HCI COMPASS (A Living Document) © 2020 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. Disclaimer The HCI Compass is a living document that will be updated as we learn from its implementation. If you have any comment or feedback to strengthen the usefulness of the product, please contact the Human Capital Project team at humancapital@ worldbank.org. HCI COMPASS 2 HCI COMPASS INTRODUCTION Human capital is central to various benefits in the long run. As an index that aspects of the development process. captures the distance to the frontier, it First, it is an essential driver of labor can also help countries set an explicit productivity, which in turn drives goal that policymakers can hope to meet. economic growth. Second, human capital is key to ensuring growth is inclusive– However, as a tool for policymaking the (i.e. to ensure all parts of society can HCI is limited. Although it identifies the benefit from the fruits of growth). Third, broad areas in which a country is far from human capital is a key building block of its potential, the HCI does not inform social cohesion and trust in institutions. what to do to get there. And because Societies with high human capital and it moves only very slowly, it does not high equality of opportunity are more provide timely feedback to policymakers socially cohesive, more able to find on whether their policies are working. solutions to complex challenges, and The objective of the Human Capital ultimately more prosperous. Index Compass is to serve as a guidance note that addresses these limitations. The Human Capital Index (HCI) is a tool designed to measure how well a country is doing in terms of fulfilling its Human Capital potential. It converts core indicators on survival, schooling, and health into measures of future worker productivity. The HCI is a useful advocacy tool for policy makers in that it allows them to see spending in the social sectors as investments that reap HCI COMPASS 3 The Human Capital Index Compass has two objectives: First, it aims to help countries answer the question: “What do we need to do to improve our HCI and its sub components (child survival, adult survival, A stunting, years of schooling, test scores)?” It does so by providing a checklist of key policies, legal framework and aspects of service delivery that characterize countries with good human capital outcomes and/or are proven to be important to improving the key components of the HCI. Pinpointing the set of policies and interventions that drive human capital outcomes is complicated by the fact that the underlying production function and how the different factors interact to produce outcomes is not straight forward. As such, some of the policies and service delivery indicators identified in this note could be mere correlates rather than determinants of human capital formation. The relative importance of the indicators would also vary based on where a country currently stands. Second, it aims to help countries answer the linked questions: “How well are these policies working? And how do we know we are on track?” It does so by identifying intermediate outcome variables and benchmark variables B that will help policymakers assess progress on the ground towards a better HCI. We can think of these variables both as the intermediate results of the policies recommended under point A above, and as “leading indicators” of what will happen to the HCI over time. For this, these variables need to meet at least two core criteria: they must be analytically linked to the policies recommended above and they must be good predictors for eventual changes in the HCI. These variables may be quantitative or qualitative depending on what they are trying to measure. The HCI Compass does not intend to replace comprehensive diagnostics of constraints to human development in a country. That is something that is part of the regular dialogue on policy. What it seeks to do is to provide a checklist for policymakers to assess whether the key policies are in place; how mature and developed they are; whether they are being implemented properly on the ground; and whether they are yielding the expected intermediate results. It is, in essence, a guidance note rather than a diagnostic tool which aims to inform policy makers what data to collect and which indicators to consider in discussing policy options. THE HCI IS COMPOSED OF THREE COMPONENTS: SURVIVAL SCHOOL HEALTH PRODUCTIVITY Children who Contribution of Contribution of health of a future worker don’t survive quality-adjusted (average adult survival (relative to benchmark don’t grow up years of school rate and stunting) of complete education to become to productivity to productivity of and full health) future workers of future workers future workers) HCI COMPASS 4 HUMAN CAPITAL INDEX COMPASS STRUCTURE At its core, the guidance note assumes that households themselves produce human capital and are the ones making the decisions about investments in human capital. But these decisions are in turn the result of their interactions with the overall policy and legal environment (the broader enabling environment in