Integrating Economic and Social Policy: Good Practices From High-Achieving Countries

INTEGRATING
ECONOMIC
AND SOCIAL POLICY:
GOOD PRACTICES
FROM HIGH-ACHIEVING
COUNTRIES
I NNOCENT I WORK I NG PAPERS
No. 80
Santosh Mehrotra
3
a
bozza 22 novembre 2000
Integrating Economic
and Social Policy:
Good Practices
from High-Achieving Countries
Innocenti Working Paper
No. 80
SANTOSH MEHROTRA*
October 2000
*Senior Economic Adviser, UNICEF Innocenti Research Centre
3
a
Acknowledgements
Earlier versionsof thispaper werepresented at a conferenceon Best Practices
in Poverty Alleviation, Council for Research on Poverty (CROP), Amman,
Jordan, 10 November, 1999, and thePrepCom of theWorld Summit for
Social Development, United Nations, New York, April 2000. EnriqueDela-
monica and John Micklewright provided extremely useful comments.
Copyright UNICEF, 2000
Cover design: Miller, Craig and Cocking, Oxfordshire UK
Layout and phototypsetting: Bernard & Co., Siena, Italy
Printed by: Tipografia Giuntina, Florence, Italy
ISSN: 1014-7837
Readerscitingthisdocument areasked to usethefollowingform of words:
Mehrotra, Santosh (2000), Integrating Economic and Social Policy:
Good Practices from High-Achieving Countries. Innocenti Working
Paper No. 80. Florence: UNICEF Innocenti Research Centre.
3
a
UNICEFINNOCENTI RESEARCHCENTRE
The UNICEF Innocenti Research Centre in Florence, Italy,
was established in 1988 to strengthen the research capability
of the United Nations Children's Fund (UNICEF) and to
support its advocacy for children worldwide. The Centre
(formally known as the International Child Development
Centre) helps to identify and research current and future
areas of UNICEF's work. Its prime objectives are to improve
international understanding of issues relating to children's
rights and the economic and social policies that affect them.
Through its research and capacity building work the Centre
helps to facilitate the full implementation of the United
Nations Convention on the Rights of the Child in both
industrialized and developing countries.
The Centre's publications are contributions to a global
debate on child rights issues and include a wide range of
opinions. For that reason, the Centre may produce publica-
tions that do not necessarily reflect UNICEF policies or
approaches on some topics. The views expressed are those of
the authors and are published by the Centre in order to stim-
ulate further dialogue on child rights.
The Centre collaborates with its host institution in Flo-
rence, the Istituto degli Innocenti, in selected areas of work.
Core funding for the Centre is provided by the Government
of Italy, while financial support for specific projects is also
provided by other governments, international institutions
and private sources, including UNICEF National Commit-
tees. In 1999/2000, the Centre received funding from the
Governments of Canada, Finland, Norway, Sweden, and the
United Kingdom, as well as the World Bank and UNICEF
National Committees in Australia, Germany, Italy and Spain.
The opinions expressed in this publication are those of
the authors and editors and do not necessarily reflect the
policies or views of UNICEF.
Abstract
This paper examines the successes of ten high-achievers countries with
social indicators far higher than might be expected, given their national
wealth pulling together the lessons learned for social policy in the devel-
oping world. Some of them have immense populations, others small. Most
are market economies, but one is not. Their cultures, languages and histo-
ries are varied. They have little in common, except in one crucial respect:
they have all managed to exceed the pace and scope of social development
in the majority of other developing countries. Their children go to school
and their child mortality rates have plummeted. The paper shows how, in
the space of fifty years, these countries have made advances in health and
education that took nearly 200 years in the industrialized world. Indeed,
many of their social indicators are now comparable to those found in indus-
trialized countries. UNICEF-supported studies examined data on the evo-
lution of social policy, social indicators and public expenditure patterns in
these countries over the 30-40 years of the post-colonial epoch. The studies
pinpointed policies that have contributed to their successes in social devel-
opment policies that could be replicated elsewhere.
1. Introduction
Within the last fifty years, most developing countries have made health and
educational advances that took nearly two centuries in the industrialized coun-
tries (Corsini and Viazzo, 1997). Life expectancy has risen dramatically on
average, as has the percentage of children going to school (UNDP, 1998).
However, these significant achievements may not be immediately obvious
given the scale of the task remaining to be accomplished.
Nearly 12 million children die every year from easily preventable diseases
two-thirds of them in Sub-Saharan Africa. Half a million mothers in devel-
oping countries still die every year during child birth. Some 183 million chil-
dren still suffer from moderate and severe malnutrition 80 million of them
in South Asia.
1
Shockingly, half of all children born in South Asia suffer from
moderate or severe malnutrition. Two in every five children in the developing
world are undernourished.
Nearly one billion people in the world are illiterate. Despite the goal of
universal primary education adopted in 1990, some 130 million school-age
children (57 per cent of them girls), do not attend school most of them in
South Asia and Sub-Saharan Africa. Most of these are working children, many
of whom are below age 10. A staggering one-third of all children in developing
countries fail to complete four years of primary education, the minimum time
period required for basic literacy and numeracy.
3
a
1
These data are drawn from a UNICEF database.
3
a
Clean water, basic sanitation and a standard of living that allows families
to meet their basic needs are still beyond the reach of billions of people in all
parts of the world. Some 1.7 billion people are without safe water, of whom
600 million are in east Asia and the Pacific and almost another 300 million in
Sub-Saharan Africa. Well over half of humanity is without access to adequate
sanitation 3.3 billion people of whom 1.2 billion are in East Asia and the
Pacific, and 850 million in South Asia. Moreover, these global numbers or
averages barely begin to describe the real dimensions of deprivation and
inequity in many countries.
Clearly, while progress has been made, much remains to be achieved in
the vast majority of developing countries. This paper concentrates on ten
developing countries that managed to exceed the pace and scope of social
progress of most other developing countries. In fact, many of their social indi-
cators are now comparable to those prevailing in industrialized countries. In
order to understand why and how this social achievement was made possible,
UNICEF supported the study of these ten countries Costa Rica, Cuba and
Barbados from Latin America and the Caribbean; Botswana, Zimbabwe and
Mauritius in Africa; Kerala state (India) and Sri Lanka in South Asia; the
Republic of Korea and Malaysia in East Asia (Mehrotra and Jolly, 1997).
2
This paper attempts to pull together the lessons for developing countries
from the experience of these high-achievers. The good practices discussed here
clearly relate to health and education interventions. In other words, we were
concerned with the health and education status of the population or the social
dimensions of poverty not income-poverty though the latter issue is also
analysed. Studies were carried out in each country by national teams with
high-achieving states selected in each region. The selection of countries was
determined by the output or outcome indicators relating to health status,
nutritional level, educational status, and to access to services. We were looking
for countries which were high-achievers relative to their level of income the
selection was, in that sense, purposive. These were longitudinal studies exam-
ining historical data on the evolution of social indicators, and their determi-
nants (social policy and public expenditure patterns). They covered, in each
country, a 30-40 year time period, spanning mostly the post-colonial epoch
and the immediate pre-colonial period.
3
The health transition and educational advances that took nearly 200 years
to accomplish in the now industrialized countries were achieved within a gen-
eration or so in the selected developing countries. Many of their social indica-
tors are now comparable with those of industrialized countries (see Table 1).
2
These country cases are discussed in detail in Mehrotra and Jolly, 1997 (also paperback, Oxford Univer-
sity Press, 2000; see also Ledveloppement visagehumain, Economica, Paris, forthcoming).
3
African and Asian countries became independent after the second world war, while Costa Rica and Cuba
had become independent of Spanish rule in the first quarter of the 19
th
century, though in Cuba the influ-
ence of the US was dominant until 1959. Barbados ceased to be a colony in 1938.
2
3
3
a
T
a
b
l
e

1
I
M
R
3
L
i
f
e

e
x
p
e
c
t
a
n
c
y
P
r
i
m
a
r
y

E
n
r
o
l
m
e
n
t

R
a
t
i
o
S
e
c
o
n
d
a
r
y

E
n
r
o
l
m
e
n
t

R
a
t
i
o
L
i
t
e
r
a
c
y

r
a
t
e
H
D
I
*
*
*
3
(
1
9
9
8
)
(
1
9
9
8
)
(
g
r
o
s
s
)

(
1
9
9
0
-
9
7
)
(
g
r
o
s
s
)

(
1
9
9
0
-
9
6
)
(
1
9
9
7
)
M
a
l
e

F
e
m
a
l
e
M
a
l
e
F
e
m
a
l
e
M
a
l
e
F
e
m
a
l
e
C
o
s
t
a

R
i
c
a
1
4
7
6
1
0
8
1
0
7
4
8
5
2
9
5
9
5
0
.
8
0
1
C
u
b
a
7
7
6
1
0
8
1
0
4
7
3
8
2
9
6
9
6
0
.
7
6
5
B
a
r
b
a
d
o
s
1
3
7
6
9
0
9
1
9
0
8
0
9
8
9
7
0
.
8
5
7
B
o
t
s
w
a
n
a
1
3
8
6
1
*
1
1
1
1
1
2
6
3
6
9
7
0
7
5
0
.
6
0
9
Z
i
m
b
a
b
w
e
1
5
9
5
6
*
1
1
5
1
1
1
5
2
4
4
9
0
8
0
0
.
5
6
0
M
a
u
r
i
t
i
u
s
1
9
7
2
1
0
7
1
0
6
6
3
6
6
8
6
7
8
0
.
7
6
3
K
e
r
a
l
a
*
*
1
7
7
0
1
0
9
.
1
1
0
7
.
0
9
8
.
0
9
5
.
7
9
4
.
5
8
6
.
9
0
.
7
7
5
*
S
r
i

L
a
n
k
a
1
7
7
3
1
1
0
1
0
8
7
1
7
8
9
8
9
6
0
.
7
2
1
R
e
p
.

o
f

K
o
r
e
a
5
7
3
9
4
9
4
1
0
2
1
0
2
9
9
9
5
0
.
8
5
2
M
a
l
a
y
s
i
a
9
7
2
9
0
9
2
5
8
6
6
8
9
7
9
0
.
7
6
8
I
n
d
u
s
t
r
i
a
l
i
z
e
d

c
o
u
n
t
r
i
e
s
6
7
8
1
0
4
1
0
3
1
0
5
1
0
7
9
8
*
*
9
6
*
*
0
.
9
1
9
L
o
w

i
n
c
o
m
e

c
o
u
n
t
r
i
e
s

1
9
9
6
2
8
0
6
0
n
.
a
.
n
.
a
.
n
.
a
.
n
.
a
.
6
5
4
1
n
.
a
.
L
o
w
e
r

m
i
d
-
i
n
c
o
m
e

c
o
u
n
t
r
i
e
s
2
3
7
7
1
n
.
a
.
n
.
a
.
n
.
a
.
n
.
a
.
8
8
7
3
n
.
a
.
U
p
p
e
r

m
i
d
-
i
n
c
o
m
e

c
o
u
n
t
r
i
e
s
2
3
1
7
3
n
.
a
.
n
.
a
.
n
.
a
.
n
.
a
.
8
8
8
3
n
.
a
.
S
o
u
r
c
e
:
U
N
I
C
E
F
,

S
t
a
t
e

o
f

t
h
e

W
o
r
l
d
s

C
h
i
l
d
r
e
n

2
0
0
0
,

e
x
c
e
p
t

f
o
r

*

(
M
e
h
r
o
t
r
a

a
n
d

J
o
l
l
y
,

1
9
9
7
)
,

*
*

(
U
N
I
C
E
F
,

S
t
a
t
e

o
f

t
h
e

W
o
r
l
d
s

C
h
i
l
d
r
e
n
,

1
9
9
9
)

a
n
d

*
*
*

(
U
N
D
P
,
H
u
m
a
n

D
e
v
e
l
o
p
m
e
n
t

R
e
p
o
r
t
,

1
9
9
9
)
.
N
o
t
e
s
:
1
.

