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This report finds that in developing countries over the past 15 years, high priority was accorded to increasing enrolments in primary schools, but much less attention was directed to the crucial issue of whether children are learning adequately. The report recommends that countries, the World Bank and development partners give the same emphasis to learning outcomes as to access, so that the world's increasing investments in primary education have a far greater impact on poverty reduction and national development. The World Bank is the largest provider of external financial support to education in developing world. Since 1963, it has transferred about US$36.5 billion for education, over $14 billion of which has been for primary education. Its current lending portfolio consists of about 143 operations in 88 countries amounting to US$8.4 billion. (DIPF/Orig.).

This thematic study discusses strategies for sustainable financing of secondary education in Sub-Saharan Africa. The report provides insight into options for financing the expansion of secondary education and training in Africa. This comes with a hefty price tag and points to the need to undertake fundamental reforms swiftly. This publication messages are clear: secondary education and training in Sub-Saharan Africa faces the challenge of improved efficiency and improved quality simultaneously with a fast growing demand. Sustainable financing will also require more effective public-private partnerships, because governments have many priorities and do not have a lot of room for significant additional public funding of post-primary systems. Educational reforms are needed to expand enrollment in secondary schooling in affordable ways. These reforms will contribute to poverty reduction by increasing the levels of knowledge, skills, and capability; diminishing inequalities in access that limit social mobility and skew income distribution; and contributing to the achievement of the Millennium Development Goals (MDGs) that relate to education.

Despite the Millennium Development Goals of the United Nations Millennium Project, having its third goal as promoting gender equality and empowering women, and even with all new progress in equality, Kenya is still lagging behind when comparing the educational opportunities of boys and girls. In most cases where cultural beliefs are involved, the girl- child falls victim to violation of her rights, including her rights to education and freedom of expression. Many girls are forced into early marriages, experience Female Genital Mutilation (FGM) and sexual exploitation, among many other concerns and at some point they all lead to her inability to achieve her education. The purpose of the study was geared towards exploring the socio- cultural and economic factors and activities that hinder girls from accessing education in Kenya and toward overcoming the obstacles. The research was conducted in Taita Taveta, Nairobi, Kwale and Samburu Counties in Kenya, in different areas within these counties. The study employed qualitative data collection and purposeful Sampling was used to select individuals and sites, involving 72 participants' i.e. students, teachers and principals, community leaders, Government officials and parents. Sampling occurred through a combination of two strategies including snowball and homogenous sampling methods from the various study locations. Focus group interviews, one-on-one interviews were conducted, and students filled out questionnaires. Data was then transcribed following the participants' responses. The findings indicate that socio-cultural and economic factors contributed to girls being out of school especially in Samburu and Maasai communities where cultural practices including FGM, early forced marriages, among many others were persistent. Another factor was poverty which participants mentioned affected their education because of high dropout rates to find jobs to sustain their needs. The majority of the participants desired more women's empowerment programs in and out of school.

Delivery of health services to people with hearing impairment is poorly understood in Nigeria and limited research has been done to throw more light on the process involved. This study described experiences of 167 girls with hearing impairment in accessing reproductive health services in Ibadan using a validated questionnaire. Descriptive statistics and binary logistic regression were used to analyze the data. Almost 95.0% of respondents had ever visited health facility for reproductive health issues. Of these 6.2% and 4.6% went for treatment of STIs and pregnancy termination respectively; 36.7% were embarrassed to ask questions in the presence of an interpreter, communication (40.5%) and cost (10.8%) were key barriers to access and 85.6% would use facility if hearing impairment-friendly services are provided. Respondents who were currently working were 20 times more likely to receive services they wanted (OR=20.29, CI=1.05-392.16). Availability of certified interpreters and ensuring confidentiality are key to effective service delivery for the hearing impaired. La prestation des services de santé aux personnes atteintes de déficience auditive est mal comprise au Nigéria et il n'y a pas eu assez de recherche faite pour jeter plus de lumière sur le processus impliqué. A l'aide d'un questionnaire validé, cette étude décrit les expériences de 167 filles atteintes de déficience auditive, face à l'accès aux services de santé de la reproduction, à Ibadan. Les statistiques descriptives et de régression logistique binaire ont été utilisées pour analyser les données. Près de 95,0% des interviewées avaient déjà visité un établissement de santé pour les questions de santé de la reproduction. Parmi elles, 6,2% et 4,6% sont allées pour le traitement des ISTs et l'interruption de grossesse, respectivement; 36,7% étaient gênées de poser des questions à la présence d'un interprète ; la communication (40,5%) et le coût (10,8%) étaient les principaux obstacles à l'accès et 85,6% se serviront des établissements de santé si les services adaptés à la déficience auditive sont assurés. Les interviewées qui travaillent actuellement étaient 20 fois plus susceptibles de recevoir des services qu'ils voulaient (OR = 20,29, IC = 1,05 à 392,16). La disponibilité des interprètes certifiés et l'assurance de la confidentialité sont essentielles à la prestation efficace des services pour les personnes atteintes de déficience auditive