which both households and service providers operate), and with service delivery providers. So, for example, households will invest in the education of their children if quality schooling services are available and affordable and/or if the household has the resources and means to send their children to school or to educate them at home. How much they invest will also depend on what the returns are to those investments. These decisions may also be affected by social norms and culture, as well as by geography and broader infrastructure beyond the service delivery systems themselves. The same is roughly true for investments in health. Governments cannot directly impact household decisions, but they do influence the broader enabling environment and they greatly influence and shape service delivery systems. Even in the absence of service delivery, governments can nudge households to invest in their children’s human capital. With this background in mind, the HCI Compass has three distinct components. The first two align with those areas that governments can influence. The intermediate outcomes are, in a way, leading indicators of what we expect to see in the HCI, which can be thought of the final outcome of this chain. 1. ENABLING 2. QUALITY OF 3. INTERMEDIATE HUMAN ENVIRONMENT SERVICE DELIVERY OUTCOMES CAPITAL INDEX This component This component focuses This component presents presents policies and on the quality of service outcomes which directly laws, financing delivery, which reflects or indirectly affect the arrangements, and the implementation human capital index, government capacity of these policies, and which map more or that shape the enabling financing arrangements less to the policies and environment. and capacity. interventions outlined in the first two components. Policymakers in a country would use the HCI Compass as a guide, adapting it to their particular needs and challenges. For example, a country that is lagging in stunting but doing well on test scores would naturally focus more on the policies that pertain to improving stunting outcomes. The guidance note can (and should) be tailored and adapted to country needs, circumstance and data availability. It is a self-assessment, carried out by countries’ own policymakers with or without technical support from the World Bank or other development partners, depending on what a country wants or needs. To capture equity, indicators need to be disaggregated along social, economic, demographic, or geographic lines, depending on the aspect of equity that is most pressing in the country. HCI COMPASS 5 1. ENABLING ENVIRONMENT 1.1 Policies and Legal Framework Nurturing human capital requires a outcomes and cognitive skills are partly conducive policy environment as the latter determined by what happens at the earliest affects household decisions and the quality stage of development, parental knowledge of service delivery- two critical determinants and awareness about optimal child of human capital outcomes. Households development practices are critical. In this represent the key driver of demand, while vein, the maturity of policies to prevent early providers shape supply. The behavior of both pregnancy, promote healthy pregnancy, households and providers are influenced by ensure safety and promote Early Child policies, systems and legislation. Development (ECD) and nutrition services are crucial; mothers that start child bearing While not all demand side factors can later in life are more likely to be educated, be directly affected by actions taken by have fewer children and invest better in their governments, certain legal and policy children. Policies and legal frameworks also measures may create the space for affect the longevity and quality of life of the improving utilization of services. Poor and productive workforce through, for example, vulnerable households often struggle to tax and non-tax policies that discourage the make rewarding investments in their children consumption of unhealthy products which because they are financially constrained are known to contribute to chronic diseases and find the alternative use of their kids’ and premature death (including road traffic time (child labor) appealing in the short run. accidents). As these price considerations are critical determinants of utilization of services, it is Even when the demand for services is important that policies are in place to remove revealed, poor service delivery affects user fees for basic education and essential human capital outcomes. This is partly why healthcare. Even when these services are we have the learning crisis. Although huge available for free, their utilization by the progress is made in terms of bringing kids to chronically poor cannot be guaranteed due school, the low quality of schooling leaves to related expenses and the opportunity children without the foundational skills costs involved. The chronically poor may they need to be productive. The quality of also have sub-optimal investments on their services people receive in both schools and nutrition and other aspects that determine health facilities is a function