L
i
f
e

e
x
p
e
c
t
a
n
c
y

i
n

B
o
t
s
w
a
n
a

f
e
l
l

t
o

4
7

y
e
a
r
s

a
n
d

i
n

Z
i
m
b
a
b
w
e

t
o

4
7

y
e
a
r
s

i
n

1
9
9
8

(
U
N
I
C
E
F
,

S
t
a
t
e

o
f

t
h
e

W
o
r
l
d
s

C
h
i
l
d
r
e
n
,

2
0
0
0
)

a
s

a

r
e
s
u
l
t

o
f

t
h
e

i
m
p
a
c
t
o
f

t
h
e

A
I
D
S

p
a
n
d
e
m
i
c
;

t
h
e
y

w
e
r
e

m
u
c
h

h
i
g
h
e
r

i
n

t
h
e

e
a
r
l
y

1
9
9
0
s
.
2
.

T
h
e

L
o
w

I
n
c
o
m
e

C
o
u
n
t
r
i
e
s

a
r
e
:

S
r
i

L
a
n
k
a
,

K
e
r
a
l
a
,

Z
i
m
b
a
b
w
e
.

T
h
e

L
o
w
e
r
-
M
i
d
d
l
e

I
n
c
o
m
e

C
o
u
n
t
r
i
e
s

a
r
e
:

C
o
s
t
a

R
i
c
a
,

C
u
b
a
,

B
a
r
b
a
d
o
s
.

T
h
e

U
p
p
e
r
-
M
i
d
d
l
e

C
o
u
n
t
r
i
e
s

a
r
e
:

B
o
t
s
w
a
n
a
,

M
a
u
r
i
t
i
u
s
,

R
e
p
u
b
l
i
c

o
f

K
o
r
e
a
,

M
a
l
a
y
s
i
a
.
3
.

I
M
R
=

I
n
f
a
n
t

M
o
r
t
a
l
i
t
y

R
a
t
e

(
p
r
o
b
a
b
i
l
i
t
y

o
f

d
y
i
n
g

b
e
t
w
e
e
n

b
i
r
t
h

a
n
d

o
n
e

y
e
a
r

o
f

a
g
e

p
e
r

1
0
0
0

l
i
v
e

b
i
r
t
h
s
.

