The Added Value and Case for Investing in Health and Education across the Commonwealth

 

The Commonwealth Secretariat’s Health and Education Unit (HEU) works to enhance the positive impact of social development by building capacity for health and education policy across member countries. The HEU programme supports each element of the policy cycle through advocacy, assessment, development and implementation activities.

 

A low cost catalyst for Development, Democracy and Diversity

Adding global value – Key Deliverables for Health and Education in the Commonwealth

There are many partners working in the health and education field, who mainly deliver vertical programmes. The Commonwealth Secretariat builds upon these and acts as a low-cost, high value catalyst to enhance effectiveness of cross-sector governance systems that enable Democracy, Development and Diversity, through its unique position in:

Advocacy:

–       Ministerial meetings: The Commonwealth Health and Education Ministerial meetings and unique convening power, provides global advocacy and influence on the other international organisations, Heads of Government and Ministerial meetings in other sectors on key strategic levers that enhance the relevance of health and education for wider outcomes.

–       The Health Ministers meeting 2017 is on: Sustainable Financing of UHC as an Essential Component for Global Security Including the Reduction of All Forms of Violence’.

–       The Education Ministers Conference in 2018 will be on: Climate change and Sustainable Development.

–       Ministerial Action Plans – and implementation mechanisms have been developed to take forward tangible actions across the Commonwealth, including:

Governance:

Our health and education policy frameworks promote good governance and accountable, co-ordinated systems that are sustainably financed for long-term solutions that enable self-sufficiency and the efficient delivery of vertical programmes and services. Whilst the Commonwealth Curriculum outlines the core skills needed to promote good governance across all the SDGS.

Innovation policy hubs:

Our health and education policy hubs, expert meetings, networks, and think tanks, enable the sharing of good practice and innovative solutions to scale up practice and research into policy. The Commonwealth has advanced the following areas at global level: Cross-sector policy frameworks, Digital System strengthening, Non- Communicable Diseases, A code for Human resources for Health; the underachievement of Boys in Education, Technical and Vocational Education and Training, Quality education and teacher standards.

Scaling up Capacity:

–       Collaborative partnerships: our hubs enhance coherence and the strategic value of Commonwealth family and delivery partners, including civil society, and enable collaborative partnerships to mobilise resources and enhance country capacity to deliver health and education results.

–       Building a workforce for Sustainable Development: our commonwealth curriculum for delivering the SDGs and emphasis on promoting the health and well-being of populations enhance the relevance and productivity of the workforce to deliver the Sustainable Development Goals.

Governments have a multitude of priorities competing for scarce resources, however health and education hold an important place in this for two key reasons:

  • Health and Education act as drivers for sustainable development and growth: The unique contribution both can make to delivering sustainable and effective development and the consequent just, stable and equitable societies this produces.
  • Health and Education offer important returns on investment: with approximately a doubling of investment, through the establishment and maintenance of strong health and education systems. Conversely significant risks, both to the economy and security exist from inadequate health and education provision.

The Commonwealth provides unique access and convening power to forge common goals and work together as well as being independent and impartial to achieve consensus on policy positions and collaborative action for Health and Education across a third of the world’s population. For example, the Commonwealth is providing global advances in the development of quality standards in Education and minimum financing recommendations for health.

  • The Health and Education unit at the Commonwealth acts as a high value horizontal systems enabler, costing approximately £1.5 million annually for core funds
  • This acts to enhance self-sufficient governance mechanisms and efficient and effective delivery of multi-million pound investments in vertical programmes.
  • Recommended Irreducible Staffing levels per Team size= 5/ team ie approximately 10 staff for Health and Education (DFID).