of the quality human capital outcomes. The quality of of providers, availability of infrastructure policies to identify and target the poor and and other inputs. The maturity of policies the governments’ readiness to protect the that set these standards and the monitoring vulnerable from the ill-effects of disasters mechanisms to ensure them will determine are key in this regard. the rate at which resources will be converted into human capital outcomes. In addition to these measures that relax financial constraints to human capital Table 1.1 provides a list of guiding questions investments, legal measures can be taken to assess de jure policies and legal to alter parental preferences through framework. De facto policy implementation compulsory basic education, forbidding will be assessed through the guiding child labor and creating a conducive questions in the quality of service delivery environment to facilitate learning (educating and intermediate outcomes sections. kids in their mother tongue). As health HCI COMPASS 6 TABLE 1.1. POLICIES AND LEGAL FRAMEWORK GUIDING QUESTIONS TO ASSESS WHAT NEEDS SCALE OF REMARK TO BE IN PLACE RESPONSE P1. How adequate is the country’s policy and legal framework to ensure equitable human capital development? • Has the country established a framework for quality educationand Scale to learning for all? be defined. • Has it established Universal Health Coverage? • Has it put in place a core national system of social protection to protect households from extreme poverty and shocks? P2. Have user fees been removed for essential health care (childbirth, Scale to be immunizations, nutrition services, emergencies, family planning) and defined. basic education? P3. How mature are the policies or strategies that establish early Scale to be Refer to System Approach for childhood development as a priority? defined. Better Education Results (SABER). P4. How adequate are policies/programs for prevention of early pregnancy? Scale to • Does the legal framework establish access to family planning be defined. (including for adolescents)? • What is the legal age of marriage (<18 or >=18)? In the education sector, this refers to safety from physical, sexual and P5. How adequate are policies/programs to guarantee safety in the Scale to psychological abuse and in health it provision of education and health services? be defined. also refers to safety from infections. Refer to Global Program for Safer Schools and WHO’s Guide to Patient Safety Policy. P6. How developed is the country’s foundational identity system – civil register, population register, and/or national ID system? • Is there a clear legal framework? Scale to Refer to Guidelines for ID4D • Are registration and documentation free? • Are the systems accessible in terms of – time, distance, be defined. Diagnostics. procedures? • Is privacy protected and technology robust? • Are the systems interoperable with other systems or programs? This will include a judgment as to whether or not standards for P7. How mature are policies to establish quality of standards for inputs disability-friendliness of facilities and infrastructure and monitoring mechanisms in………………..? exist. The monitoring mechanisms Scale to be should consider presence of a) education sector defined. pre-service (upon graduation) and periodic assessment of providers’ b) health sector competency (not only knowledge). Refer to Global Education Policy Dashboard (GEPD) and adapt it for the health sector. P8. How mature are the policies to attract, select, support, evaluate, and monitor……….? a) teachers Scale to be Refer to GEPD and adapt it to defined. healthcare worker. b) healthcare workers P9. How mature are the policies that stipulate and allocate key Scale to be management functions as well as policies to attract, select, support, defined. Refer to GEPD. and evaluate principals (school management)? HCI COMPASS 7 TABLE 1.1. POLICIES AND LEGAL FRAMEWORK (CONTINUATION) GUIDING QUESTIONS TO ASSESS WHAT NEEDS SCALE OF REMARK TO BE IN PLACE RESPONSE P10. Is the legal framework conducive to school attendance, completion and learning? a) Does the legal framework establish compulsory schooling through lower secondary level? Scale to be defined. b) Does the legal framework forbid child labor? c) Is the language of instruction in the early grades different from native tongue? P11. How developed is the country’s system to identify the poor and vulnerable to direct programs and benefits? • Is there one or multiple social registry(ies)? Refer to Social Registries for • What is the legal, regulatory and policy framework? Scale to Social Assistance and Beyond: a • Are the intake or registration processes accessible? be defined. Guidance Note and Assessment • What is the periodicity of registration? Tool. • Is it interoperable with the ID system and social programs? • Are there established management standards, guidelines and processes for operating the Social Registry? P12. Is the national disaster risk management framework adequate to protect human capital? • Does the legal framework for disaster risk management include shock- Refer to