H
D
I
=

H
u
m
a
n

D
e
v
e
l
o
p
m
e
n
t

I
n
d
e
x
.
3
a
Drawn from three continents, this is a highly diverse group of countries
geographically, socially, politically and economically. Among them, there are
small and large countries, island states and states that are land-locked. There
are ethnically homogenous nations, as well as socially pluralist countries. There
is a one-party state and many liberal democracies. There is one centrally
planned economy but most are market economies. In other words, on the basis
of their experiences one could argue that there are many routes to social devel-
opment, low mortality rates and relatively high educational status but we
found that in many respects their social and economic policies were common.
These policies are the subject of this paper.
All ten countries were low-income economies in the mid-20
th
century. Half
of them have combined rapid economic growth with social achievement, and
are now considered to have high-performing economies. Significantly, the high-
growth economies achieved social progress very early in their development
process, when national incomes were still low. Others grew more slowly and
experienced interrupted growth. They demonstrate that it is possible to achieve
a high level of social development (and mitigate the worst manifestations of
poverty) even without a thriving economy, if the government sets the right pri-
orities. Nevertheless, for that to be achieved, macro-economic policy cannot be
divorced from social policy, since the former has an impact on social outcomes.
Sections 2 and 3 offer the policy lessons that emerge from an examination
of these ten countries. Section 2 presents the characteristics of the macro-eco-
nomic and social policy that can be derived from the experience of these ten
developing countries. Section 3 examines their good practices in health and edu-
cation. Section 4 addresses the question how income poverty fares in the high-
achieving countries. We avoided any discussion of the historical context, which
made those policies possible. In other words, our interest was in how health and
education advance were achieved, not why they were made possible.
4
Section 5
asks the question: in which context do the good practices work, or in what kind
of context are they not likely to function. The last section briefly assesses the
potential for replication of these good practices in social policy to other areas.
2. Policy Lessons from High-Achieving States
2.1The role of public action and economic growth
The first common theme that emerged from these very different countries was
the pre-eminent role of the state in ensuring that the vast majority of the pop-
ulation had access to basic social services. This was the case regardless of
whether the state in question was socialist Cuba or one that has been regarded
4
The latter is an interesting question, but is really a question relevant to social history. It can only be exam-
ined individually for each country by understanding the configuration of social forces that led to the for-
mulation of these policies. However, the configuration of social forces cannot be replicated, but policies
can be.
4
as the doyen of market-orientation the Republic of Korea.
5
In other words,
there was no reliance on a growth-alone strategy, nor faith in the trickle-down
to the poor of the benefits of income growth. In principle, such trickle-down
could indeed enable the poor to buy educational and health services but that
was not the assumption made by these countries regardless of whether
income per capita grew rapidly or not.
This is hardly surprising for anyone who takes a historical approach to the
states role in social policy in the now industrialized countries. Each of the
European countries passed through a period of free trade and laissez-faire, fol-
lowed by a period of anti-liberal or social legislation or measures in regard to
public health, education, public utilities, municipal trading, social insurance,
and factory conditions. This was as true of Victorian England as of Bismarcks
Prussia, of France during the Third Republic or the Empire of the Habsburgs.
As Karl Polanyi puts it, While laissez faire economy was the product of delib-
erate state action, subsequent restrictions on laissez faire started in a sponta-
neous way. Laissez faire was planned; planning was not. (Polanyi, 1944).
Specifically in the field of education, in the early 19
th
century learning
became equated with formal, systematic schooling, and schooling became a
fundamental feature of the state, (Green, 1990). The classic form of the pub-
lic education system, with state financed and regulated schools, with free
tuition, and an administrative bureaucracy, occurred first in Europe in the
German states, in France, Holland, Switzerland and the American North. All
these countries had established the basic form of their public systems by the
1830s. Britain, the southern European states, and the American South, where
the state took less action, were much further behind. But in each case the state
was finally critical to the expansion of the system and the universalization of
elementary education. As a consequence, most European countries saw a con-
sistent rise in the literacy rate during much of the 19
th
century.
6
Similarly, on health, before the late 19
th
century both governments and
parents regarded serious illness and the ensuing mortality of infants and young
children as inevitable. The first great successes of medical science contributed
to creating a widespread awareness that many deaths were preventable, and
public health programmes to address infant mortality were eventually started
in earnest (Corsini and Viazzo, 1997). Such measures had a major impact on
the infant mortality rate (IMR) in the industrialized countries from the late
1800s, and the decline in these rates has been dramatic ever since. The sharp
drop in the 20
th
century was linked, in particular, to expanding maternal and
child medical care, including pioneering efforts to establish local child health
clinics, increase the number of babies born in hospital, and organize ante-natal
clinics and neo-natal units.
5
3
a
5
The Republic of Koreas success may have been touted by some (see World Bank, 1993a) as the result of
market-oriented policies. This has been strongly disputed by others (see e.g. Amsden, 1992; Wade, 1990).
6
For a more detailed discussion, see Mehrotra and Delamonica (forthcoming).
3
a
There is an interesting question on how much general improvements in the
standard of living helped to reduce infant mortality in industrialized countries.
This historical question is still relevant to the present day problem of childhood
mortality in developing countries (but also industrialized ones) and is posed by
Preston and Haines, in their groundbreaking book, Fatal Years: Child Mortality
in LateNineteenth-Century America : In 1900, the United States was the richest
country in the worldOn the scale of per capita income, literacy, and food con-
sumption, it would rank in the top quarter of countries were it somehow trans-
planted to the present. Yet 18 per cent of its children were dying before age 5, a
figure that would rank in the bottom quarter of contemporary countries. Why
couldnt the United States translate its economic and social advantage into better
levels of child survival? Preston and Haines took the coexistence of high levels
of child mortality alongside relative affluence as proof of the inadequacy of a the-
sis which became very influential proposed by the British physician and his-
torical demographer, Thomas McKeown. This emphasised improvements in
material resources as a causal factor in the reduction of mortality.
7
The inability
of the US to translate economic growth into improvements in health status seems
to imply that it was advances in medical sciences that did the job.
The question asked for the US could equally be asked for some developing
countries. Why does Brazil, with many times the income per head of China and
Sri Lanka, still have a lower life expectancy than the latter countries?The con-
trasts between some African economies, which experienced rapid economic
growth are also telling. Between 1960 and 1993 Botswana managed to increase
life expectancy for its population from 48 years to 67 years and Mauritius from
60 to 73 years. But why did Africas most populous country, Nigeria, whose econ-
omy had grown at 9.7 per cent per annum over 1965-73, and thereafter experi-
enced the windfall gains of the oil price increases, only manage to reduce its
under-five mortality rate by less than 10 per cent (212 to 188) over three decades?
The answer lies in the role of public action. As Sen (1999) says, The
support-led process does not wait for dramatic increases in per capita levels of
real income. It works through priority being given to providing social services
(particularly health care and basic education) that reduce mortality and
enhance the quality of life. The contrast between the high-achievers and other
developing countries is instructive in respect of the role of the state in educa-
tion. For instance, primary education was the responsibility of the state in all
the high-achievers from an early stage. On the other hand, there is evidence
that the percentage of students enrolled in private schools in other developing
6
7
McKeown (1976) argued that historically both therapeutic and preventive medicine had been ineffective,
and that the reduction of infant mortality was primarily an economic issue. Thus, instead of investing
money in sophisticated medical technology, perhaps even in public health measures, it seemed preferable to
promote programmes capable of increasing the nutritional level of the whole population and enhancing the
resistance of its younger members to the aggression of germs and parasites. Preston and Haines, however,
suggested, on the basis of the lack of social-class differentials in child mortality in the US around 1900,
that lack of know-how rather than lack of resources was principally responsible for foreshortening life.
countries was not insignificant, especially in East and West Africa and in Latin
America (Mehrotra, 1998).
2.2Spend on basic services
In each of the high-achieving countries, the states commitment to social devel-
opment was translated into financial resources. Education expenditure as a pro-
portion of GDP (1978-93) for each of our countries was higher for the high-
achievers relative to the region to which they belong, without exception. For
health too, the expenditures were higher than the regional average, except in
the case of Korea.
8
In other words, the evidence suggests that the high-achiev-
ers gave higher macro-economic priority to health and education than the so-
called low-achievers, as Figure 1 demonstrates.
While the ratios of expenditure give an idea of the macro-economic or fis-
7
3
a
0.0
0.5
1.0
1.5
2.0
2.5
SS Africa Botswana Mauritius Zimbabwe
South Asia Kerala Sri Lanka
0.0
0.5
1.0
1.5
2.0
0
1
2
3
4
5
6
7
Barbados Costa Rica Cuba LAC
Source: IMF, Government Finance Statistics, Washington, D.C.
Figure 1: Health expenditureas% of GDP 1978-93
8
Republic of Korea did not have a public health system worth the name until 1976, and even then spend-
ing was relatively low. For a detailed analysis of the Korean case, see Mehrotra, et al., (1997).
3
a
cal priority accorded the populations health and education by governments,
what matters at the receiving end is the absolute size of the expenditure in per
capita terms. Relative to other countries in their region, the high-achievers
were spending much more per capita than other countries (though some of it
may be due to differences in per capita income). This is particularly so in edu-
cation, and to a lesser extent in health as well. Thus in 1992 the median expen-
diture in education was $49 in East Asia, but $174 in Korea and $123 in
Malaysia. The Sub-Saharan median was $11, but even a low-income country
like Zimbabwe spent $26, while Botswana and Mauritius spent several times
as much. Even though Costa Rica is not one of the countries with the highest
per capita income in Latin America, it spent nearly three times as much per
capita on education than the regional median ($43).
9
It may appear like a near tautology to argue that the states commitment
in the form of resources translated into high achievement. However, there were
many other attributes or associated conditions of that commitment, quite apart
from the quality and timing of the social investment (which are discussed later
in this and the next sections).
The contrast between the high-achievers and the rest of the developing
world (or low-achievers) with respect to defence expenditures is instructive.
On average the defence expenditure in the high-achievers was lower than for
developing countries (the average for the latter was 5%) for the period for which
we have information (1978-93). Defence expenditure was not very significant
in most of the high-achieving countries, except Korea (4-6 per cent of GDP)
and Zimbabwe (6-8 per cent of GDP). In the case of Korea the potentially neg-
ative effects of the relatively high defence expenditure appears to have been off-
set by high economic growth rates. In Zimbabwe this was not the case; but high
defence expenditure was necessitated by its geographical location as a frontline
state against the former apartheid regime in South Africa, which destabilized the
sub-region through the 1980s.
10
Like Zimbabwe, Botswana too was burdened
by the destabilization of the sub-region by South Africa, and had a relatively
high defence expenditure to GDP ratio (2-4 per cent), though this was some-
what eased by the states rents from the mineral sector. In Sri Lanka, defence
expenditure was very low until the mid-eighties, by which time significant social
gains had already been made; from 1984 to 1986, it grew from 0.8 to 2.4 per
cent of GNP onward because of the civil war conditions prevailing in the north
and north-east of the country. However, in the remaining countries, defence
was hardly any burden at all (Figure 2). Mauritius and Costa Rica do not have
9
Since exchange rates influence the dollar value of these per capita expenditures, one should be careful in
interpreting these numbers, especially for purposes of cross-country comparisons. However, the order of
magnitudes seem to suggest that the differences noted in the text are real, especially when taken together
with the differences in macro-economic and fiscal priority.
10
In Zimbabwe, the tension resulting from unproductive defence expenditure and the commitment to pro-
vide social services to the poorest through the 1980s finally resulted in a decline in the capacity to sustain
social services in the context of structural adjustment.
8
armies, while in Kerala there is almost no defence expenditure, given that
defence is the responsibility of the central government in Indias constitution.
2.3Adjustment with a human face
Once made, the social investment was sustained by the high-achievers, in bad
times as well as good.
11
The reaction of most developing countries, mainly in
Africa and Latin America, to the economic crisis starting in the early 1980s and
the structural adjustment that resulted, was to cut health and education expen-
ditures (Cornia, Jolly and Stewart, 1987). However, government expenditure
as a proportion of GDP was maintained in all the high-achievers through the
1980s. In Sub-Saharan Africa as a whole, health and education expenditure
definitely declined in per capita terms and as a ratio of GDP in the vast major-
ity of countries during adjustment between 1980 and 1993 (World Bank,
1994; Jayarajah, et al., 1996), but it held steady in Botswana, Zimbabwe and
Mauritius. In Latin America too, health and education expenditures share in
GDP and in per capita terms was lower during adjustment than it was before
adjustment, but in the high-achievers it remained stable. It appears, therefore,