Proposed core funding for Health and Education within the Commonwealth – addressing gaps and adding value in international policy for Health and Education:

  1. Advocacy: (Approximate core funding £900,000)
  • The Health Ministers meeting 2017: is on Sustainable Financing of UHC as an Essential Component for Global Security Including the Reduction of All Forms of Violence’.
  • The Education Ministers Conference in 2018: will be on Climate change and Sustainable Development.
  • Ministerial Action Plans –to deliver key recommendations from Ministerial meetings with countries and partners
  • Advocacy for Heads of Government – enhancing the relevance of Health and Education for wider Government and international partners
  1. Governance: (Approximate cost = £350)
  • Legal and policy frameworks and toolkits to strengthen governance in health and education systems as well as the role of education in teaching core skills for multi- sector governance.
  • Application of toolkits country capacity – working jointly with TAU experts in country – eg Sierra Leone, Mauritius; multi-country policy workshops for national education and health frameworks eg Africa, Caribbean
  • As mandated in the Strategic Plan outcomes: 3.1 and 3.2.
  1. Innovation Policy Hubs – Mobilising Resources: (Approximate cost=£250)
  • Health: Digital Health Systems for global security, sustainable Universal Health Coverage and sustainable development
  • Education: Knowledge Hub to ensure access to Education for all Commonwealth Citizens – eg via MOOCs and free education resources; resources for policy to scale up workforce development to deliver the SDGs
  • Mobilising Resources: by convening partners and establishing collaborative mechanisms eg the Commonwealth Colombo Declaration and Action Plan (and the establishment of the Colombo Institute for Digital Health); eg Commonwealth Accelerated Development Mechanism for Education and the Malaysian Tertiary Education Facility.
  • As mandated by the Strategic Plan:4

Health and Education as an asset to mobilise resources for the wider Commonwealth, with interest from many donor agencies and the private sector eg Venture Capital Funding for digital health was $4.2 billion, an increase by 125% from 2013.

Depending upon EBR resources: country capacity can be scaled up with delivery partners

 

The case for investing in health and education

Health

  • Analysis of data between 1970 and 2000 attributes about 12 per cent of economic growth in low- and middle-income countries to a reduction in the rates of adult mortality (Jamison 2005).
  • The Colombo declaration urged Commonwealth governments to aim for an evidence based (WHO 2010) minimum investment of 6% of GDP for health.
  • Investment should be prioritised toward the most cost effective approaches including public health and primary health care, sustainable, and best practice health systems” (CMA, 2016).

Education

  • The Nassau declaration reaffirmed a commitment to financing of education at 4-6% of GDP (or 15-20% of total public expenditure) (Nassau 2015).
  • Schooling has been shown to increase earnings later in life, with an average increase of 10% per each additional year of schooling (Montenegro and Patrinos, 2013; 2014).
  • At the country level, each additional year of schooling raises average annual GDP growth by 0.37 per cent (UNESCO, 2011).
  • If all students in low-income countries left school with basic reading skills, 171 million people across the globe could be lifted out of poverty; this equates to a 12% cut in global poverty (UNESCO, 2011).

Evidence of cost- effectiveness

Maintaining a healthy, well-educated and productive population with good social protection systems builds resilience, fuels economies (Jamison 2005) and contributes to preventing civil unrest and extremism.

Health 

Macroeconomic studies show positive correlations between reduction in mortality and economic growth. Data from 100 countries over a 20-year period showed increasing life expectancy raises worker productivity and GDP (Liu 2016). Around 12% of economic growth in low – and middle-income countries has been linked to reduced adult mortality (Jamison 2005).

 Health category Economic benefits from enhancing health outcomes
Pandemics preparedness The World Bank estimates benefits of a global pandemic preparedness system to be in excess of $37 billion per year with economic rates of return ranging from 50 to 123 per cent per annum (World Bank 2014). The risks of not acting are significant; disease outbreaks are often unpredictable and tend to have a negative effect on economies by reducing in-country productivity and leading to wider restrictions on travel and trade across borders. By 2015, the Ebola Virus Disease outbreak resulted in the loss of an estimated 12 per cent of the combined GDP in the worst affected countries. In 2016 alone, the Zika virus outbreak is projected to have led to a loss of US $3.5 billion and fiscal losses of up to US $420 million in the Latin American and Caribbean region (World Bank 2016).
Maternal,

Child Health and Vaccination

The Lancet Commission on investing in health estimates that every $1 directed towards preventing deaths through vaccination and reducing maternal and child mortality could produce up to a 20-fold return in investment.
HIV, Tuberculosis and Malaria Money spent on HIV vaccine development is expected to produce between 100 per cent to 6700 per cent returns (Hecht 2012), whilst investments in malaria control produce up to a 500 per cent return (Mills 2004). Significant loss of lives as well as worker productivity occur to this day, for example the average TB patient loses 3-4 months of work and 20-30 per cent of yearly household earnings due to the disease (Peter 2008).
Non-Communicable Diseases Between 2011 and 2025, the economic losses to low- and middle-income countries (LMICs) from four largely preventable non-communicable diseases are estimated to surpass US$7 trillion equivalent to an average of USD 500 billion per year and roughly 4 per cent of these countries’ GDPs.