framework presentation responsive safety net programs? Scale to and in-depth presentations on • Does it include a plan to ensure social infrastructure is resilient or be defined. various elements here and here. included in reconstruction plans? • Does it have an early warning system to trigger social responses? • Does the country have a financing plan in place to fund emergencies? • Are there strong coordination mechanisms in place? P13. How adequate are policies to address malnutrition? • Are nutrition services (preventive and treatment) included in UHC minimum package of services? Scale to • Are nutrition services linked to demand side interventions such as be defined. conditional cash transfers and behavioral change interventions? • Is there code for marketing of breast-milk substitutes? • Is there legislation on Universal Salt Iodization? P14. How mature are policies to adequately discourage the consumption of goods such as tobacco, alcohol and sugary beverages through fiscal policy and non-price instruments? • Is there complete ban on advertisement and promotion of tobacco products (direct and indirect) Scale to • Is there complete ban on smoking in all public spaces? be defined. • is excise tax on cigarettes more than 70% of the retail price of the most popular brand? • Does the country have excise tax on sugar sweetened beverages? • What is the legal alcohol drinking age? • Are there restrictions to alcohol advertisement and promotion? P15. How mature are policies to promote road safety? • Do they allow for the management and monitoring of road safety performance based on a safe system through a dedicated agency which is responsible for road safety for the country? • Do they manage speeds down to safe system levels which provide appropriate to the road users present (30km/h where vulnerable road users – especially pedestrians and bicyclists are present; 50km/h where side impact crashes are possible, etc.)? • Do they ensure that vehicles sold meet minimum standards for safety Scale to be (as set by UN conventions) and keep up to date on maximizing the defined. introduction of new safety technologies? • Do they require safety of road design to the highest standard in the construction, expansion, and maintenance of roads? • Do they deliver strong general deterrence of risky road user behaviors through well publicized, uncorrupted effective enforcement with unavoidable penalties which effectively deter? • Do they deliver effective rapid post-crash care with well-resourced facilities and well-trained medical staff, available to all regardless of financial means to pay? P16. How adequate are policies to promote women’s labor force participation? a) Is there mobility restriction for women? Scale to Refer to Women, Business and be defined. the Law. b) What is the country’s score in the Women, Business and the Law Index?” TEXT COLOR KEY Education Sector Indicators Health, Nutrition and Cross Sectoral Indicators Social Protection and Jobs indicators Population Indicators HCI COMPASS 8 1.2 FINANCING Public investment in the social sectors is critical care, basic education and social assistance. The to improve human capital outcomes. Health and relative budget allocated to this level of care is, education systems that mainly rely on out-of- hence, an important consideration in creating a pocket payments are likely to leave some section conducive enabling environment. of the society behind. Since these sectors are grossly underfunded in most low-income and Table 1.2 presents a list of guiding indicators related lower middle-income countries, policy measures to financing and public financial management. that aim at increasing the per capita spending It is crucial to note that more spending is not on health, education and social protection or necessarily the solution nor is there a magic level their prioritization in the government budget are of spending countries should aspire to. Progress essential. Equally important as the volume of in these dimensions should be monitored in spending is a country’s budgeting process- its light of a country’s context (coverage of critical reliability, predictability and execution- issues at interventions, room for efficiency gains, etc). the center of Public Expenditure and Financial Disaggregating these indicators at sub-national Accountability assessment (PEFA). Human capital levels and looking at benefit incidence across outcomes also depend on allocative decisions socio-economic groups is also critical (please within a sector budget. Many of the most-cost refer to BOOST Public Expenditure Database effective interventions that augment human for disaggregated expenditure data) capital development happen at primary levels of TABLE 1.2 FINANCING GUIDING QUESTIONS TO ASSESS SCALE OF REMARK WHAT NEEDS TO BE IN PLACE RESPONSE F1. Per capita health expenditure (public, private and Continuous total). measure. F2. Share of government health expenditure spent on Continuous primary health care. measure. F3. Nutrition spending as percentage of health Continuous Where available, expenditure. measure nutrition expenditure includes nutrition