Background Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. Methods Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. Results Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers’ identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. Conclusion Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.

Despite the substantial burden caused by childhood cancer globally, childhood cancer incidence obtained in a nationwide childhood cancer registry and the accessibility of relevant health services are still unknown in China. We comprehensively assessed the most up-to-date cancer incidence in Chinese children and adolescents, nationally, regionally, and in specific population subgroups, and also examined the association between cancer incidence and socioeconomic inequality in access to health services. In this national cross-sectional study, we used data from the National Center for Pediatric Cancer Surveillance, the nationwide Hospital Quality Monitoring System, and public databases to cover 31 provinces, autonomous regions, and municipalities in mainland China. We estimated the incidence of cancer among children (aged 0–14 years) and adolescents (aged 15–19 years) in China through stratified proportional estimation. We classified regions by socioeconomic status using the human development index (HDI). Incidence rates of 12 main groups, 47 subgroups, and 81 subtypes of cancer were reported and compared by sex, age, and socioeconomic status, according to the third edition of the International Classification of Childhood Cancer. We also quantified the geographical and population density of paediatric oncologists, pathology workforce, diagnoses and treatment institutions of paediatric cancer, and paediatric beds. We used the Gini coefficient to assess equality in access to these four health service indicators. We also calculated the proportions of cross-regional patients among new cases in our surveillance system. We estimated the incidence of cancer among children (aged 0–14 years) and adolescents (aged 15–19 years) in China from Jan 1, 2018, to Dec 31, 2020. An estimated 121 145 cancer cases were diagnosed among children and adolescents in China between 2018 and 2020, with world standard age-standardised incidence rates of 122·86 (95% CI 121·70–124·02) per million for children and 137·64 (136·08–139·20) per million for adolescents. Boys had a higher incidence rate of childhood cancer (133·18 for boys vs 111·21 for girls per million) but a lower incidence of adolescent cancer (133·92 for boys vs 141·79 for girls per million) than girls. Leukaemias (42·33 per million) were the most common cancer group in children, whereas malignant epithelial tumours and melanomas (30·39 per million) surpassed leukaemias (30·08 per million) in adolescents as the cancer with the highest incidence. The overall incidence rates ranged from 101·60 (100·67–102·51) per million in very low HDI regions to 138·21 (137·14–139·29) per million in high HDI regions, indicating a significant positive association between the incidence of childhood and adolescent cancer and regional socioeconomic status (p<0·0001). The incidence in girls showed larger variation (48·45% from the lowest to the highest) than boys (36·71% from lowest to highest) in different socioeconomic regions. The population and geographical densities of most health services also showed a significant positive correlation with HDI levels. In particular, the geographical density distribution (Gini coefficients of 0·32–0·47) had higher inequalities than population density distribution (Gini coefficients of 0·05–0·19). The overall proportion of cross-regional patients of childhood and adolescent cancer was 22·16%, and the highest proportion occurred in retinoblastoma (56·54%) and in low HDI regions (35·14%). Our study showed that the burden of cancer in children and adolescents in China is much higher than previously nationally reported from 2000 to 2015. The distribution of the accessibility of health services, as a social determinant of health, might have a notable role in the socioeconomic inequalities in cancer incidence among Chinese children and adolescents. With regards to achieving the Sustainable Development Goals, policy approaches should prioritise increasing the accessibility of health services for early diagnosis to improve outcomes and subsequently reduce disease burdens, as well as narrowing the socioeconomic inequalities of childhood and adolescent cancer. National Major Science and Technology Projects of China, National Natural Science Foundation of China, Chinese Academy of Engineering Consulting Research Project, Wu Jieping Medical Foundation, Beijing Municipal Administration of Hospitals Incubating Program.