Education

Education Category Economic benefits from enhancing education outcomes
Social
  • If all students in low income countries achieve basic reading skills by the time they finish school, there would be a 12% reduction in global poverty.
  • Educated citizens have better knowledge of health issues and diseases, identify symptoms of illness early and typically use health carer services and preventative measures more than those who are not educated.
  • Educating women results in lower under-5 mortality – if all women in low and lower middle income countries completed primary education, there would be a 15% decrease in the under-5 mortality rate, and a 49% decrease with completion of secondary education.
  • Girls’ school completion is a strong preventative measure of child marriage – if all girls in sub-Saharan Africa and South and West Asia completed primary school there would be a 14% reduction in the number of girls getting married by the age of 15, and 64% reduction with secondary school completion.
  • Education increases knowledge and understanding of politics and citizen participation in politics, support for democracy and likelihood of voting.
Economic
  • Those that are educated are more likely to establish their own business, and it is also more likely that these businesses are more profitable. In Uganda those who had completed primary education and own household enterprises earned 36% more than those without any education, with earnings for those who had completed lower secondary education 56% higher than those without any education.
  • Farmers with good literacy and numeracy skills have the ability to understand and respond to new information and better utilise new inputs and technologies to increase productivity and help them to expand to cultivating higher value crops. In Mozambique, literate farmers were 26% more likely to raise cash crops than non-literate farmers.
  • Increasing a country’s population’s average educational achievement by one year increases annual per capita GDP growth from 2% to 2.5%.
Environmental
  • Education has significant potential to address climate change by increasing awareness and concern through improving people’s understanding of the scientific and environmental issues related to climate change. Data shows that in 57 countries, students with higher sciences scores stated that they were more aware of complex environmental issues. It has also been shown that in 29 (mostly high income) countries, a quarter of those with less than secondary education conveyed concern for the environment, whilst 37% of those who had completed secondary education and 46% of those who had completed tertiary education, conveyed concern for the environment.
  • Education is valuable in supporting people with adapting to climate change. In Ethiopia, the completion of six years of education resulted in a 20% higher chance of a farmer adapting their practices to climate change.

(UNESCO. 2011. Education for All Global Monitoring Report)

 

Mandate and relevance for health and education in the Commonwealth

Sustainable Development Goals

Goal 3: Ensure healthy lives and promote well-being for all at all ages

Goal 4: Ensure inclusive and quality education for all and promote lifelong learning

Source: http://www.un.org/sustainabledevelopment/sustainable-development-goals/

Strategic Plan objectives

3.1 Strengthened national frameworks and policies improve health outcomes

3.2 Strengthened national policies and frameworks improve educational outcomes

3.4 Improved capacity-building for social development

Source: http://thecommonwealth.org/sites/default/files/page/documents/ComSec%20Strategic%20Plan%202013_2017.pdf

The Commonwealth Charter

Access to health, education, food and shelter: We recognise the necessity of access to affordable healthcare, education, clean drinking water, sanitation and housing for all citizens and emphasise the importance of promoting health and well-being in combating communicable and non-communicable diseases. We recognise the right of everyone to have access to safe, sufficient and nutritious food, consistent with the progressive realisation of the right to adequate food in the context of national food security.

Source:  http://thecommonwealth.org/our-charter

Commonwealth Heads of Government Meeting (CHOGM) 2015 Communique

On Public health (Paragraph 32):

Heads recognised the importance of tackling communicable and non-communicable diseases, including malaria. They underlined the importance of routine immunisation programmes. Heads reaffirmed their commitment towards making the complete eradication of polio a global priority. Heads called on the Commonwealth at large to support the strengthening of policies for universal health coverage in order to build strong and resilient health systems that will, in turn, enable better responses to public health threats and emergencies, as well as to address the increasing burden of communicable and non-communicable diseases. Heads also called for continued promotion of collaborative research into communicable and non-communicable diseases, as well as collective Commonwealth action to advocate for global health security and the reduction of all public health threats, including the global imperative of addressing antimicrobial resistance.