sensitive expenditures outside the health sector. F4. Government expenditure per student in pre-primary Continuous This can also be per FINANCING education as a percentage of GDP per capita. measure. child spending, where the denominator F5. Government expenditure per student in primary is the age specific education as a percentage of GDP per capita. population size corresponding to preprimary and primary level. F6. What is the status of the country’s public financial Scale A to D. management (using PEFA assessment). F7. Spending on social assistance as % of GDP. Continuous measure. F8. Spending on social insurance as % of GDP. Continuous measure. F9. Spending on labor market interventions as % of GDP. Continuous measure. TEXT COLOR KEY Cross Sectoral Indicators Education Sector Indicators Social Protection and Jobs Indicators Health, Nutrition and Population Indicators HCI COMPASS 9 1.3 GOVERNMENT CAPACITY TO MANAGE The weak-link between social sector spending and service delivery will be; the closer to a purely outcomes that we often see in low income settings meritocratic system a country is the higher the is a product of poor planning and management value for money. The partiality-impartiality of across the state machinery. Government capacity decision making will determine bureaucrats’ to manage, adopt a meritocratic system and capacity and motivation to deliver results. A inculcate accountability is critical to convert government system that clearly defines mandates resources allocated to social sectors into human and shows transparency in accountability and capital outcomes. High performing public systems instills mechanisms to enforce quality standards rely on data and evidence to adjust service delivery, has a better chance of converting resources into inform policy and operational decisions such better outcomes. as those that relate to procurement, personnel management, targeting etc. Where a country lies Table 1.3 presents a list of guiding questions to in continuum of a politicized-meritocratic system monitor government’s capacity to manage and would determine how effective and efficient achieve value for money. TABLE 1.3. GOVERNMENT CAPACITY TO MANAGE GUIDING QUESTIONS TO ASSESS SCALE OF REMARK WHAT NEEDS TO BE IN PLACE RESPONSE G1. Is core decision-making impartial, as measured by extent of a) politicized personnel management, b) politicized Scale to be Refer to GEPD. policy-making, c) politicized procurement and d) politicized defined. GOVERNMENT CAPACITY TO MANAGE identification or targeting processes. G2. What is the quality of bureaucracy, as measured by Refer to a) knowledge and skills, Scale to be GEPD and b) work environment, defined. Bureaucracy c) merit, and Lab. d) motivation? G3. To what extent does the system (health, education, social Scale to protection, other) collect and utilize data for planning and be defined. service delivery? G4. Is there monitoring and enforcement of quality standards in Scale to education and health sectors? be defined. G5. Is there clarity, coherence and transparency of Scale to accountability & mandates? be defined. TEXT COLOR KEY Cross Sectoral Indicators Education Sector Indicators Social Protection and Jobs Indicators Health, Nutrition and Population Indicators HCI COMPASS 10 2. QUALITY OF SERVICE DELIVERY Quality of service delivery is a critical driver of human capital outcomes as the latter is partly determined by different forms of services utilized. Service delivery is where the policies, legal frameworks, financing arrangements and overall government capacity manifest their effectiveness. This can be assessed in the following three ways: AVAILABILITY OF COMPETENCE SERVICE PROVIDER PROTOCOLS, INPUTS OF SERVICE PRACTICE AND AND INFRASTRUCTURE PROVIDERS ADHERENCE TO PROTOCOLS These are ingredients that Across both the education and Various studies have shown service providers have to work health sector, competence of that competence alone may with. In the education sector, service providers is a critical not guarantee quality service this refers to the percentage of constraint. In the education delivery as motivation, provider schools with electricity, drinking sector, content knowledge and effort and practice matter (this is water, functioning toilets, pedagogical skills of teachers what is often referred to as the blackboard, chalk etc. The health determine student learning. know-do gap). Provider effort can sector is a little more complicated The effectiveness of the be measured by the presence as input requirements vary teacher-student interaction is or absence rate of providers, across disease burden and life a function of the competence especially those of teachers. For cycle of patients. In much of low- of school principals. The same various reasons, health providers income and lower middle-income applies to the health sector, in most low-income settings are countries, a large part of the especially for conditions where either unable or not motivated disease burden is communicable provider training is thin. As enough to practice what is stated diseases. It is important to make the relative