people and planet

3
Improvements in child health and nutrition can boost
attendance and achievement. Short-term hunger and
intestinal worm infection weaken children, making
it more difficult for them to travel to school and to
concentrate on learning. The benefits of school meals
and deworming thus extend to education outcomes. In
experiments in areas of Kenya and Uganda with high
rates of worm infection, deworming had a dramatic
impact on school attendance in the short term, and on
test scores and employment in the long term. In Kenya,
girls who received the treatment were 25% more likely to
pass the national primary school exit exam, and as adults
were more likely to grow cash crops and reallocate time
from agriculture to entrepreneurship (Ahuja et al., 2015).
Parental health has a critical impact on children’s
education. Disease weakens parents’ ability to educate
their children and support them through schooling.
Children suffer emotional
distress and may need to
take on parental roles at
In Kenya, girls who
home, such as taking care
received deworming of younger siblings, to the
treatment were 25% detriment of learning. In
countries without effective
more likely to pass
social welfare systems,
the national primary the loss of income caused
school exit exam by parental disease
and the cost of medical
care may impoverish
families, making schooling unaffordable. Parental death
is particularly devastating. Evidence from the AIDS
epidemic in sub-Saharan Africa and from Indonesia
shows that the timing of parental death is associated
with the timing of school dropout, and orphans are
less likely to attend school than the children of their
caretakers (Vogl, 2014).
Health and nutrition infrastructure can be used to deliver
education interventions. Care programmes for infants
and toddlers up to age 3 can complement medical
care and food supplementation with child stimulation
and parenting education. Home visits by community
health workers can include sessions in which mothers
learn how to stimulate their children by playing with
them, using positive feedback and avoiding physical
punishment. Longitudinal evidence from a series of
experiments targeting stunted children, run in Jamaica
since the 1980s, shows long-term benefits including
higher cognitive skills at ages 7 and 11; improved reading
achievement, attention, behaviour and self-esteem at
age 17; and higher earnings at age 22. More recent trials
in Bangladesh, Brazil, India, Pakistan, Saint Lucia and
South Africa tend to confirm these results, which depend
on the quality of the training received by community
health workers (Leclercq, 2015). Short-term health
education programmes, such as nutritional counselling
and contraceptive education, are usually delivered by
health professionals or community health workers.
Access to quality health care for teachers and students is
indispensable to the functioning of the education sector.
Disease is a cause of teacher absenteeism and attrition
(Ejere, 2010; Herrmann and Rockoff, 2010). Teachers
in rural areas, in particular, face shortages of qualified
health professionals, and when unwell may be absent
for longer than if medical care were readily available.
The impact of disease and treatment availability on the
education sector has been particularly strong in the case
of the AIDS epidemic in the worst affected countries
of sub-Saharan Africa. Without antiretroviral therapy,
infected teachers are increasingly absent and eventually
die. Other teachers may be absent to take care of
infected family members. Teachers who are infected or
suspected of being infected may face discrimination
and stigma from colleagues, parents or the community
(World Bank, 2009). In that respect, the advent and
spread of antiretroviral therapy has contributed to the
sustainability of education systems.
ACCESS TO WATER, SANITATION AND ENERGY
AFFECTS EDUCATION OUTCOMES
Just as health services and interventions can support
education, so can access to water, sanitation and energy.
For example, reducing the time it takes to collect water
and firewood can improve education outcomes by
freeing time for educational activities, especially for
women and girls (UNESCO, 2015). In Ghana, research
using four rounds of DHS (1993/94 to 2008) found that
halving water fetching time increased school attendance
by 2.4 percentage points, on average, among girls aged 5
to 15, and the impact was stronger in rural areas (Nauges
and Strand, 2013). In 2001, female literacy rates were
found to be almost 5% higher for women in villages with
better water access in Uttar Pradesh, India (Sekhri, 2013).
Similarly, electricity availability can improve study time
and education outcomes via means such as night-time
studying, access to technology and, when demand is
great, use of double shifts. Access to electricity has
been shown to have a positive impact on education
2016 • GLOBAL EDUCATION MONITORING REPORT 85