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Since the early 1990s, countries in the Middle East and North Africa (MENA) Region have made admirable progress in reducing the gap between girls and boys in areas such as access to education and health care. Indeed, almost all young girls in the Region attend school, and more women than men are enrolled in university. Over the past two decades, maternal mortality declined 60 percent, the largest decrease in the world. Women in MENA are more educated than ever before. It is not only in the protest squares that have seen women whose aspirations are changing rapidly but increasingly unmet. The worldwide average for the participation of women in the workforce is approximately 50 percent. In MENA, their participation is half that at 25 percent. Facing popular pressure to be more open and inclusive, some governments in the region are considering and implementing electoral and constitutional reforms to deepen democracy. These reforms present an opportunity to enhance economic, social, and political inclusion for all, including women, who make up half the population. However, the outlook remains uncertain. Finally, there are limited private sector and entrepreneurial prospects not only for jobs but also for those women who aspire to create and run a business. These constraints present multiple challenges for reform. Each country in MENA will, of course, confront these constraints in different contexts. However, inherent in many of these challenges are rich opportunities as reforms unleash new economic actors. For the private sector, the challenge is to create more jobs for young women and men. The World Bank has been pursuing an exciting pilot program in Jordan to assist young women graduates in preparing to face the work environment.

This report on voice and agency, which builds on the 2012 World Development Report, focuses on several areas key to women's empowerment: freedom from violence, control over sexual and reproductive health and rights, ownership and control of land and housing, and voice and collective action. It explores the power of social norms in dictating how men and women can and cannot behave, deterring women from owning property or working even where laws permit, for example, because those who do become outcasts. The report distills vast data and hundreds of studies to shed new light on constraints facing women and girls worldwide, from epidemic levels of gender-based violence to biased laws and norms that prevent them from owning property, working, and making decisions about their own lives. It highlights promising reforms and interventions from around the world and lays out an urgent agenda for governments, civil society, development agencies, and other stakeholders. Among its keys findings: girls with little or no education are far more likely to be married as children, suffer domestic violence, live in poverty, and lack a say over household spending or their own health care than better-educated peers, which harms them, their children, and communities.

Private Health Sector Assessment in Ghana is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank’s ongoing research and to stimulate public discussion. The private health sector in Ghana is a large and important sector in the market for health-related goods and services. However, little has been documented concerning the size and configuration of private providers and their contribution to health sector outcomes. With better information about the size, scope, distribution, and constraints of private actors, Ghana’s public policy makers could engage more effectively with the private sector. The scope of the Ghana study involved assessing the role of its private sector in the overall health system; considering the potential of the private sector to play a greater role; and identifying ways to improve the public-private interface to increase equity, access, and efficiency in the health system.

This chapter contains sections titled: Symptoms, health and life expectancy Work tasks Unpaid work and total workload Children, women and stress

Background and ObjectivesPatients undergoing breast cancer surgery frequently experience chronic postoperative pain. The primary objective of this randomized study was to determine if thoracic paravertebral block (TPVB) reduced the incidence of chronic pain after a modified radical mastectomy (MRM) when compared with general anesthesia (GA).MethodsOne hundred eighty women undergoing MRM were randomized to 1 of 3 study groups: group 1: standardized GA, group 2: GA with a single-injection TPVB and placebo paravertebral infusion, and group 3: GA with a continuous TPVB. Outcomes assessed postoperatively included acute postoperative pain and analgesic consumption and, at 3 and 6 months, the incidence and severity of chronic pain and physical and mental health-related quality of life (HRQOL).ResultsThere was no significant difference in the incidence of chronic pain at 3 months (P = 0.13) and 6 months (P = 0.79) after the MRM between the study groups. The relative risk of developing chronic pain (P = 0.25) was also similar between the groups. There was no difference in acute pain (P = 0.22) or postoperative analgesic consumption (P = 0.67) between the groups. Nevertheless, differences were observed in chronic pain–related secondary outcome variables. The TPVB groups reported lower chronic pain scores (P < 0.05), exhibited fewer symptoms and signs of chronic pain (P ⩽ 0.01), and also experienced better physical and mental HRQOL than did the GA group. Chronic pain scores also decreased with time in all study groups (P < 0.05).ConclusionsThere is no significant difference in the incidence or relative risk of chronic pain at 3 and 6 months after an MRM when TPVB is used in conjunction with GA. Nevertheless, patients who receive a TPVB report less severe chronic pain, exhibit fewer symptoms and signs of chronic pain, and also experience better physical and mental HRQOL.