importance of in condition specific protocols. sure that the sector is equipped non-communicable diseases From the perspective of human to diagnose, treat and manage among adults increases, the capital outcomes (under five these diseases. In addition to the competence of primary care mortality), critical areas to monitor volume of health professionals providers to provide drug therapy include the extent to which all and presence of condition and counseling to individuals dimensions of essential newborn specific protocols that are who have had a heart attack/ care and integrated management relevant for different age groups stroke determines human capital of childhood illnesses are and diseases, inputs for quality outcomes (such as adult survival practiced. From the perspective childbirth experience are critical rate and productivity of work of social protection schemes, in most low-income countries force). For the provision of social quality of service delivery can where a significant share of protection benefits and services, be measured by the utilization under 5 mortality happens in the the quality of service providers of social registry for social first 28 days. is also essential to ensure they assistance programs, the rates of reach the poor and vulnerable inclusion and exclusion in safety with relevant messages and net programs and the regularity of benefits. support, and the extent to which programs effectively implement accompanying measures such as information, counseling, and training activities. HCI COMPASS 11 TABLE 2.1 QUALITY OF SERVICE DELIVERY Table 2.1 presents indicators to measure the adequacy of these inputs and infrastructure and monitor the competence and practice/adherence of providers. GUIDING QUESTIONS TO ASSESS WHAT NEEDS SCALE OF REMARK TO BE IN PLACE RESPONSE Q1. Number of active skilled health professionals (doctors, midwives, nurses) who Continuous Refer to Global Health Observatory (Inputs). are actively providing clinical care per 10,000 population. measure. Q2. Proportion of facilities which had stock-outs of essential medicines in Continuous Refer to Service Delivery Indicators (SDI) a specified period. measure. (Inputs). Q3. How endowed are childbirth facilities with inputs necessary to provide high quality childbirth care, including emergencies (this includes Scale to be defined. (Inputs). competent personnel)? Pick a couple of conditions that are most Q4. How widely are condition specific protocols for management of patients Continuous relevant for a country. Refer to Service in place? measure. Availability and Readiness Assessment (SARA). Q5. Is the health sector equipped for adequate diagnosis, treatment and management of communicable conditions such as Tuberculosis, Malaria Scale to be defined. This is a proxy for quality of care for communicable diseases. (Inputs). and HIV/AIDS? Q6. Can the health system diagnose, triage and treat malnutrition? Scale to be defined. (Inputs). Q7. Percentage of primary care providers competent to provide drug therapy and Continuous This is a proxy for quality of NCD care for counseling to individuals who have had a heart attack or stroke and to high risk measure. adults (Competence). individuals (using vignettes). Q8. Proportion of newborns who received all four elements of essential care: i) The focus on newborns is justified immediate and thorough drying ii) immediate skin-to-skin contact, iii) delayed cord Continuous because most U5M happens in the first 28 clamping, iv) initiation of breastfeeding in the first hour. measure. days. (Practice/adherence). Q9. How widely is integrated management of childhood illness practiced? Scale to be defined. (Practice/adherence). Please refer to Primary Health Q10. PHCPI quality index. Continous Care Performance Initiative (PHCPI) measure. (comprehensive measure). Q11. UHC Service Coverage Index. Scale to be defined. Refer to Tracking UHC. Q12. Quality of inputs, measured by percentage of schools with (a) functioning blackboard and chalk, (b) pens, pencils, textbooks, and exercise books in Refer to GEPD or SDI (Inputs). Scale to be defined. 4th grade classrooms, (c) basic classroom furniture (tables/desks and chairs), and (d) information technologies. Q13. Quality of infrastructure as measured by percentage of schools with (i) drinking water, (ii) functioning toilets (separate for girls), (iii) classroom visibility, Scale to be defined. Refer to GEPD and SDI (Infrastructure). (iv) electricity, (v) and accessibility for people with disabilities. Q14. Quality of teaching as measured by percent of teachers with at least Refer to GEPD and SDI (competence + minimum content knowledge, b) percent of teachers with a given level of Scale to be defined. practice/adherence). pedagogical skills, c) presence/absence rate [grade-specific as relevant]. Q15. Quality of school management as measured by a) percent of schools where instructional leadership is present, b) percent of principals with a good Scale to be defined. Refer to GEPD (competence). understanding of their schools, c) percent of principals with a good command of management practices, d) percent of schools