Conclusions
It is evident that no single policy solution can improve teaching quality. Poor
education is more likely to occur in low-income and rural areas or when
parents have low levels of education, implying a risk of a vicious circle of
poverty and poor education. Central control over appointments and job secu-
rity led to absenteeism in various developing countries. Teacher attendance can
be significantly increased by close monitoring and financial incentives but this
will be difficult to implement when service providers are politically influen-
tial. More central spending on primary education led to declining quality in
Tanzania and decentralized funds in Uganda went missing without proper
local information and accountability. Three institutional features form a coher-
ent reform programme for education: competition introduced by private-sector
participation; decentralization of responsibilities to give schools autonomy in
making decisions related to teaching methods and hiring/firing of staff; and
features such as regular centralized exams that provide information on student
progress, increasing transparency and making schools and teachers ultimately
accountable to citizens and administrators. But these are not isolated policies
that can be introduced separately. Local autonomy without strong accountabil-
ity may be worse than doing nothing if politically influential teachers then
abandon their classrooms. Accountability without choice will put little pres-
sure on schools to improve. Choice cannot be exercised effectively without
good information about school performance (Hanushek and Woessmann,
2009).
Health and economic growth
There are very significant problems with measuring health status but evidence
does show that health is linked to economic growth. There are no clearly
agreed priorities to improve health outcomes.
Measuring health
Measuring health presents even greater difficulties than measuring educational
attainment. Comprehensive clinical evaluations of health are generally too
expensive for developing countries to include in large-scale surveys so small
samples tend to be used. In the household surveys that have generally been
used, respondents are usually asked to rate health on a scale from excellent to
poor, which cannot account for the complexity and diversity of individual
health status. ‘Good’ health may not mean the same thing to all people and self-
ev aluations reflect perceptions of health which are likely to be influenced by
the extent of current and prior use of healthcare. Those individuals who have
little prior experience with the healthcare system (the poorest) usually report
themselves as being in good health.
Education and Health 131