This paper, based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity, aims at understanding the performance of primary health care providers in four states in Nigeria. As possible ways to improve performance, the paper concludes that clearly defining lines of responsibility, implementing performance-based financing of local governments and providers, and collecting, analyzing, and sharing information are some options that can help realign incentives and improve accountability in the service delivery chain and service provision. This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharma-ceuticals, Governance and Service Delivery, and Infrastructure and ICT.

This book analyzes skills demand and supply in Sri Lanka and scrutinizes how skills are formed, the factors shaping skills demand, and the responsiveness of the system. Sri Lanka has made strong progress in economic growth and poverty reduction. Economic growth and structural changes in the economy, however, make skills development imperative as Sri Lanka implements its the Mahinda Chintana plan to become a regional hub in strategic economic areas. Yet, skills shortages and mismatches are widespread, and firms with undereducated employees and a shortage of skilled labor are less productive. This book proposes an effective skills development system to help diversify the country's economy, improve its labor productivity and competitiveness, offer the country the flexibility to compete effectively in the global economy, and further reduce poverty in the country. After the book's introduction to the Mahinda Chintana plan, chapter two describes the general education and training system in Sri Lanka, especially the TVET sector. Chapter three examines the main drivers of skills demand and skills mismatches and gaps in Sri Lanka. Chapter four studies the relationship between education, training, and labor market outcomes, including skills already available in the workforce. Chapters five and six analyze factors affecting the skills supply system, such as cost, financing, and governance and also private sector provision. Chapter seven briefly reviews firm-based training in Sri Lanka based on evidence from the employer survey. Chapter eight assesses workforce development policies in Sri Lanka based on the World Bank's Systems Approach for Better Education Results (SABER) framework. Finally, chapter nine provides the summary of main findings and outlines possibilities for the way forward in skills development in Sri Lanka. Please note that Figure 5.2 in the book is incorrect, and should be replaced by the corresponding figure in volume 2 of this report.

Realizing the potential of young people in Latin America and the Caribbean is essential both to their well-being and to the region's long-term welfare. Young people are often seen as the source of problems that plague the area, namely rising levels of crime and violence, unemployment, and drug use. However, there is little understanding of the problems young people face, the reasons that some engage in risky behaviors, and how best to support the most vulnerable. Youth at Risk in Latin America and the Caribbean attempts to fill this knowledge gap by identifying at-risk youth and providing policy makers with evidence-based guidance that will make their countries' investments in young people more effective. The authors find that more than half the region's young people can be considered \"at risk\" of engaging in negative behaviors, which each year reduce regional economic growth by up to 2 percent. They also confirm that the causes of risky behavior in developed countries—weak relationships with schools and family, poor self esteem, household poverty, negative gender norms, and misguided laws—are also relevant in Latin America and the Caribbean. Based on this analysis, the authors describe 23 policies and programs that experts agree are the foundation of a successful youth development portfolio, ranging from early childhood development programs to parent training to cash transfers granted in exchange for positive behaviors. It also lays out strategies for implementing such a portfolio in a budget-constrained environment. This book will be of great interest to those working in the areas of social analysis and policy, social development and protection, and poverty reduction.

Bridging the Gap: Addressing Health Worker Imbalances in Sub-Saharan Africa This working paper tackles the critical issue of geographical imbalances in the health workforce across Sub-Saharan Africa. It analyzes labor market dynamics and their impact on urban-rural inequities, offering a fresh perspective on why these imbalances persist. Discover effective policy options for improving health resource allocation and achieving better health outcomes. This is for researchers, policy analysts, and policymakers seeking to understand and address health workforce challenges in the developing world. Learn how to: * Analyze health labor markets using economic principles * Evaluate the effectiveness of different policy interventions * Improve health system efficiency and reduce poverty