with operational functions covered. Q16. Quality of the social registry (as measured by the extent to which the Refer to Social Registries for Social data is up-to-date, the number of programs using the registry to identify their Continuous measure. Assistance and Beyond: a Guidance Note beneficiaries, and/or the share of social assistance budget directed through it, and Assessment Tool. etc.). Q17. Quality of targeting of safety net programs (measured by rates of inclusion or Continuous exclusion, by program type). measure. Q18. Quality of content of safety net programs (measured by share of programs Continuous which provide information services or incentives for increased investments in measure. human capital, or share of beneficiaries from these programs). Q19. Quality of services provided by safety nets (measured by the share of Continuous program staff who are qualified social workers). measure. Q20. Quality of safety net transfers, measured by the adequacy of benefits, the regularity of payments, and the share of payments made through financially- Scale to be defined. inclusive accounts or electronic means. *PHCPI quality index is a composite measure of quality based on comprehensiveness of services provided, continuity, person-centeredness, provider availability, provider competence and safety. This index can be used where data exist. HCI COMPASS 12 3. INTERMEDIATE OUTCOMES One of the objectives of the HCI a complex production function makes it Compass is to help countries gauge if necessary to improve along a wide range they are on the right track to improve of intermediate outcomes simultaneously. their human capital outcomes. Putting While a one-to-one positive association in place the critical policies, laws, public between these indicators and the HCI may financing, transparency and accountability not necessarily exist, improvements along mechanisms is meant to influence service these dimensions altogether would bring delivery quality and its use by households. about improvements in the index. It is only if the enabling environment and its impact on service delivery translate to The set of intermediate indicators chosen some household/individual level outcomes, here either directly affect the index would we find improvement in human components (e.g enrollment rates), or capital outcomes. The pressing question, are indirectly related to the components from the perspective of enabling course of the index (e.g. the relevance of early correction within a government’s political pregnancy and early marriage to infant cycle, is “which types of intermediate mortality, the association of fertility rates outcomes to track on a frequent basis”. with per capita human capital investment, the link between maternal and child health These indicators need to be leading services with infant mortality and stunting, indicators to the HCI, analytically linked the link between road traffic accidents and to the policies and amenable to change hypertension with adult survival, etc.). with some government action. While most of the indicators presented below Table 3.1 presents a list of intermediate fulfill the criteria of being relatively more indicators and indicates how these amenable to change with some action indicators roughly map to the list of (compared to the HCI), some do not. The enabling environment and service delivery latter are chosen with the objective of level indicators presented above. providing governments with a broader set of indicators to account for the complexity of the human capital production function. The fact that human capital outcomes have HCI COMPASS 13 TABLE 3.1. INTERMEDIATE OUTCOMES ENABLING SERVICE DELIVERY ENVIRONMENT LEVEL INDICATORS INTERMEDIATE OUTCOMES (AT HOUSEHOLD OR INDIVIDUAL LEVEL) LEVEL INDICATORS* (MPLEMENTATION)** P1-3 Q1-8, Q10-15 1. PHCPI access index (summary index of perceived financial and geographic barriers to access) (Refer to PHCPI). 2. Proportion of women of reproductive age (15-49) who have their need for family planning satisfied with modern methods. (Refer to Demographic and Health Survey (DHS), Multiple Indicator Cluster Survey (MICS) or World Development Indicators (WDI)). 3. Percentage of pregnant women receiving all guideline-recommended actions during antenatal care visits (including iron-folic acid supplementation, immunizations, STI screening and advice on breastfeeding, complementary feeding and weight gain during pregnancy)). 4a. Proportion of births attended by skilled personnel (Refer to DHS) 4b. Proportion of women receiving oxytocin within 1 min of birth of infant (denominator includes out-of-facility births). 5. Share of target population covered with all vaccines included in national program (Refer to DHS or MICS). 6. Proportion of children under 5 receiving appropriate Vitamin A supplementation (Refer to DHS or MICS). 7. Percentage of women who receive appropriate routine cervical cancer screening 8. Prevalence of normal blood pressure, regardless of treatment status. (Refer to the World Health Organization’s STEPS Instrument). 9. Enrollment rate at pre-primary level (Refer to UNESCO Institute for Statistics (UIS)). 