is the final published version. It first appeared at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109343.; Objectives The UK government has noted the public health importance of food prices and the affordability of a healthy diet. Yet, methods for tracking change over time have not been established. We aimed to investigate the prices of more and less healthy foods over time using existing government data on national food prices and nutrition content. Methods We linked economic data for 94 foods and beverages in the UK Consumer Price Index to food and nutrient data from the UK Department of Health's National Diet and Nutrition Survey, producing a novel dataset across the period 2002?2012. Each item was assigned to a food group and also categorised as either ?more healthy? or ?less healthy? using a nutrient profiling model developed by the Food Standards Agency. We tested statistical significance using a t-test and repeated measures ANOVA. Results The mean (standard deviation) 2012 price/1000 kcal was ?2.50 (0.29) for less healthy items and ?7.49 (1.27) for more healthy items. The ANOVA results confirmed that all prices had risen over the period 2002?2012, but more healthy items rose faster than less healthy ones in absolute terms:?0.17 compared to ?0.07/1000 kcal per year on average for more and less healthy items...