Challenge
In spite of significant investment in basic education and health, Peru, a middle-income country, has exhibited persistent lack of progress in basic human development outcomes in education and health. In 2005, only 15 percent of Peru’s second-grade students were reaching full sufficiency in literacy, and roughly half were unable to read at all. In health, 25 percent of births nationwide were not institutionally supported, and fully 30 percent of 5-year old children were chronically malnourished. In each case, the outcomes are particularly poor in rural areas and among indigenous communities.
A central challenge has been to define standards that are comprehensible to parents while being technically acceptable to professionals in the health and education sectors. Another challenge is establishing and strengthening national monitoring systems that provide data on all children. Finally, the decentralization process brings further challenges, since the locus of responsibility for human development programs is shifting to sub-national agencies.
Approach
Since 2005, the International Bank for Reconstruction and Development (IBRD) has provided $2.6 million to Peru’s Accountability for Social Reform (RECURSO) program—an effort to define and popularize simple-to-understand standards for children’s development in education, health, and nutrition. The standards promoted by the Government are as follows:
- Children should reach a minimum height of 82 cm by the age 2
- All women should have access to good-quality institutional births
- All grade-2 children should attain age-appropriate reading comprehension, which means reaching level 2 in the national standard test
In addition, IBRD has provided $480 million in budgetary support through Results and Accountability (REACT) development policy loans that have helped the government set targets for improvement, implement supporting strategies, and monitor results.
Key activities of the RECURSO/REACT strategy that contribute to improved outcomes of these standards include the following:
- Hard-hitting videos popularize the standards, show the standards are feasible to attain even for poor families, and highlight the potential for schools and health posts to greatly improve outcomes.
- Tracking outcomes at facility level for every child in every school and every health post takes place through nutritional monitoring and counseling sessions and through standard comprehension tests in second grade. The results provide a basis for action to improve outcomes for the child and within the schools or health posts.
- Financing supporting strategies geared to improving performance under decentralization bridges the effective work among national, regional, and local government agencies.
Results
- Chronic malnutrition among children under five was reduced to 24 percent in 2009 (first half), down from 28 percent in 2005
- Rural institutional births coverage reached 55 percent in 2009, up from 50 percent in 2007
- The proportion of second grade children with age-appropriate reading comprehension (level 2) rose from 16 percent in 2007 to 23 percent in 2009 while those below level 1 fell from 30 percent in 2007 to 23 percent in 2009.
Toward the Future
The next phase of RECURSO is being implemented in 2010 with a focus on identifying the lessons learned to date in improving results and accountability in the health sector. The third and final REACT development policy loan from IBRD, which will be processed in 2010, will support a further strengthening of policy actions to popularize basic standards and monitor the related outcomes. The IBRD is also supporting the government with analysis of a national survey of parental understanding of basic standards for child development. At the same time, initiatives are underway with IBRD funding to further strengthen outcomes and help institutionalize support for the strategies that have been originated under RECURSO and REACT.
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