10. Enrollment rate at primary level (Refer to UNESCO Institute for Statistics (UIS)). 11. Drop-out rates at end of primary (Refer to UNESCO Institute for Statistics (UIS)). 12. Enrollment rate at secondary level (Refer to UNESCO Institute for Statistics (UIS)). 13. Foundational skills for children upon entering schools (Refer to GEPD). P4-5, 7-9 Q12-15 14. Prevalence of early marriage (Refer to DHS). 15. Prevalence of early pregnancy (Refer to DHS). 16. Prevalence of violence (GBV, including violence by teenagers) (Refer to WDI). 17. Perceptions/awareness of parents and children on value of education. 18. Percentage of children reading by age 10 (Refer to Learning Poverty). 19. Drop-out rates at end of secondary (Refer to UNESCO Institute for Statistics (UIS)). 20. Percentage of children with disabilities currently excluded from the schooling system (Refer to available census data). P10 Q12-15 21. Percentage of children not attending school (Refer to UNESCO Institute for Statistics (UIS)). 22. Incidence of child labor (Refer to UNICEF Data Warehouse). 23. Learning gaps between majority and minority/indigenous children and between the bottom and top quintile l (Refer to UNESCO Institute for Statistics (UIS)). P11-12, F7-8 Q16-20 24. Coverage of the social registry, as measured by the share of the country’s population covered, share of the bottom quintile covered, or share of the poor registered. (Refer to Social Registries for Social Assistance and Beyond: a Guidance Note and Assessment Tool). 25. Coverage of safety net programs, measured as share of population which benefits (or number of beneficiaries) and share of poor households (or households in the bottom quintile or bottom 2 quintiles) who are beneficiaries of programs). 26. Poverty impact of social safety nets, measured by the difference in pre- and post- transfer poverty incidence, poverty gap, and consumption of the poor. 27. Coverage of labor market programs, measured by the number of beneficiaries of programs that foster the labor force participation or earnings of women and/or youth. 28. Coverage of shock-responsive social protection programs measured by the share of shock-affected poor and vulnerable households supported by programs during the most recent large-scale covariant shock TEXT COLOR KEY Cross Sectoral Indicators Education Sector Indicators Social Protection and Jobs indicators Health, Nutrition and Population Indicators *Corresponds to “Enabling Environment” indicators in Table 1.1, 1.2 and 1.3. (P=policies; F=financing; G=government capacity) **Corresponds to “Service Delivery” level indicators in Table 2.1. (Q=quality of services) HCI COMPASS 14 TABLE 3.1. INTERMEDIATE OUTCOMES: (CONTINUATION) ENABLING SERVICE DELIVERY ENVIRONMENT LEVEL INDICATORS INTERMEDIATE OUTCOMES (AT HOUSEHOLD OR INDIVIDUAL LEVEL) LEVEL INDICATORS* (IMPLEMENTATION)** P3-4, P13 Q9 29. Proportion of infants 0–5 months of age who are fed exclusively with breast milk (Refer to DHS) 30. Proportion of children 6–24 months of age who are fed breast milk (Refer to DHS) 31. “Proportion of children 6-24 months with Minimum Acceptable Diet. (Refer to DHS)” P6, P15 Q16 32. Percentage of adults with a national ID number (or percentage of adults with an ID card). (Refer to ID4D) 33. Percentage of children under age 5 whose births are registered (Refer to UNICEF data) 34. Number of road traffic deaths per year (Refer to Global Health Observatory) F1-2 35. Percentage of households at risk of catastrophic and impoverishing health expenditures (different thresholds) (Refer to Health Equity and Financial Protection Indicators (HEFPI)) 36. Out of pocket health expenditures as a percentage of total health expenditure (Refer to Health Equity and Financial Protection Indicators (HEFPI)) F8 37a. Female labor force participation (%) 37b. Youth employment (%) (age 15-29) (Refer to International Labor Organization Statistics (ILOSTAT))” TEXT COLOR KEY Cross Sectoral Indicators Education Sector Indicators Social Protection and Jobs indicators Health, Nutrition and Population Indicators *Corresponds to “Enabling Environment” indicators in Table 1.1, 1.2 and 1.3. (P=policies; F=financing; G=government capacity) **Corresponds to “Service Delivery” level indicators in Table 2.1. (Q=quality of services) HCI COMPASS 15 The Human Capital Project is a global effort to accelerate the quantity and quality of investments in people to promote sustained and shared economic growth. The project aims to create the political space for national leaders to prioritize transformational investments in health, education and social protection. The objective is rapid progress toward a world in which all children are well nourished and ready to learn, can attain real learning in the classroom, and can enter the job market as healthy, skilled, and productive adults. The HCI Compass is a product of the Human Capital Project prepared in close collaboration with the Education Global Practice, the Health, Nutrition and Population Global Practice, and the Social Protection and Jobs Global Practice of the World Bank. www.worldbank.org/humancapital