that the higher-than-average (relative to other countries in their region) macro-
economic priority given to health and education expenditures by most of the
high-achievers was sustained throughout the crisis years of the 1980s.
It is not just that most high-achievers protected social investment during
times of economic crisis. When crisis forced a macro-economic stabilization
and adjustment, the adjustment process was a relatively unorthodox one. This
is particularly true of Korea, Malaysia, Mauritius and Costa Rica in the 1980s.
In Korea, for example, inflationary pressures built up in the late 1970s as nom-
inal wages rose faster than productivity. The state launched a phase of stabiliza-
tion: it restrained its own budgetary expansion through zero-based budgeting,
wage earners were urged to accept smaller wage increases, farmers were to
accept fewer subsidies, businesses were to refrain from price increases, and
9
3
a
11
UNICEF has often called this the principle of First Call for Children.
0
1
2
3
4
5
6
Developing countries High achievers
Source: Mehrotra (1997a).
Figure 2: Defenceexpenditureasa % of GNP
3
a
households were to spend less and save more. One reason why the government
was able to make both capital and labour share the costs of adjustment was that
income distribution was relatively equal in the country.
12
Similarly, Costa Rica was a pioneer among Latin American countries in
the sense that it was the first to show concern for the social cost of adjustment.
Between 1980 and 1982, output declined, wages fell 40 per cent, and unem-
ployment doubled. However, in 1982 a new government began to implement
an unconventional stabilization process, maintaining public employment
(through an employment subsidy), indexing wages, a business rescue plan to
protect jobs all part of a social compensation plan. The stabilization reduced
the fiscal deficit, not only by reducing spending (as in most other countries)
but also by increasing revenues (Garnier et al., 1997). This enabled the gov-
ernment to provide financial support for its social institutions. Thus, it was
able to implement far-reaching adjustment measures without provoking the
popular backlashes seen in other countries, such as Argentina, Brazil, the
Dominican Republic, and Venezuela. This was because the cost had been even-
ly distributed among the countrys main social groups.
In its own way, the transition that Cuba has been attempting since the
early 1990s also contrasts strongly with the experience of the countries of East-
ern Europe and the Commonwealth of Independent States, where the social
costs of the transition to a market economy have been severe.
13
On the other hand, in Zimbabwe, where the adjustment process in the
1990s has been much more orthodox, in keeping with the Washington Con-
sensus, the social costs have seen a reversal in the 1990s of some of the social
achievements of the 1980s (Loewenson and Chisvo, 1997).
2.4Allocative efficiency and equity in public spending
It is both equitable and efficient in the health and education sectors to allocate
public resources to the lower or primary levels of service. Prevention is cheaper
than cure hence it is cost-effective to allocate sufficient resources within the
health sector to primary levels of care in order to prevent potential cases reach-
ing hospitals. Such cases are dealt with more cheaply for both the patient and
the provider at the primary health centre (PHC); the human cost is also lower,
as care can be delivered easily due to the physical proximity of the PHC. It is
equitable because a larger proportion of the population are likely to use a PHC,
than a hospital - assuming the PHC is effective since it is more likely to be
physically accessible than most hospitals. Similarly, the social return to prima-
ry education is known to be higher than that for secondary/higher education
10
12
It has been argued that, the more equal the distribution of income economy-wide, the higher the qual-
ity of government intervention and, hence, the faster the rate of growth of manufacturing output and pro-
ductivity. (Amsden, 1992).
13
For an analysis of the social costs of the adjustment process, see UNICEF 1991;1992;1993; also Kaser
and Mehrotra (1997). For a comparison with Cuba, see Mesa-Lago (1997); Mehrotra (1997c).
(Psacharopoulos, 1985); besides, in most developing countries, rarely do the
poor manage to graduate beyond primary school, if that. Hence, it would be
both allocatively efficient and equitable to meet the resource needs of primary
education from the government budget on a priority basis.
A significant common feature about the expenditure pattern on education
in the high-achieving countries was the efficiency and equity of allocation by
level of education, compared to other countries in their regions. Equity may be
a pre-requisite to ensuring essential inputs for schools. A comparison between
the high-achievers (where primary enrolment is universal) and other countries,
where education for all has not yet been achieved, shows some interesting con-
trasts, demonstrated in Figures 3 - 5.
11
3
a
1980 1990
1980 1990
South Asia
Sri Lanka
p
e
r
c
e
n
t
a
g
e
0
10
20
30
40
19.8
7.6
18.8
13.4
p
e
r
c
e
n
t
a
g
e
0
10
20
30
40
Sub-Saharan Africa
Botswana
Mauritius
Zimbabwe
0
10
20
30
40
1980 1990
p
e
r
c
e
n
t
a
g
e
Rep. of Korea
Malaysia
East Asia and Pacific
19.1
8.7
12.4
16.9
7.4
14.9
1980 1990
16.2
26.1
6.9
14.9
19.2
35.8
14.4
p
e
r
c
e
n
t
a
g
e
0
10
20
30
40
Latin America
Barbados
Costa Rica
Cuba
20.3
13.2
7.7 7.5
18
12.2
7.2
10.3
18.1
Source: UNESCO, Statistical Yearbook, Paris, various issues (1990-99)
Figure 3: Selected high achieversby geographuc region: higher education
asa shareof current government expenditureson education
3
a
First, there is a difference in the share of education expenditure allocated
to higher education. With the exception of two of the Latin American coun-
tries, the high-achievers have tended to spend less than other countries in the
region. This is particularly true for the earliest year for which we have data
(1980), and was still the case in 1990. Second, there is a sharp difference in pri-
mary education expenditure as a proportion of per capita income, with the high
achievers normally spending more than the regional average as Figure 4 shows.
Third, per pupil expenditures are also relatively equitable in the high-
achievers as demonstrated in Figure 5. Per pupil expenditure in higher educa-
tion as a multiple of primary per pupil expenditure is lower in all the high-
achievers than in other countries in the region (Mehrotra, 1998).
While expenditures by level of education are readily available, it is much
more difficult to find information on health expenditure by level (primary, sec-
12
0
2
4
6
8
10
12
0
E. Asia Rep. of Korea Malaysia
SSA Botswana Mauritius Zimbabwe
5
8
12 12 12
11 11
3 1
15
14
25
0
5
10
15
2
25
0
2
4
8
10
12
6
Source: UNESCO, World Education Report, Paris, 1993
Figure 4: Primary per pupil expenditureas% of per capita income
ondary and tertiary), or type of service (preventive and curative).
14
There are,
however, a few countries where information is available on the allocation of
health expenditure to primary versus non-primary activities.
15
It appears that
13
3
a
14
The primary level is the first level of care, usually a health clinic; the secondary level would usually con-
sist of a district hospital, as a first-level referral centre, while the tertiary level may consist of a teaching or
specialist hospital.
15
This gap in information on public spending on basic social services will be filled in a forthcoming book,
based on country studies carried out in over 34 developing countries. See Mehrotra and Delamonica
(forthcoming).
SS Africa Botswana Mauritius Zimbabwe
L. America Barbados Costa Rica Cuba
0
1
2
3
4
5
6
7
8
9
0
5
10
15
20
25
30
35
0
10
20
30
40
50
60
Source: Mehrotra (1997b).
Figure 5: Per pupil expenditureismoreequitable
Dollars spent per pupil
on tertiary education
as multiple of primary
education
3
a
Malaysia allocated one-fifth (in 1986-1990) and Barbados one quarter (in
1990-1991) of its health expenditure to primary health care activities, while
Costa Ricas allocation in 1992 may have been about 10 per cent (Choon Heng
and Siew Hoey, 1997; Bishop, et al., 1997; and Garnier et al., 1997). What is
clear is that primary health activities (which have considerable overlap with
preventive and basic curative services) are low-cost activities and ones that do
not absorb a very large part of public expenditure. It is the clinical activities,
largely provided at the secondary or tertiary level, which are relatively more
expensive (Joseph, 1985; World Bank, 1993).
Qualitative evidence from the selected countries indicates that emphasis
was placed on primary health care in the organization of the health system;
they also attenuated the urban bias in health services that had previously exist-
ed. All the countries succeeded in providing access to health services in both
physical and cost terms in both rural and urban areas. Access to health ser-
vices was nearly 100 per cent in urban areas for all the selected countries by the
late 1980s, and in the range of 80 and 100 per cent in rural areas not the case
for other countries in their region. A universally available and affordable sys-
tem, financed out of government revenues (with minimal out-of-pocket costs
for users), functional at the lowest level, made effective by allocating resources
at the lower end of the health system pyramid these were the keys to an equi-
tably-structured health system. This is in strong contrast to the pattern of intra-
sectoral spending in most developing countries, where a significant proportion
of the total health budget is spent on one or two centrally-located referral or
teaching hospitals, while starving the primary health care system despite the
fact that the latter services the majority of the population.
2.5Educational achievement preceded high health status
As regards the sequencing of social investment, the investment in basic educa-
tion by the state preceded or was simultaneous with the breakthrough in infant
mortality reduction (or public health expansion) it did not post-date the
breakthrough period. The synergies between interventions in health and edu-
cation are critical to the success of each and increase the return to each invest-
ment and the sequence is important.
In a comparison of decadal rates of reduction of IMR we define the
breakthrough period in IMR reduction as that decade during which the
largest percentage decline in IMR took place. We found that high education
indicators preceded the health breakthrough in our selected countries (see
Table 2). These gave the selected countries a tremendous advantage over the
others, since high education levels are closely linked to positive health
improvements. When the investments in health infrastructure came, high
educational levels ensured a strong demand and effective utilization of health
services.
The most interesting example of this synergy between educational
14
health interventions comes from Korea. Before 1976 Korea had no publicly
supported health system worth the name, and no form of broad-based med-
ical assistance or medical insurance scheme. Health care was predominantly
in the hands of private professionals, especially pharmacists. But its literacy
rate was already 90 per cent in 1970. When the investment in public health
came after 1976, IMR, which was still 53 in 1970 and 41 in 1975 dropped
to 17 within a matter of five years (1980). Similarly in Sri Lanka, literacy lev-
els were already 60 per cent before independence in 1948, higher than they
are in (much larger and more populous) India and Pakistan today. Not sur-
prisingly when health services expanded immediately after independence, Sri
Lanka experienced a very rapid increase in life expectancy in the first decade
of independence.
The point about this sequence of social investment is that the synergy
between the interventions is triggered. The health interventions have more
impact because they build upon a base of relatively high educational status in
the population. The demand for the health services is greater, as is their uti-
lization. For instance, Caldwell (1986) notes in an analysis of data from two
15
3
a
Table 2:
Education Health IMR%
Breakthrough Period Breakthrough Period reduction
Rep. of Korea 1960-70 1970-80 68
esp 1975-80 58
Malaysia 1947-60 1960-70 40
1975-85 50
Kerala 1956-60 1975-85 40
Sri Lanka 1947-60 1940-50 40
Botswana 1970-80 1980-90 37
Mauritius Before 1950 (m) 1945/9 50/4 40
1950-60 (f )
Zimbabwe 1980-85 1980-90 30
Barbados Before 1938 1950-60 50
1970-80 1970-80 50
Costa Rica Before 1960 1970-80 68
1940-50 30
Cuba 1958-60 1970-80 40
1975-85 50
Source: Mehrotra (1997b)
3
a
Nigerian villages, the equivalent gain in the expectation of life at birth was 20
per cent when the sole intervention was easy access to adequate health facilities
for illiterate mothers, 33 per cent when it was education (as measured by moth-
ers schooling) without health facilities, but 87 per cent when it was both, i.e.,
neither merely additive, nor multiplicative, but greater than either.
This notion of synergy can, in fact, be clearly understood by examining the
life-cycle of an educated girl. An educated girl is likely to marry later, have fewer
children, and provide better care for herself and her children than a girl with-
out education. As more women become educated, there is a cumulative effect
on more households with respect to fertility. As more households become small-
er the provision of care improves for more children. Taken together, the bene-
fits of greater education among women adds up to a virtuous circle of social
development.
2.6The role of womens education and womens agency
Underlying all the above characteristics the quality, timing and sequence of
investments in these countries lies womens agency role (Sen, 1995) i.e. the
freedom women have to work outside the home, the freedom to earn an inde-
pendent income, the freedom to have ownership rights, and the freedom to
receive education.
16
60
65
70
75
80
85
90
95
100
SSAfrica Botswana Mauritius Zimbabwe
South Asia Kerala Sri Lanka
0
10
20
30
40
50
60
70
80
90
100
96
97
98
99
100
101
0
20
40
60
80
100
120
Source: UNICEF, State of the Worlds Children, 1995
Figure 6: Women agency: primary education (girlsenrolled asa percentage
of boys, circa 1990)
Health outcomes for children are not only the result of adequate food
consumption and the availability of health services, but proper child-caring
practices. In this respect the position of women in the household and in soci-
ety, and the freedoms they enjoy, acquires major significance. Relative to other
countries in their region, the selected countries were characterized by much
greater access to education by women in the early stages of our period of analy-
sis. In 1960 in the selected countries, female enrolment ratios at primary level
were above the regional average (except in Malaysia). In 1970, female adult lit-
eracy rates were also higher than the regional average for all countries. By 1970,
primary enrolment ratios were similar for males and females in all the selected
countries, and substantial parity existed between males and females in sec-
ondary-school enrolment. In other words, any disparity in educational levels in
terms of primary/secondary enrolment of men and women was completely
eliminated by 1970 in striking contrast to the large disparities that continue
to exist to date in the vast majority of countries in Asia and Africa.
While education is an important determinant of womens position in soci-
ety, there are other factors at play as well. Culturally, where there are no taboos
attached to girls taking up roles outside the house, the task of setting up an
effective health service becomes easier. In Sri Lanka and Kerala, where rural
women have become educated, and where parents permit them to engage in