On Education

Paragraph 4: “Heads reaffirmed the relevance of Commonwealth solutions, including recommendations in the Commonwealth report, Civil Paths to Peace, on ways of addressing, through education and the media, the conditions conducive to grievance and alienation, with a particular focus on women and young people.”

Paragraph 30: “In that context, Heads gave special emphasis to the overarching importance of female education in their social uplift, and in their political and economic empowerment.”

Paragraph 31: “Heads also encouraged support for already married girls, adolescents and women who have been affected by such practices. Heads encouraged cooperation with regional and global efforts, and concerted action at the national level to develop and implement holistic, comprehensive and coordinated responses and strategies to address this issue, including those aimed at the eradication of poverty, and protecting girls’ and women’s right to education.”

Source: http://thecommonwealth.org/sites/default/files/news-items/documents/CHOGM%202015%20Communique.pdf

Ministerial Statements

Commonwealth Health Ministers Meeting 2016

Paragraph 4: We encourage the Commonwealth to continue to advocate using its platforms for the financing of Agenda 2030 for Sustainable Development with particular reference to those related to health. We recognise the need to acknowledge the graduation of many Commonwealth small states to middle income status, which affects their access to financing. Acknowledging the importance of prevention, promotion and protection, we note reference to the World Federation of Public Health Associations’ ‘Global Charter for the Public’s Health’.

Paragraph 16: We agree that ‘Sustainable Financing of UHC as an Essential Component for Global Security Including the Reduction of All Forms of Violence’ would be an appropriate theme for the 2017 Commonwealth Health Ministers Meeting.

Source: http://thecommonwealth.org/sites/default/files/events/documents/Ministerial%20Statement%20-%20Commonwealth%20Health%20Ministers%20Meeting%202016.pdf

Nassau Declaration from the 19th Conference of Commonwealth Education Ministers (CCEM)

19CCEM Theme/title: Education in the Commonwealth: Quality Education for Equitable Development: Performance, Paths and Productivity (3Ps)

Paragraph 2: “Education for Sustainable Development is recognized as a priority for future planning by Ministers, as well as the role of education at the heart of the process for driving the SDGs.”

Paragraph 5: “Likewise, the role of education for building resilience is championed by Ministers as a key factor in combating issues of vulnerability, particularly those faced by small states, such as climate change, migration, mobility, and financing.”

Paragraph 8: “Ministers commit to focus on the core purpose of education, to serve the needs of their diverse populations, furthering international drives for sustainable development, and equitable, high quality provision, while recognizing the continued role of education in supporting efforts for economic growth and poverty eradication, as well as acting as a tool for socialization.”

Paragraph 14: “Ministers recognize the potential of learners and youth to act as agents of social change and peacebuilding, and will continue to support policies and programmes in schools that actively engage pupils in building conflict resolution skills, tolerance, respect, and social inclusion, as a way of preventing school based violence and extremism. They support Commonwealth action, including in partnership with UNESCO, in keeping with the report on Civil Paths to Peace by the Commonwealth Commission on Respect and Understanding.”

Paragraph 16: “The role of the Commonwealth in continuing to support development of effective education initiatives is recognized by Ministers, as is the need for greater coordination of quality assurance in education by Commonwealth institutions, where requested by member states, as well as the potential for shared curricula and quality frameworks where this is something member states wish to explore.”

Source: http://thecommonwealth.org/sites/default/files/news-items/documents/2015-06-26_2300_Draft%20Communique%20FINAL%20(2)%20Ministerial%20Changes%20-%20FINAL%20CHANGES_with%20titles%20(1).pdf

The 20th Conference of Commonwealth Education Ministers will be on climate change and sustainable development – the conference title is “Sustainability and Resilience: Can education deliver?”

