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Performance in poverty alleviation
Declining availability of land per capita is associated with rising poverty, finds a World Bank report
3/4/2005
SIMULATIONS of the poverty head-count ratio in Bangladesh to 2015, based on a multivariate probit model estimated in the report of the World Bank about Bangladesh's performance in the light of the Millennium Development Goals (MDGs), have been undertaken under the assumption that real GDP per capita grows at 4.0 per cent annually between now and 2015. Furthermore, it has also been assumed that consumption inequality increases, and per capita land availability declines, at roughly the same rate as during the 1990s. Additionally, it has also been assumed that mean schooling of adult males and females increases at 0.3 years annually, and that bus transport and electricity coverage expand by one percentage point annually.
The simulations indicate that declining availability of land per capita is associated with poverty rising from about 50 per cent in 2000 to 52 per cent in 2015. Increasing consumption inequality is associated with another 8.0 percentage point increase in poverty (to 60 per cent). However, all the other interventions contribute to reductions in poverty. Both the expansion of male and female schooling are associated with large declines (10-12 percentage points each) in poverty incidence, but the contribution of transport and electricity access are very small (less than one percentage point each over the entire period).
Finally, annual per capita GDP growth of 4.0 per cent is associated with the largest decline in poverty (of about 21 percentage points). Together, the seven policy and environmental variables are associated with a reduction of about 33.5 percentage points in the incidence of poverty -- bringing the poverty head-count rate well below the MDG level (16 per cent versus 30 per cent). Indeed, the projections suggest that real per capita economic growth of 4.0 per cent annually without any consumption inequality, would by itself allow Bangladesh to meet its Millennium Development (MD) target. However, if consumption inequality increases at the same rate as it has during the 1990s, this would not be possible.
What these simulations underscore is that attainment of the poverty MDG certainly appears plausible in Bangladesh, but only if the country maintains strong economic growth and continued expansion of male and female schooling, and prevents income and consumption inequality from rising, in the years ahead.
The infant mortality rate in Bangladesh barely dropped (from 168 infant deaths per 1,000 live births to 161 deaths) during the two decades after 1951. But since 1974, the rate has fallen secularly and rapidly, reaching a level of 125 by 1984-85, 80 in 1994-95, and 66 currently. The decline has been most rapid during the 1990s. Indeed, not only has infant mortality fallen much more rapidly in Bangladesh than in India, but the level of infant mortality is now lower in Bangladesh than in India -- a country that has two times the income per capita of Bangladesh.
However, there are wide variations in infant mortality across divisions, with the division of Sylhet having an infant mortality rate that is nearly two times as high as that in Khulna. The division having the highest level of infant mortality in 1993-94 -- Dhaka -- experienced the slowest rate of infant mortality decline (14 per cent) over the following six years. In contrast, Khulna, which enjoyed the lowest level of infant mortality in 1993-94, experienced a rate of infant mortality decline that was two times as much as that experienced by Dhaka.
Thus, regional variations in infant mortality appear to have become more pronounced. However, there has been a remarkable convergence in infant mortality rates across rural and urban areas, thanks to much more rapid decline in infant mortality in the rural areas. While the infant mortality rate in rural areas was 27 per cent higher than in urban areas in 1993-94, it was only 8.0 per cent higher in 1999-2000.
One of the factors explaining the rapid decline in infant and under-five mortality in Bangladesh has been a very successful family planning programme. The programmes has achieved extraordinary results by building an extensive network of health and family welfare clinics throughout the country, training thousands of female workers to take family planning advice directly to women, and the using of the mass media campaigns to create awareness about family planning in the population. The programme has enjoyed strong political commitment from the government, grassroots- level partnership with NGOs, and generous and coordinated assistance from donors. Indeed, Bangladesh's experience has shown that it is possible to bring about fertility and mortality decline in poor countries even in the absence of strong economic growth and improving socio-economic conditions.
Despite the successful family planning programmes, the quality of service delivery in the overall public health sector in the country remains poor. There is widespread absenteeism of doctors and paramedics at government health centres and sub-centres; most government health facilities are in disrepair; and the availability of drugs and medical supplies at public health facilities is very limited.
A multivariate analysis of under-five mortality, using unit record data from the 1999 Demographic and Health Survey, indicates that while the risk of mortality is not significantly different across girls and boys, higher birth order girls have a significantly greater likelihood of dying than higher birth order boys. Maternal schooling -- but not father's schooling -- as well as the mother's age at the time of a child's birth are observed to be significantly and inversely associated with under five mortality.
In addition, the standard of living of a household, as proxied by the predicted log of monthly consumption expenditure per capita, has a strong and significant (inverse) association with under-five mortality. However, rather surprisingly, the availability of piped drinking water, access to toilet facilities and electricity coverage are not observed to have any significant associations with under-five mortality, after controlling for household living standards and parental schooling.
Bangladesh has made tremendous progress in expanding child immunisation coverage over the last two decades. The WHO Vaccine Preventable Diseases Monitoring System indicates that Bangladesh went from virtually no measles vaccination coverage in 1980 to 72 per cent coverage by 1998. The empirical results suggest that district-level immunisation coverage of measles has a strong (inverse) association with under-five mortality, with each percentage point increase in measles vaccine coverage being associated with a reduction of 0.4 child deaths per 1,000 live births. These estimates imply that universal measles vaccine coverage would be associated with a reduction in under-five mortality of about 16 deaths per 1,000 live births.
Simulations based on the multivariate model and on various assumptions about changes in mean consumption per capita, adult female schooling, delayed child bearing among women, and expanded measles coverage suggest that the under-five mortality in Bangladesh could decline substantially - by more than 50 per cent - over the period through 2015. The largest de-cline (of 18 deaths per 1,000 live births) would come about from the expansion of female schooling, followed by expanded measles vaccination coverage (15 deaths per 1,000 live births).
Delayed child bearing, which reflects both a delayed age at which the first child is borne as well as better spacing among subsequent children, is also associated with a large reduction (of about 11 deaths per 1,000 live births) in the under-five mortality rate, The smallest association is observed with living standards improvement.
The results suggest that real annual GDP per capita growth of 4.0 per cent (or annual growth of household consumption expenditure per capita of 2.7 per cent) would be associated with a reduction in under-five mortality of 8.0 deaths per 1,000 live births.
Together the four interventions are associated with a reduction of 52 deaths per 1,000 live births in the under-five mortality rate -- bringing that rate below the MDG level (46 deaths per 1,000 live births).
Thus, the simulation results suggest that it should be possible for Bangladesh to attain the child mortality-related Millennium Development Goal (MDG), but only with a package of interventions that includes strong economic growth, expansion of female schooling, family planning programmes that motivate women to delay child bearing, and expanded child immunisation coverage.
Child malnutrition rates in Bangladesh are very high -- among the highest in the world. Recent surveys indicate that nearly one-half of children below the age of five or six-years are moderately underweight or stunted and about 10-18 per cent of children are severely underweight or stunted. Thus, children in Bangladesh suffer from short-term, acute food deficits (as reflected in low weight-for-age) as well is from longer-term, chronic under-nutrition (as manifested in high rates of stunting).
(To be continued)
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