work outside the home, it is easier to hire them as nurses or train them as mid-
wives. Because they work in their own areas in their own language, they are
accepted more easily by the community in house-to-house visits (Caldwell,
1986). In many parts of northern India (especially the Hindi-belt), the short-
age of local recruits has meant the perennial under-supply of female health
workers.
In schools the presence of female teachers has a positive impact on female
enrolment. The proportion of female teachers in school is very high in the
high-achieving countries (Figure 7). On the other hand, in most South Asian,
Middle Eastern, and Sub-Saharan societies, there is a considerable male-female
differential even in primary school enrolment, which in fact tends to worsen at
the secondary level. Not surprisingly, many of the educational systems are char-
acterized by a low proportion of female teachers in schools.
16
If one examines the overall sectoral distribution of womens employment
in the high-achievers, women, as a percentage of men in the workforce, are well
represented in non-agricultural sectors of employment.
17
Non-agricultural
employment is a better indicator than agricultural employment of the propen-
17
3
a
16
Dreze and Gazdar (1998) find a similar contrast between the educationally backward state of Uttar
Pradesh in India and the relatively advanced states of South India, and especially Kerala.
17
If both agricultural as well as non-agricultural employment are included, the regional average in East Asia
and Africa and even Latin America for female economic activity rate tends to be higher than in our select-
ed countries, since agricultural work has traditionally been part of female economic activity. Hence, we
particularly examined data on the non-agricultural employment of women.
3
a
sities to work outside the home and of an independent source of income.
18
Because of the high educational levels achieved by women in the selected coun-
tries, women are nearly as well represented as men in the professional categories
of employment. This is not to suggest that parity has been achieved with men
even in these societies, but that considerable advances have been made.
In many of these societies the modern State has helped to strengthen the
position of the woman in society. Nowhere is this more obvious than in Cuba.
18
Regional average: SS Africa
High achievers average
Regional average: Asia
High achievers average
Regional average: LAC High achievers average
Male Female Male Female
Source: UNESCO, Statistical Yearbook, various issues (1990-1999)
Figure 7: High shareof femaleteachersin primary schoolshelpsgirls enrolment
18
Agricultural sector employment will not givve women an independent income unless undertaken as wage
labour, which is more likely to be undertaken within landless families by the male.
Many sections in Cubas constitution explicitly refer to gender equality, and its
penal code treats the infringement of the right to equal treatment as a criminal
offence. In Zimbabwe changes in legislation have conferred majority status on
women and now ensure inheritance and maintenance rights; women no longer
need their husbands consent to buy immovable property, and law allows equi-
table distribution of family property between spouses upon divorce. In many
of these respects Zimbabwe is quite unusual in Sub-Saharan Africa.
3. Systemic Operational Efficiency the Essence
of Good Practice in Health and Education Sectors
As we have seen above, in terms of allocative efficiency the fact that resources
in the health system are spread relatively equitably throughout the pyramid of
the health structure minimizes overall costs for a very simple reason that pre-
vention is cheaper than cure. Primary level services are largely of a preventive
nature, and when they function well, they are actually used by the majority of
the population, especially those who cannot afford private providers. A large
number of hospital cases in developing countries could either be prevented or
treated at much lower cost to the health system (and to the individual) had a
primary health care system been functional one that also provided basic
curative care.
Similarly, despite the social rate of return to primary education to the soci-
19
3
a
Korea
Costa Rica
0
20
40
60
80
100
120
140
160
Non-agriculture paid employment Professional and technical
Botswana
Mauritius
Zimbabwe
Sri Lanka Barbados Cuba
Malaysia
Figure 8: Womensagency: employment outsidethehousehold, 1990
(women aspercentageof men)
Source: Mehrotra (1997a)
19
External efficiency of the education sector refers to the absorption rates of graduates in the labour
market.
3
a
ety being higher than the return to higher education, governments in many
developing countries have invested in higher education at the expense of prima-
ry schooling. In terms of allocative efficiency, the pattern of state investment
should have been the other way round, leaving the investment in higher educa-
tion to be made by families. As we have seen above, all the selected high-achiev-
ers ensured allocative efficiency through a pattern of state spending in the edu-
cation sector by placing emphasis on the lowest level of the education pyramid.
Even more important than the allocative efficiency is the technical effi-
ciency in the use of resources invested at the primary level, i.e. obtaining the
best results (outputs) from the use of given resources (or inputs), both finan-
cial and human.
The evidence from these countries in the primary education sub-sector
suggests that unit costs per pupil should be kept low if the system is to expand
in coverage without precipitous loss of quality. This is because education is, in
most developing countries, one of the single largest categories in the budget,
and in most countries the primary system accounts for half of that expenditure.
In other words, unless costs are kept low it rapidly becomes almost impossible
for the public exchequer to bear the burden of the rising recurrent costs as the
system expands, particularly if quality is to be maintained.
Several methods were employed to keep costs low in the high-achieving
countries in primary education. Zimbabwe offers useful lessons on how to
expand the number of teachers a dire need in most African and South Asian
countries where there is a serious shortages of teachers. A four-year teacher-
training course was introduced, with only the first and last terms spent in col-
lege. The rest of the time was spent teaching in the schools (Chung, 1993).
The cost of training a teacher under this programme was less than half the
cost of conventional training, and schools had teachers as enrolment expand-
ed. Another mechanism used in Korea, Malaysia and Zimbabwe to reduce
costs was to utilize existing facilities more fully by having double-shifts in
schools.
Other means were also adopted to keep technical efficiency high. High
repetition rates are a common feature of most primary schools in developing
countries. High repetition often leads to drop-out by the repeaters. Both cause
wastage of resources, and repetition places a limit on the number of school
places available for new cohorts of children. Reducing this kind of wastage
improves what is called internal efficiency within the education sector.
19
One
of the means adopted to reduce wastage and maintain internal efficiency was
automatic promotion, practised in Korea, Malaysia, Kerala, Barbados, and
Zimbabwe. Automatic promotion increases the number of years low-achieving
students spend in school, and thus may increase learning. Given that it is
known that spending at least four years in school is essential to retain literacy
20
21
3
a
and numeracy skills, this system ensures a minimum level of learning. Second,
automatic promotion clears the backlog of repeaters in grades 1 and 2 (grades
where much of the repetition is concentrated), creating space for new students.
There could be problems, however, with such a system. If automatic promo-
tion is implemented with no attempt to eliminate factors associated with
school failure, problems of learning in the early grades may be passed on. There
is a strong case for automatic promotion if accompanied by a minimum pack-
age of inputs, especially teacher training and materials.
Korea managed to keep costs low by maintaining a very high pupil-
teacher ratio (early 1950s: 68; 1980: 48). High pupil-teacher ratios (normally
high in most developing countries) combined with low teacher motivation and
inadequate instructional materials cannot contribute to learning. However, in
the selected countries adequate levels of financing for primary education
ensured that teachers were not poorly paid, and funding for materials was avail-
able (Mehrotra, 1998). While maintaining low unit costs, minimum standards
of quality were maintained in the high-achieving countries. While early on the
ratio was relatively high, a situation forced on the country by the expansion of
coverage, the pupil-teacher ratio has declined in all the selected countries. The
decline in the pupil-teacher ratio would not by itself be an indicator of improv-
ing quality, unless repetition rates and drop-out rates were simultaneously low
which they are.
On the demand side, the reduction of costs to parents of sending children
to school seems to have been a primary reason for the rapid expansion of pri-
mary enrolment in the selected countries. In all countries (except Korea) pri-
mary schooling has been entirely free of tuition fees. In many cases, even the
indirect costs have been progressively reduced. By contrast, in many develop-
ing countries, out-of-pocket costs and user charges (and Parent-Teacher Asso-
ciation contributions) remain a barrier to enrolment for poor children and an
incentive to drop out (Mehrotra and Delamonica, 1998).
Apart from private cost, another family-related factor that should be taken
into account is the language of instruction. In the early years the mother tongue
was used as the medium of instruction at the primary level in the high-achiev-
ing countries. Contrast this to the situation prevailing in most francophone and
lusophone (Portuguese-speaking) African countries, where the colonial lan-
guage is still the medium of instruction even in the earliest years of school.
Expanding girls enrolment and keeping them in school is the key to uni-
versal enrolment in South Asia and Sub-Saharan Africa. In the selected coun-
tries, the expansion of physical facilities and proximity to schools laid the basis
for the participation of girls. Moreover, an important underlying factor was the
high proportion of female teachers in schools in the selected countries (Figure
7). Female teachers give parents of girl-children a sense of security as well as
providing a role model for girls in the community. In countries that are farthest
from achieving Education for All these good practices low private costs,
3
a
mother-tongue instruction, female teachers adopted by the high-achievers
have tended to be overlooked.
What about good practices in the health sector?The high-achievers empha-
sized health-system building and a comprehensive (not selective) approach to
primary health care. They achieved major reductions in the mortality of moth-
ers and children by focusing their primary health care activities on mother and
child health thus applying the principles of the Alma Ata Declaration on
Health (1978) long before the principles were written down.
20
Almost all chil-
dren were born under medical attention, supported by good health referral sys-
tems. This was followed by household visits by the first-level health worker. High
levels of immunization of children provided mainly by primary health care
centres - ensured that communicable diseases, which dominate the disease bur-
den in any developing country, did not lead to high levels of morbidity or mor-
tality for mother and child. Immunization coverage, which was high in these
countries, is usually an indicator of a relatively effective formal health system that
can reach a large proportion of the population. In the majority of the selected
countries, immunization coverage had reached high levels long before the
UNICEF-WHO campaign for universal immunization was launched in 1985.
21
Primary health care is supposed to be delivered by first-level health work-
ers acting as a team. Zimbabwe specifically trained a large number of commu-
nity health workers. Sri Lanka relied heavily on the primary health midwife. In
many societies, it is advantageous if these health workers come from the com-
munity in which they live, so that they have local support as was the case in
Kerala and Sri Lanka.
The first-level health worker should be able to turn for help to more high-
ly trained staff. A serious problem facing most developing countries is that
physicians and other health professionals trained at public expense have not
been willing to work in rural hospitals or health centres. Malaysia ensured that
all doctors trained at public expense were required to serve the public health
system for at least three years. This allowed the government to post doctors to
the rural areas. Sri Lanka would not permit the registration of doctors with the
General Medical Council without requiring doctors to work for the govern-
ment health service. This involved being posted out to rural areas.
Among the determinants of nutritional status, it is noticeable that most of
the selected countries have a calorie supply at 120 per cent of requirements or
above, which is a rough rule of thumb to offset for inequality of distribution
among households. It is also higher than the calorie availability in other devel-
22
20
At a major international conference held in 1978 in Alma Ata, the Kazakhastan capital, an important
principle already in practice in many countries was internationally recognized in a declaration that the
organization of the health system in developing countries be based on primary health services. The prin-
ciple responded to the nature of the disease burden in developing countries.
21
Thus, in 1982, the immunization rate was (as a percentage of 1-year olds): Korea 61, Malaysia 60, Sri
Lanka 56, Botswana 63, Mauritius 94, Barbados 62, Costa Rica 81 and Cuba 99. Zimbabwe became inde-
pendent in 1980 and had 75 per cent immunization coverage by 1986.
oping countries in the region. Second, as we have seen above, most provide
geographical access to health services for a substantial part of their population,
including immunization coverage. Immunization against measles reduces mor-
tality from poor nutrition; and tetanus immunization also reduces child mor-
tality. Third, maternal and child health services usually included surveillance of
young-child growth (weight and growth-cards). Fourth, most high-achieving
countries have safe water for most of their population rarely the case in other
countries in their region. They are also ahead on the provision of sanitary
means of excreta disposal, except in rural areas of Sri Lanka, Kerala, and Zim-
babwe. Diarrhoea, largely caused by infection from water and the environ-
ment, is a major cause of malnutrition; the typical growth curve dips below
that usually found in industrialized countries at 4-6 months of age when the
baby begins to crawl on the ground and to take foods complementary to breast
milk (which makes access to safe water crucial).
In addition to the above factors, the provision of a nutritional floor in
low-income countries (or those that have remained low-income countries
because of lower per capita income growth) was found to be an effective mech-
anism of reducing protein-energy malnutrition. In three of them (Cuba, Sri
Lanka, and Kerala) a system of food subsidies has been maintained from the
1960s to date. Fair price food shops (as part of a public distribution system
providing essential commodities at below market prices) have existed in other
states of India as well since the 1960s, but the point here is that in Kerala they