 

References

Commonwealth Medical Association, (2016). Colombo Declaration. Commonwealth Medical Conference, Sri Lanka. October 2016. Available at: https://www.thecommonwealth-healthhub.net/cmacolombod1

Hecht R, Jamison DT. Vaccine research and development assessment paper. In: Lomborg B, ed. Rethink HIV: smarter ways to invest in ending HIV in sub-Saharan Africa. New York: Cambridge University Press, 2012.

Jamison DT, Lau L, Wang J. Health’s contribution to economic growth in an environment of partially endogenous technical progress. In Lopez- Casasnovas G, Rivera B, Currais L (eds.). Health and economic growth: Findings and policy implications. Cambridge, MA: MIT, 2005

Liu G, Hackney C, Yao Y. Health and Wealth: The role of health in economic growth. Working paper, China Centre for Health Economics Research, Peking University, 2016

Mills A. Shillcutt S. The challenge of communicable disease. In Lomborg [eds.]. Global crises, global solutions. Cambridge, UK: Cambridge University Press, 2004.Montenegro, C. E., & Patrinos, H. A. (2013). Returns to Schooling around the World. Paper for the World Development Report 2013.

Montenegro, C. E., & Patrinos, H. A. (2014). Comparable estimates of returns to schooling around the world. World Bank Policy Research Working Paper 7020.

Ozawa, Mirelman A, Stack ML, Walker DG, Levine OS. Cost-effectiveness and economic benefits of vaccines in low-and middle-income countries: A systematic review. Vaccine. 2012

PAHO and WHO, 2014. ‘Strategy for Universal Access to Health and Universal Health Coverage: 66th session of the Regional Committee of WHO for the Americas. Pan American Health Organisation and WHO regional Office for the Americas; 2014. http://www.paho.org/uhexchange/index.php/en/uhexchange-documentsitechnical-information/26-strategv-for-uniyersal-access-to-health-and-universal-health-coyerage

Peter NF. Pricing infectious diseases; The economic and health implications of infectious diseases. Embo reports. 2008. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327542/pdfiembor2008110.0df

Thomas, Mark Roland; Smith, Gregory, Ferreira, Francisco H G.; Evans, David; Maliszewska, Maryla; Cruz, Marcia; Himelein, Kristen, Over, Mead. 2015. The economic impact of Ebola on sub-Saharan Africa : updated estimates for 2015. Washington, DC. World Bank Group.2015. Available at: http://documents.worldbank.orgicuratedien/541991468001792719/The-economic-impact-of-Ebola-on-sub-Saharan-Africa-updated-estimates-for-2015

Nassau Declaration, (2015). 19th Commonwealth Education Ministers Meeting. Nassau Bahamas. Accessible at http://tinyurl.com/h8b5joj

UN, 2001. Abuja Declaration on HIV/AIDS, Tuberculosis and other related infectious diseases. African Summit. 2001. Available at: http://www.un.org/ga/aids/pdf/abuja_declaration.pdf

UNESCO. (2011). Global Education Monitoring (GEM) Report, Education Counts, Toward the Millennium Development Goals, (2011) Paris: United Nations Education, Scientific and Cultural Organisation. Acessed December 9, 2016, at: http://unesdoc.unesco.org/images/0019/001902/190214e.pdf

UNESCO. (2014). Education For All Global Monitoring Report 2013/14: Teaching and Learning: Achieving Quality for All. Paris: UNESCO.

World Bank (2014). World Bank. Pandemic Risk and One Health. World Bank Group. Washington, DC. 2014. Available at: http://www.worldbank.org/en/topic/health/brief/pandemic-risk-one-health

World bank (2016). The short-term economic costs of Zika in Latin America and the Caribbean (LCR). World Bank Group. Washington, DC.2016. Available at: http://pubdocs.worldbank.org/en/410321455758564708/The-short-term-economic-costs-of-Zika-in-LCR-final-doc-autores-feb-18.pdf

World Health Organisation. From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases in Low- and Middle-Income Countries. World Health Organisation. 2011. Available at: http://apps.who.intimedicinedocsidocuments/s18804en/s18804en.pdf

World Health Organisation, 2010. The World health report: health systems financing: the path to universal health coverage. Geneva: WHO; 2010. Available from: http://www.who.int/whr/2010/en/