Common mental disorders (CMDs) are prevalent among adolescent girls and young women (AGYW) in high HIV-burden settings. However, mental health is underprioritized within HIV interventions targeting AGYW. We conducted a qualitative study to explore AGYW and healthcare providers' perceptions of mental health service delivery within HIV clinics. Between 16th February and 14th June 2021, we conducted in-depth interviews with AGYW receiving HIV services and healthcare providers from eight clinics in Central Kenya. Eligible AGYW were aged 16-25 years and reported mild-to-moderate CMD symptoms, determined by the Self-Reporting Questionnaire 20-item (SRQ-20) mental health screening tool. Eligible providers currently provided HIV or mental health services. Interviews explored AGYW's experiences with CMDs and factors influencing mental health service delivery by providers within HIV clinics. We analyzed data deductively and inductively using thematic analysis and organized findings using the socio-ecological model. Median age among AGYW (n = 20) was 21 years (IQR:18-24), and SRQ-20 screening score was 9 (IQR: 8-11). Providers (n = 10) comprised seven females; and included six HIV and four mental healthcare providers. AGYW described experiences of CMDs due to multi-level risk factors, including HIV stigma, financial problems, and relationship challenges. AGYW reported a high demand for mental health services but described a systemic lack of access. Convenience and positive experiences with providers facilitated AGYW's access to services. Conversely, HIV care providers felt less confident in delivering mental health services due to inadequate mental health training compared to mental healthcare providers. Providers also reported inadequate training, poor referral systems, and unclear guidelines that hindered service delivery. AGYW and providers endorsed mental health service integration within HIV clinics to potentially reduce referral burden for AGYW and improve service quality. Our findings highlight gaps in mental health service delivery among AGYW receiving HIV services. Integrated service delivery within HIV clinics could improve AGYW's access to mental health services.

Background Vulnerable adolescents are exposed to sexual and reproductive health harms. Ignoring the sexual and reproductive health of this group can have irreparable consequences. The present qualitative study aimed to explore the barriers to the access of vulnerable adolescent girls to sexual and reproductive health. Methods In this study, sixteen 14-19-year-old adolescent girls and twenty-two key informants were selected using purposive sampling method. Through in-depth semi-structured interviews, they expressed their experiences of barriers to sexual and reproductive health in vulnerable adolescent girls. The data were encoded using the conventional qualitative content analysis. Results Based on the results of the study, neglecting the reproductive and sexual health of vulnerable adolescent girls at different levels leads to serious challenges and obstacles in providing and maintaining it. Lack of a responsible family, the repulsive behaviors of the family and following risky behaviors of peers led to ignoring the sexual and reproductive health of adolescent girls. Unanswered sexual questions, defective life skills, unwanted pregnancy during adolescence, lack of awareness of unsafe sex, violating cultural norms and wounded psyche in vulnerable adolescent girls threaten their sexual and reproductive health. Ineffectiveness of key organizations in providing sexual and reproductive health services alongside lack of legal, political and social support in this area indicate that the sexual and reproductive health of these girls is not a priority for the society. Conclusion Numerous personal, family, social, legal and political barriers challenge the sexual and reproductive health of vulnerable adolescent girls. Developing a comprehensive and practical program beside legal and political support for this issue can provide the basis for the sexual and reproductive health of this group of adolescents in societies.