are found in the rural areas, while they are effectively non-existent in the rest
of rural India.
22
However, provision of the nutritional floor was one among a
number of factors accounting for the low level of malnutrition in these coun-
tries, the others being better disease control through health services and
womens control over resources.
In the majority of the selected countries, the health transition has been
accompanied by a demographic transition. In fact, the country cases strongly sug-
gest that it was non-family planning interventions mortality decline and rising
education, with rising marriage age and increased economic participation by
women that resulted in behaviour change in relation to fertility and ultimate
decline of fertility. (Only in Korea is there evidence of a strong family-planning
programme.) In other words, the demand for family planning services increased
with the behavioural change in regard to fertility, which was in turn determined
by factors that had little to do with family planning programmes. However, that
does not mean that the supply of the means and instruments of family planning
was unimportant only that without an effective demand for contraceptive
means, any conscious government-led family planning programme is unlikely to
23
3
a
22
See Dreze and Gazdar (1998) for the contrast between the state of Uttar Pradesh, with a very high level
of child under-nutrition, and the state of Kerala, in this respect. While 97 per cent of Keralas villages had
a fair price shop (part of the system of public distribution of essential commodities) in 1992-3, only 38
per cent of villages in Uttar Pradesh did.
3
a
be effective.
23
The inter-play between supply and demand for family planning is
demonstrated by the fact that although all of the high-achievers have managed
to reduce infant mortality rates below 20 per 1000 live births per year (except
Botswana and Zimbabwe), those that have not raised contraceptive prevalence
rates over 50 per cent (Malaysia, Botswana, Zimbabwe) still have population
growth rates that are hardly declining. Hastening the demographic transition
will require more than ensuring a health transition in some of these countries.
However, in most of the selected countries the demand for family planning ser-
vices followed the health/education breakthroughs. In fact, this pattern is con-
sistent with the phenomenon in all industrialized countries, where fertility
rates were very low before modern contraception was even around.
4. Income-Poverty in the High-Achievers
It is clear from the initial discussion in this paper that universal access to, and
provision of, services was the guiding principle in the high-achieving states. In
some ways, an equally interesting question in respect of these states, regarded
as high-achievers in terms of social development (longevity and knowledge,
two critical elements of human development), is how well they did in reduc-
ing income-poverty. In other words, while they certainly eliminated the social
dimensions of poverty for the vast majority of the population, were they equal-
ly successful in reducing income-poverty?
We have information for incidence (or head-count ratio) of poverty for
two points of time for most of the countries based on consistent national
poverty lines. In Malaysia and Korea, overall poverty incidence declined to neg-
ligible levels. In Mauritius and Cuba, too, poverty declined significantly. How-
ever, in other countries, while there are downward trends, poverty has proved
much stickier than might have been expected from the evidence on the health
and education indicators.
In Sri Lanka, the headcount ratio for a low poverty line was 27 per cent
in 1985-6, which fell to 22 per cent in 1990-1. Similarly in Kerala, while the
incidence of poverty has declined from nearly 59 per cent of the population in
1973-4 to 32 per cent in 1987-8, it still remains high. Although information
is less adequate about poverty incidence in Zimbabwe the unchanged distrib-
ution of wealth and slow economic growth suggests that the incidence of
poverty has not declined. In Botswana too, it remains high, despite some
decline. Thus, the very poor (those below the food poverty line) accounted for
24
23
The contrast between the states of Uttar Pradesh (UP) and Kerala in India brings home the point. While
the proportion of villages with medical facilities in 1981 in UP was ten, in Kerala it was 96, with a simi-
lar contrast in 1991 between the number of births taking place in medical institutions. In other words, in
Kerala health centres provided family planning services as part of overall health care and the total fertil-
ity rate was 3.9 in 1981 and less than 2 in the mid-90s. On the other hand, the few health services in rural
UP concentrated on family planning campaigns, especially female sterilization, often using force. The total
fertility rate was 5.9 in 1981 and has stagnated since (5.1 in 1991) (Dreze and Gazdar, 1998).
41 per cent of all individuals in 1985-6, and in 1993-4 they still made up 30
per cent of the population.
In Costa Rica and Barbados the incidence of overall poverty may have
worsened somewhat during the 1980s, as it did in much of Latin America. In
Costa Rica, the proportion of households below the poverty line was stagnant
in the 1970s, but increased sharply in the urban areas in the 1980s, while it fell
somewhat in rural areas. In Barbados, working on the basis of an internation-
al poverty line of $1 per day, the incidence of poverty in urban areas was neg-
ligible (4.9 per cent in 1980 and 2.3 per cent in 1989), but increased sharply
in urban areas (from 10.5 to 21 per cent).
24
Thus while all these countries became high-achievers in terms of health and
education status early in their development process when per capita incomes
were still low, they have shown much less progress in terms of income-poverty
alleviation with the exceptions of Korea, Malaysia, Mauritius and Cuba.
The factors underlying the greater resistance of income-poverty vary. In the
South Asian cases, slow economic growth has remained a barrier. Kerala experi-
enced landownership reform that was much more effective than that in the rest of
India (Jose, 1985). Communist party governments in Kerala alternated with the
Congress party in state elections, and the effect of competitive electoral politics
was to bolster the social agenda. However, because of slow economic growth in the
state, incomes have not risen much. Sri Lanka had a landownership pattern much
more equitable than that prevailing in most parts of the Indian subcontinent, and,
until the 1970s at least, economic policies were also relatively egalitarian becom-
ing much less so in the 1980s. All of these factors, taken together with relatively
slow growth in income, prevented a sharp decline in the incidence of poverty. In
other words, social policies conducive to health and educational development and
equitable wealth distribution are not sufficient conditions for successful income-
poverty reduction; equitable income growth is a necessary condition.
An unequal distribution of assets and income in the African cases seems to
be a contributory factor in the persistence of poverty. Zimbabwe had been
through a revolutionary liberation war against racist white rule, and liberation
fervour carried over into social policies. However, in regard to landownership,
the governments hands were tied for a decade by the terms of the agreement
between the erstwhile white regime and the winners of the liberation war. In
addition, most industry remained in the hands of the white owners after inde-
pendence, and the income distribution is simply a reflection of the unequal dis-
tribution of assets in the economy. The lack of economic growth over the 1980s
compounded the problem of poverty. In Botswana, income-poverty appears to
have proved stubborn because of wealth distribution despite rapid economic
growth in a resource-rich economy. In a primarily agrarian economy, with a
large proportion of the population dependent on agriculture, the ownership of
25
3
a
24
Income distribution has been relatively equitable in Barbados; together with relatively good economic
growth, poverty levels have remained low.
3
a
land and cattle (an important source of wealth in this country) is highly
unequal. Nevertheless, the Botswanan government has succeeded in using its
diamond rents to invest in the health and education of the population.
In Costa Rica, the persistence of poverty is also the result of unequal land
ownership and inequality in income distribution. The distribution of land
remains highly inequitable even by Latin American standards, and in 1988, 44
per cent of the rural population was landless (IFAD, 1992). Income inequali-
ty is a further contributory cause: the ratio of the income of the top 20 per cent
of the population to the bottom income quintile is 12.7 (not much below Zim-
babwe 15.7 and Botswana 16.4) (World Bank, 1995).
Thus, while high levels of social indicators are common to all the select-
ed countries, this does not necessarily translate into a uniformly high level of
human development (a composite index of income, longevity and knowledge).
Only a few of them (Korea, Malaysia, Mauritius) come out well in terms of all
three kinds of desirable outcomes economic growth, income-poverty reduc-
tion and social development. Others fail, to a lesser or greater degree, on one
or even two other counts (i.e. income growth or poverty reduction).
5. In What Context Do Good Practices Function?
Methodologically, the approach in this section is quite different from that in sec-
tions 2 and 3. In those sections we looked at the concentration of various char-
acteristics among the high-achievers, and compared them with the concentration
of the same characteristics among the low-achievers. In this section we attempt
a much more difficult exercise. Here we search for the concentration of under-
lying reasons for success causes if you will among the high-achievers.
25
The role of ideology and politics cannot be ignored as driving forces
behind public action in the selected countries. Thus, in Cuba, as in all other
developing centrally planned economies (eg Vietnam is another good exam-
ple), communist ideology was the driving force behind state action in not only
reducing poverty, but also providing equitable access to health and education
services to all. In Kerala, the process began during colonial times in the inde-
pendent royal state of Travancore-Cochin, partly as a response by the local king
to missionary activity. After independence, however, which is when most of the
social development occurred, the process was driven by the competitive elec-
toral politics between the Communist Party and the populist Congress Party.
In Sri Lanka, public action stemmed from the combined influence of socialist
26
25
An alternative method could be followed at least in theory. We could, for instance, have looked at the
incidence by each characteristic (rather than the concentration of a characteristic among the high-achiev-
ers). In other words, we would have looked at the percentage of all countries with certain characteristics
that are high-achievers compared to the percentage of high-achievers among all countries. However, there
are several methodological problems with such an approach. The search for characteristics across countries
is, essentially, a qualitative matter, and estimating percentages (or incidence) in quantitative terms may
raise questions about differences of the degree to which a characteristic is present in a given country ques-
tions that are impossible to answer.
ideology, competitive electoral democracy and Buddhism (characterised by the
tenets of equality of all human beings and compassion for all living beings).
In Costa Rica it was essentially a social-democratic consensus in a democ-
racy that has lasted almost 150 years, with elections every four years, in strong
contrast to the rest of Latin America. Similarly, in the island states of Mauri-
tius and Barbados, it was competitive electoral politics that drove the states
interest in health and education services. Both island states have a tradition of
electoral democracy based on the parliamentary system.
Likewise, Botswanas political history since independence has been rather
exceptional by African standards (Duncan, et al., 1997). As in other African
countries, independence was preceded by a multiparty election and Western-style
constitution, but it is unusual in that these were retained after independence. The
political process in Botswana has been for the most part democratic, with regu-
lar free elections and a range of political parties both within and outside parlia-
ment.
26
In Zimbabwe, social development came more as a natural consequence of
the liberation struggle; and the country has maintained a democratic framework
within a one-party dominant state. During the liberation struggle, new forms of
social organization emerged that encouraged popular participation under the aus-
pices of the liberation movements. After independence, popular participation was
mobilized and channelled by party and central-government programmes and
structures.
27
While both Botswana and Zimbabwe have a tradition of regular
democratic elections, both have remained one-party dominant states.
Cuba is a one-party state, while Malaysia and Korea (at least during the
relevant historical period) have been one-party dominant states. But even in
Cuba and Malaysia there has been scope for a public voice in the governance
process. Social mobilization by the cadres of the communist party, especially by
womens groups, was a key element of social progress in Cuba.
In Malaysia social development was the outcome of the states attempt to
correct the social and economic disadvantage of the Malay population based on
ethnicity. The dominant political party in Malaysia has indeed governed through
a coalition of parties, the other parties being essentially representative of the two
other major ethnic groups (Chinese and Indian).
28
In Korea, early social devel-
27
3
a
26
Botswana politics are indeed dominated by the Botswana Democratic Party, which has won every elec-
tion since 1964. The domination of the BDP seems to reflect the popular will, in that it has consistently
won an absolute majority of the vote.
27
Over the 1980s and 1990s, this increasingly shifted to more bureaucratic forms of participation in
response to central government policy.
28
A New Economic Policy was introduced after the race riots of 1969. The Policy was based on a strategy of
gradually redistributing wealth from growth rather than outright expropriation of the ethnic minorities. The
indigenous Malay population, which lived mainly in rural areas, was targeted to own at least 30 per cent of
the corporate wealth (companies with shareholders funds above Malaysian Ringit 2.5 mn were to allocate 30
per cent equity to Malays) and a similar proportion of modern-sector employment by 1990. To speed up
Bumiputra participation in the commercial sector, the government set up state enterprises that provided
employment opportunities at every level. Small and medium non-Bumiputra enterprises were basically unaf-
fected by this law and left to grow (Leong and Tan, 1997). The 20-year time frame, gradual approach, and
presence of escape routes for non-Bumiputra businesses helped to limit ethnic animosity towards the policy.
3
a
opment was driven by a military state (supported by the USA) facing a commu-
nist threat from the north; once set in motion the process was sustained by an
authoritarian state committed to economic growth. In other words, voice in
governance was a key element of success in all states except Korea.
It is important to emphasise here the distinction we have tried to draw above
between democracy and voice. Democracy has, unfortunately, come to mean
many things to many people. In fact, despite the considerable increase in the
number of states that became democratic in both Latin America and Sub-Saha-
ran Africa during the 1980s and early 1990s, there is no systematic evidence that
they are more progressive than the non-democratic states that preceded them.
That suggests that democracy in the conventional sense of regular
multi-party, free and fair elections is neither a necessary, nor a sufficient con-
dition but it helps. What is critical, however, is that there has to be a mech-
anism for the expression of the voice of the people.
29
The form of popular representation is one question. Another is whether a
particular structure of the organization of production is a necessary condition
of ensuring longevity and knowledge for the majority of the population. It is
noticeable that only one high-achiever was a centrally planned economy
Cuba. Of course, there are other developing countries with centrally planned
economies that have achieved health and education levels far superior to that
achieved by developing market economies at the same level of per capita
income, e.g. Vietnam, Mongolia, and the Central Asian states during the Sovi-
et period. In fact, among the small number of developing countries in the post-
war, post-colonial period that have been centrally planned, it is remarkable that
such a high proportion of them managed to achieve social indicators well above
those for other countries in the same income bracket.
30
In fact, almost all countries with centrally planned economies achieved
social indicators far better than might be expected by their level of per capital
income.
31
In that sense, the percentage of all countries with central planning that
were high-achievers compared to the overall percentage of high-achievers among
all countries is much higher. However, with the end of central planning as we
knew it whether mandatory or indicative and the shift in the dominant pol-
icy paradigm, the notion of now introducing centralized planning is a non-starter.
In fact, selected high-achievers were market economies. Given that the
vast majority of developing market economies in their region were unable to
match their improvements in social indicators, the lessons from the high-
achievers are particularly relevant for these market economies. Moreover, while
28
29
On the role of voice in improving the health sector, see Mehrotra and Jarret (2000).
30
If countries like Laos and Cambodia did not achieve significant improvements in social indicators, for
instance, a large part of the explanation must lie with the long-term effects of the war in Indo-China last-
ing over two decades and the continuing internal conflict even after 1975.
31
For an analysis of social achievement in three centrally planned economies (Vietnam, China, Cuba) see
Ghai (1997). The paper is based on case studies for UNRISD on these three countries, plus Sri Lanka,
Kerala, Costa Rica and Chile.
central planning may be unfashionable, we have demonstrated earlier that the
role of the state in these market economies in ensuring universal access to basic
services was paramount.
Another critical issue is whether economic growth is a necessary condition
of social development. We have already discussed above (section 2.1) how all
the selected countries made substantial improvements in their health and edu-
cation indicators early in their development process, when incomes were still
low. They all started as low-income countries. While some have graduated to
become middle-income countries, many of them (Cuba, Zimbabwe, Kerala,
Sri Lanka) have remained low-income countries, having experienced limited
economic growth.
In these slow-growing economies, while quantitative indicators of health
and education status have not been affected adversely, the quality of services does
seem to have been affected. Thus relative economic stagnation in Sri Lanka,
Kerala, Zimbabwe, and (in the 1990s) Cuba, has created problems for the social
sectors. In Sri Lanka, food subsidies and free health and education services were
made possible by heavy taxation of export plantation crops tea, rubber, and
coconut. When international commodity prices dipped in the late 1950s and the
1960s, and the balance of payments deteriorated, it became increasingly difficult
to sustain those expenditures. Nevertheless, because of the political difficulty of
cutting social expenditures and the food subsidy, the government continued to
heavily tax the plantation sector, and jeopardized the plantation industry (Alail-
ima and Sanderatne, 1997). Quite clearly, the economy needs to generate a sur-
plus for social investment (as the plantation sector did), but excessive surplus
extraction may lead to lower economic growth, ultimately causing a curtailment
of social expenditures.
Kerala offers similar lessons though for rather different reasons. Kerala
ranks ninth among the 25 states of India in terms of per capita income and has
had one of the lowest levels of industrialization. At the same time, trade union-
ism is common not only among industrial and public sector employees as in
other parts of India, but, unlike the rest of India, among agricultural workers.
It has even spread to the informal labour sector all aided by the high levels of
literacy. One outcome of unionization is that Kerala has the third highest wage
rate for agricultural workers in the country (after the bread-basket states of Pun-
jab and Haryana), and Kerala is the only state where real wages have nearly dou-
bled between 1960 and 1990. The result has been that the little industry that
existed has tended to shift to neighbouring states, and agricultural output has
been declining because it is cheaper for the state to import its food from the rest
of India (Krishnan, 1997). The overall result is that the economy has been prac-
tically stagnant since 1975. The scope for increasing public expenditure in order
to improve quality of services has been limited by slow growth.
Similarly, Zimbabwes per capita income growth was slightly negative
(0.2 per cent) over the 1980s. Hence the concern in the 1990s has shifted
from the social policy, distribution and equity concerns that dominated Zim-
29
3
a
3
a
babwe in the 1980s to aggregate growth and balance-of-payments concerns.
The adoption of a structural-adjustment programme has also limited social
expenditures, and there has been a rise in IMR and maternal mortality as real
health expenditures shrank and fees were introduced for health services
(Loewenson and Chisvo, 1997).
Clearly then, sustained improvements in the quality of services will require
increased per capita expenditures, especially if the population is still growing.
Increased per capita social expenditures - whether private or public - may be dif-
ficult to sustain in the absence of per capita income growth. In the absence of
sustained increase in per capita social expenditures, the quality and quantity of
services is likely to be impacted adversely. However, economic growth does not
automatically get translated into improvements in health and education status.
The example of oil-rich countries like Cameroon, Venezuela, Gabon and Nige-
ria demonstrated that windfall gains (from oil-price increases in the 1970s) can
be wasted, while Brazils example shows that the fruits of rapid economic
growth (e.g. in the late 60s and 70s) may not be shared equally.
Turning to another possible explanation of the success of social policies in
the high-achievers, an argument could be made that one reason for their success
was their relatively small size in terms of territory or population and hence
their manageability in terms of the scale and magnitude of problems facing pol-
icy-makers. While this argument may possibly hold for two of the cases that are
island states (Barbados and Mauritius), it is hardly valid for the remaining coun-
tries. Large populations are not typical for developing countries there are no
more than 15 developing countries with populations larger than 50 million
and the vast majority of these smaller states have social indicators that are worse
than those in the high-achievers. The population size of the selected countries
exhibits considerable range and is comparable to the population of most other
countries in their region. Malaysia has 20 million people, while Korea has 45
million people only Indonesia has a population in the East Asia region that is
significantly larger than Korea. In South Asia, the relevant comparison is not
with countries per se, but with states within countries, which usually have sim-
ilar populations. Kerala (30 million) and Sri Lanka (18 million) have popula-
tions comparable to those in a province of India or Pakistan.
Zimbabwes population (10 million) is larger and Botswanas (1.4 million)
smaller than that of the average African country. A small minority of African
countries have a population exceeding 10 million (Nigeria, Ethiopia and South
Africa among them). Among the Latin American cases, Costa Rica has a pop-
ulation similar to those found in Central America; Barbados is not very differ-
ent from other Caribbean island states, and Cubas population is that of a
median population for countries in Latin America. Clearly then, to the ques-
tion: is a small population size a necessary condition for rapid improvement in
health and education in a developing country, the answer must be no.
A final point: could it be argued that ethnic homogeneity is a necessary
30
condition for the state to potentially follow polices which promote human
development?It has been argued, for instance, that one reason why Botswana
was able to successfully pursue human development policies was that, more
than any other country in Africa, it is dominated by one ethnic group the
Batswana. It could also be argued that ethnic divisions are not an issue in
Korea or Cuba. However, most countries among the high-achievers had
racially or linguistically mixed populations Malaysia, Sri Lanka, Kerala
(with its caste conflicts), Zimbabwe, Mauritius or Costa Rica. Clearly, con-
flict between linguistic or racial groups is a complicating factor, but these
countries have demonstrated that there are policy instruments at hand to
allow skilful handling of those conflicts.
One can see from the preceding analysis that it is difficult to establish any
common characteristics as providing reasons for success: neither the organiza-
tional form of the government, nor organizational form of the economy, nor
geographic size, nor social composition. However, in the earlier sections we did
establish some commonality or good practices in economic and social policy.
6. Summary and Reflections on Replicability of Good Practices
We derived five principles of good social policy, and a number of good practices,
based on the experience of the high-achieving developing countries. However,
before we summarize them, we need to note the over-arching principle which
provided the foundation for the development strategy: these countries did not
give priority to achieving economic growth or macro-economic stability first,
while postponing social development.
32
The high-achievers demonstrate that it
is possible for countries to relieve the non-income dimensions of poverty, and
achieve social indicators comparable to those of industrialized countries, regard-
less of the level of income. The poor should not have to wait for the benefits of
growth. We do not downplay economic growth but, for the Washington Con-
sensus, per capita income growth is a predominant part of the strategy, since
proponents of the Consensus believe there is no general tendency for distribu-
tion to worsen with growth and that distribution remains stable over long
periods of time (Deininger and Squire, 1996). We have seen, however, that
there are plenty of historical cases of episodes of economic growth that have not
translated into improvements in health and education status.
33
We have argued
31
3
a
32
This is one respect in which our conclusions differ from those of the Washington Consensus. Leading
researchers in the World Bank suggest that economic growth typically promote[s] human development,
and a strong positive relationship is evident from the line of best fit (the regression). It is acknowledged
that there are deviations (the residuals) around this line; these are cases with unusually low, or unusually
high, performance in human development at a given level of income or a given rate of economic growth.
(Ravallion, 1997). They argue that the human development approach espoused in the current paper
devotes more attention to residuals and the regression line is ignored.
33
Cornia (2000) argues that the Deininger and Squire formulation is highly questionable in any case. In
an analysis of 77 countries he demonstrates that income inequality has worsened in 45 countries.
3
a
elsewhere (Taylor, Mehrotra and Delamonica, 1997) that broad-based pover-
ty-reducing growth has rarely occurred on a sustained basis in the absence of
the universal availability of social basic services.
The five principles of good social and economic policy we derived are:
1. The pre-eminent role of public action, regardless of whether it took place in a
centrally planned economy or a market economy. The experience of the indus-
trialized countries from a comparable period of development offers the same
insight.
2. While the level of social spending is important for health and education out-
comes, the equity of the intra-sectoral spending pattern matters even more.
34
The social investment was also protected during times of economic crisis as
well as structural adjustment.
3. Efficiency in the utilization of human and financial resources needs to be
practised if social spending is not to become a burden on the state exche-
quer. A number of specific good practices in both health and education sec-
tors ensured both allocative and technical efficiency in resource use.
4. There seemed to be a sequence of social investment: educational achieve-
ment preceded, or took place at the same time as the introduction of health
interventions. The separate sectoral interventions had a synergistic impact
on health, educational and nutrition status of the population, i.e. the sum
of their impact was greater than the effects of the individual interventions.
5. Women were equal agents of change, and not mere beneficiaries of a welfare
state.
Underlying each of these principles were specific good practices of social
policy. We found that the worst manifestations of poverty preventable child
deaths, the powerlessness of illiteracy and debilitation of ill-health were
relieved in the selected countries for almost the entire population. However,
with the exception of Cuba, Mauritius, Korea and Malaysia, income-poverty
remained more stubborn, although it certainly declined in most of the ten
selected countries. Where income-poverty has been resistant, the pace of eco-
nomic growth has been relatively slow. In fact, if there is one over-arching prin-
ciple emerging from the historical experience of the high-achievers, it is that
there is little prospect of the synergy between economic growth, income-pover-
ty-reduction and health/education advance being realised without integrating
macro-economic and social policy. If economic growth is the dominant objec-
tive with macro-economic policy determined first (with the Ministry of
Finance in the lead) with social policy trailing behind this synergy cannot
take place.
What is the potential for replication, and what kind of general insights
34
The level of social spending is often determined by such unproductive expenditures as defence (which
we found is generally low in the high-achievers) and external debt servicing (of particular significance
today in the Highly Indebted Poor Countries).
32
can be learned about processes taking place?What does it take to transfer the
specific good practices to other areas?We suggest that economic growth is a
necessary condition of sustainedimprovement in health and education indica-
tors and in the quality of social services, but it is neither a necessary nor a suf-
ficient condition for the take-off in social development.
The harder issue to resolve is what kind of political system (as opposed to
political commitment) is most conducive to the replication of these good prac-
tices. While voice in the decision-making process is a pre-requisite, the more
difficult question is how that voice is articulated. Clearly, a democratic system
alone is not sufficient, though we found that it was definitely helpful.
35
The only general insight that we can safely draw is that the causes and
driving forces behind social success were historical, and very specific to the
country in question. The social forces that combined to produce the revolu-
tionary changes within a matter of decades in these high-achievers can be
understood in a national context, but can hardly be replicated. Social forces
cannot be conjured up, nor can any amount of social engineering help to cre-
ate them. Policies, however, can be replicated. Hence this paper has focused
on those social policy principles and good practices that any state would need
to adopt in order to address some key elements of human development in
developing countries.
33
3
a
35
That it is not sufficient becomes clear from a contrast in the social indicators between two states in India:
West Bengal and Kerala. Both have had regular elections to the state legislature and both have a long tradi-
tion of multi-party politics. For over twenty years, West Bengal has had a government of the Left Front, of
which the dominant member is the Communist Party of India (Marxist). While this government has done
much to secure the tenancy rights of small-holder tenant farmers (which are extremely insecure in other
non-Communist ruled states in India), the health and education indicators in the state are not much bet-
ter than in the poorest states of northern Indias Hindi belt (Sengupta and Gazdar, 1998). Kerala, on the
other hand, is a high-achiever in terms of social indicators, as we have seen. Perhaps the fact that the Com-
munist Party in West Bengal has hardly faced any serious opposition, and has been continuously in power
for over 20 years may explain some of this difference. In contrast, in Kerala, the electoral competition
between Left Front governments and the Congress has led to each party internalising the social agenda.
3
a
References
Alailima, P. and Sanderatne, N. (1997), Social Policies in a Slowly Growing
Economy: Sri Lanka in Mehrotra, S. and Jolly, R. (eds.).
Amsden, A.H. (1992), A Theory of Government Intervention in Late Indus-
trialisation, in L. Putterman and D. Reuschenreyes (eds.), Stateand Mar-
ket in Development; Synergy or Rivalry?Lynne Rienner Publishers, Boul-
der, Colorado, and London.
Bishop, M.D., Corbin, R., and Duncan, N.C. (1997), Barbados: Social
Development in a Small Island State in Mehrotra, S. and Jolly, R. (eds.).
Caldwell, J.C. (1986), Routes to Low Mortality in Poor Countries in Popula-
tion and Development Review, 12/2.
Choon Heng, L. and Siew Hoey, T. (1997), Malaysia: Social Development,
Poverty Reduction, and Economic Transformation in Mehrotra, S. and
Jolly, R. (eds.).
Chung, Fay (1993), Educational Expansion, Cost Considerations and Cur-
riculum Development in Zimbabwe in Jill K. Conway and S.B. Bourque
(eds.), ThePoliticsof Women: Education Perspectivesfrom Asia, Africa and
Latin America, University of Michigan Press.
Cornia, A. (2000), Inequality and Poverty in the Era of Liberalisation and
Globalisation. Paper presented at the UNU Millenium Conference On
the Threshold: the United Nations and Global Governance in the New
Millenium, Tokyo, 19-21 January 2000.
Cornia, G.A., Jolly, R., and Stewart, F. (1987), Adjustment with a Human Face,
Oxford University Press, Oxford.
Corsini, C.A. and Viazzo, P.P. (1997), TheDeclineof Infant and Child Mortal-
ity: TheEuropean Experience: 1750-1990, Martinus Nijhoff Publishers,
The Hague.
Deininger, K. and Squire, L. (1996), A New Data Set for Measuring Income
Inequality, World Bank Economic Review10 (3):565-91.
Duncan, T., Jefferis, K., and Molutsi, P. (1997), Botswana: Social Develop-
ment in a Resource-rich Economy in Mehrotra, S. and Jolly, R. (eds.).
Dreze, J. and Gazdar, H. (1998), Uttar Pradesh: The Burden of Inertia, in
J.Dreze and A. Sen (eds.), Indian Development. Selected Regional Pespec-
tives, Oxford India Paperback, New Delhi.
Garnier, L., Grynspan, R., Hidalgo, R., Monge, G. and Trejos, J.D. (1997),
Costa Rica: Social Development and Heterodox Adjustment in Mehro-
tra, S. and Jolly, R. (eds.).
Ghai, D. (1997), Social Development and Public Policy. Some Lessons from
Successful Experience, UNSRID Discussion Paper 89, Geneva.
34
Green, A. (1990), Education and StateFormation: theRiseof Education Systems
in England, Franceand in theUSA, St. Martins Press, New York.
IFAD (1992), TheStateof World Rural Poverty, Geneva
Jayarajah, C., Branson, W., and Sen, B. (1996), Social Dimension of Adjust-
ment. World Bank Experience, 1980-93, World Bank Operations Evalu-
ations Study, Washington, D.C.
Jose, A.V. (1985), Poverty and Inequality: The Case of Kerala, in A.R. Khan
and Eddy Lee (eds.), in Poverty in Rural Asia, ILO-ARTEP, New Delhi.
Joseph, S. (1985), The Case for Clinical Services, in Scott B. Halstead, Julia
A. Walsh, and Kenneth S. Warren (eds.), Good Health at Low Cost, Rock-
feller Foundation, New York.
Kaser, M., and Mehrotra, S. (1997) The Central Asian Economies since Inde-
pendence in Allison, R. (eds.) Challenges in theFormer Soviet Union,
Brookings Institution Press, Washington, D.C.
Krishnan, T.N. (1997), The Route to Social Development in Kerala: Social
Intermediation and Public Action in Mehrotra, S. and Jolly, R. (eds.).
Loewenson, R. and Chisvo, M. (1997), Rapid Social Transformation despite
Economic Adjustment and Slow Growth: the Experience of Zimbabwe in
Mehrotra and Jolly (eds.).
Mehrotra, S. and Jolly, R. (eds.) (1997), Development with a Human Face,
Clarendon Press, Oxford.
Mehrotra, S., Park, I., and Baek, H. (1997), Social Policies in a Growing
Economy: the Role of the State in the Republic of Korea in Mehrotra, S.
and Jolly, R. (eds.).
Mehrotra, S. (1997a), Social Development in High-Achieving Countries:
Common Elements and Diversities, in Mehrotra and Jolly (eds.).
Mehrotra, S. (1997b), Health and Education Policies in High-Achieving
Countries, in Mehrotra and Jolly (eds.).
Mehrotra, S. (1997c), Human Development in Cuba: Growing Risks of
Reversal, in Mehrotra and Jolly (eds.).
Mehrotra, S. and Delamonica, E (1998), Household Costs and Public Expen-
diture on Primary Education in Five Low Income Countries: A Compar-
ative Analysis, in International Journal of Educational Development. 18(1)
pp. 41-61.
Mehrotra, S. (1998), Education for All: Policy Lessons from High-Achieving
Countries in International Review of Education, Volume 44, Issue 5/6,
pp. 461-484.
Mehrotra, S., and Delamonica, E., (forthcoming) Basic Servicesfor All? Public
Spendingand theSocial Dimensionsof Poverty, UNICEF.
35
3
a
3
a
Mehrotra, S., and Jarrett, S. (2000), Improving Health Services in Low-
Income Countries: A Voice for the Poor, Social Scienceand Medicine.
Mesa-Lago, Carmelo (1997), The Social Safety Net in the Two Cuban Tran-
sitions, in Transitionsin Cuba: New Challengesfor U.S. Policies, Florida
International University, Cuban Research Institute.
Polanyi, K. (1944), TheGreat Transformation: thePolitical and Economic Ori-
ginsof our Times, Reinhart, New York.
Preston, S.H. and Haines, M.R., (1991), Fatal Years: Child Mortality in Late
Nineteenth Century America, Princeton University Press, Princeton, NJ.
Psacharopoulos, G. (1985), Returns to Education: A Further Update and
Implications, Journal of Human Resources, 20/4.
Ravallion, M. (1997), Good and Bad Growth: The Human Development
Reports in World Development, Volume 25, issue 5, pp. 631-638.
Sen, A. (1995), Agency and Well-being: The Development Agenda in Noeleen
Heyzer with Sushma Kapoor and J. Sandler, A Commitment to theWorlds
Women Perspectivesfor Development for Beijingand Beyond, UNIFEM,
New York.
Sen, A.(1999) Investing in Health, General Keynote Speech at 52
nd
World
Health Assembly, May 1999.
Sengupta, S. and Gazdar, H., Agrarian Politics and Rural Development in
West Bengal in J. Dreze and A. Sen (eds.) Indian Development. Selected
Regional Perspectives, Oxford India Paperbacks.
Taylor, L., Mehrotra, S. and Delemonica, E., (1997), The Links between Eco-
nomic Growth, Poverty Reduction and Social Development: Theory and
Practice, in Mehrotra and Jolly (eds.).
UNDP (1998), Human Development Report 1998, New York.
Wade, R. (1990), GoverningtheMarket: Economic Theory and theRoleof the
Government in East Asian Industrialisation, Princeton University Press.
World Bank (1993a), TheEast Asian Miracle, Washington, D.C.
World Bank (1993b), Investing in Health, World Development Report, Wash-
ington, D.C.
World Bank (1994), Adjustment in Africa: Reforms, Results, and theRoad Ahead,
Oxford University Press, Oxford.
World Bank (1995), World Development Report, Oxford University Press, Oxford.
36
Innocenti Working Papers
The papers in this series (ISSN 1014-7837) are all available in English. (Papers
prior to number 72 were known as Innocenti Occasional Papers.) Papers 63
onwards are available for download as .pdf files from the Innocenti Research Cen-
tre web site (www.unicef-icdc.org). Individual copies are available from: Commu-
nication Unit, UNICEF Innocenti Research Centre, Piazza SS. Annunziata 12,
50122 Florence, Italy. E-mail: [email protected]. Fax +39 055-24-48-17.
EPS 1 Economic Declineand Child Survival: ThePlight of Latin America in the
Eighties. Teresa Albanez, Eduardo Bustelo, Giovanni Andrea Cornia
and Eva Jespersen. (March 1989).
EPS 2 Child Poverty and Deprivation in Industrialized Countries: Recent Trends
and Policy Options. Giovanni Andrea Cornia. (March 1990). Also avail-
able in French and Spanish.
EPS 3 Education, Skillsand Industrial Development in theStructural Transfor-
mation of Africa. Sanjaya Lall. (July 1990).
EPS 4 Rural Differentiation, Poverty and Agricultural Crisis in Sub-Saharan
Africa: Toward An AppropriatePolicy Response. Giovanni Andrea Cornia
and Richard Strickland. (July 1990).
EPS 5 Increased Aid Flowsand Human ResourceDevelopment in Africa. Paul
Mosley. (August 1990).
EPS 6 Child Poverty and Deprivation in Italy: 1950 to thePresent. Chiara Sara-
ceno. (September 1990). Also available in Italian.
EPS 7 Toward Structural Transformation with a Human Focus: TheEconomic
Programmesand Policiesof Zambia in the1980s. Venkatesh Seshamani.
(October 1990).
EPS 8 Child Poverty and Deprivation in theUK. Jonathan Bradshaw. (October
1990).
EPS 9 Adjustment Policies in Tanzania, 1981-1989: TheImpact on Growth,
Structureand Human Welfare. Jumanne H. Wagao. (October 1990).
EPS10 TheCausesand Consequencesof Child Poverty in theUnited States. Shel-
don Danziger and Jonathan Stern. (November 1990).
EPS 11 TheFiscal System, Adjustment and thePoor. Giovanni Andrea Cornia
and Frances Stewart. (November 1990).
EPS 12 TheHealth Sector and Social Policy Reform in thePhilippinessince1985.
Wilfredo G. Nuqui. (January 1991).
EPS 13 TheImpact of Economic Crisisand Adjustment on Health Carein Mexi-
co. Carlos Cruz Rivero, Rafael Lozano Ascencio and Julio Querol Vina-
gre. (February 1991).
EPS 14 Structural Adjustment, Growth and Welfare: TheCaseof Niger, 1982-
1989. Kiari Liman-Tinguiri. (March 1991).
EPS 15 TheImpact of Self-Imposed Adjustment: TheCaseof Burkina Faso, 1983-
1989. Kimseyinga Savadogo and Claude Wetta. (April 1991).
37
3
a
3
a
EPS 16 Liberalization for Development: Zimbabwes Adjustment without the
Fund. Robert Davies, David Sanders and Timothy Shaw. (May 1991).
EPS 17 Fiscal Shock, WageCompression and Structural Reform: Mexican Adjust-
ment and Educational Policy in the 1980s. Fernando Valerio. (June
1991).
EPS 18 Patternsof Government Expenditurein DevelopingCountriesduringthe
1980s: TheImpact on Social Services. Beth Ebel. (July 1991).
EPS 19 Ecuador: Crisis, Adjustment and Social Policy in the1980s. The Ecuado-
rian Centre of Social Research. (August 1991).
EPS 20 Government Expendituresfor Children and Their Familiesin Advanced
Industrialized Countries, 1960-85. Sheila B. Kamerman and Alfred J.
Kahn. (September 1991).
EPS 21 IsAdjustment Conduciveto Long-term Development?: TheCaseof Africa
in the1980s. Giovanni Andrea Cornia. (October 1991).
EPS 22 Children in theWelfareState: Current Problemsand Prospectsin Sweden.
Sven E. Olsson and Roland Spnt. (December 1991).
EPS 23 EradicatingChild Malnutrition: ThailandsHealth, Nutrition and Pover-
ty Alleviation Policy in the1980s. Thienchay Kiranandana and Kraisid
Tontisirin. (January 1992).
EPS 24 Child Welfareand theSocialist Experiment: Social and Economic Trendsin
theUSSR, 1950-90. Alexandr Riazantsev, Sndor Sipos and Oleg Labet-
sky. (February 1992).
EPS 25 ImprovingNutrition in Tanzania in the1980s: TheIringa Experience.
Olivia Yambi and Raphael Mlolwa. (March 1992).
EPS 26 Growth, IncomeDistribution and Household Welfarein theIndustrialized
CountriessincetheFirst Oil Shock. Andrea Boltho. (April 1992).
EPS 27 Trendsin theStructureand Stability of theFamily from 1950 to thePre-
sent: TheImpact on Child Welfare. Chiara Saraceno. (May 1992).
EPS 28 Child Poverty and Deprivation in Portugal: A National Case Study.
Manuela Silva. (June 1992).
EPS 29 Poverty Measurement in Central and Eastern EuropebeforetheTransition
to theMarket Economy. Sndor Sipos. (July 1992).
EPS 30 TheEconomicsof Disarmament: Prospects, Problemsand Policiesfor the
Disarmament Dividend. Saadet Deger. (August 1992).
EPS 31 External Debt, Fiscal Drainageand Child Welfare: Trendsand Policy Pro-
posals. Stephany Griffith-Jones. (September 1992).
EPS 32 Social Policy and Child Poverty: Hungary since1945. Jlia Szalai. (Octo-
ber 1992).
EPS 33 TheDistributiveImpact of Fiscal and Labour Market Policies: Chiles
1990-91 Reforms. Mariana Schkolnik. (November 1992).
EPS 34 Changesin Health CareFinancingand Health Status: TheCaseof China
in the1980s. Yu Dezhi. (December 1992).
EPS 35 Decentralization and Community Participation for ImprovingAccess to
Basic Services: An Empirical Approach. Housainou Taal. (January 1993).
38
EPS 36 Two Errorsof Targeting. Giovanni Andrea Cornia and Frances Stewart.
(March 1993).
EPS 37 Education and theMarket: Which Partsof theNeoliberal Solution areCor-
rect?Christopher Colclough. (July 1993).
EPS 38 Policy and Capital Market Constraintsto theAfrican Green Revolution: A
Study of Maizeand Sorghum Yieldsin Kenya, Malawi and Zimbabwe,
1960-91. Paul Mosley. (December 1993).
EPS 39 Tax Reformsand Equity in Latin America: A Review of the1980sand Pro-
posalsfor the1990s. Ricardo Carciofi and Oscar Cetrngolo. (January
1994).
EPS 40 Macroeconomic Policy, Poverty Alleviation and Long-term Development:
Latin America in the 1990s. Giovanni Andrea Cornia. (February
1994).
EPS 41 RformesFiscales, Gnration deRessourceset Equiten AfriqueSubsa-
harienne durant les Annes 1980. Kiari Liman-Tinguiri. (March
1994).
EPS 42 Tax Reform and Equity in Asia: TheExperienceof the1980s. Andrea
Manuelli. (April 1994).
EPS 43 Family Support Policiesin Transitional Economies: Challengesand Con-
straints. Gspr Fajth. (August 1994).
EPS 44 IncomeDistribution, Poverty and Welfarein Transitional Economies: A
Comparison between Eastern Europeand China. Giovanni Andrea Cor-
nia. (October 1994).
EPS 45 Death in Transition: TheRisein theDeath Ratein Russia since1992.
Jacob Nell and Kitty Stewart. (December 1994).
EPS 46 Child Well-beingin Japan: TheHigh Cost of Economic Success. Martha N.
Ozawa and Shigemi Kono. (March 1995).
EPS 47 Ugly Factsand Fancy Theories: Children and Youth duringtheTransition.
Giovanni Andrea Cornia. (April 1995).
EPS 48 East JoinsWest: Child Welfareand Market Reformsin theSpecial Case of
theFormer GDR. Bernhard Nauck and Magdalena Joos. (June 1995).
EPS 49 TheDemographic Impact of Sudden Impoverishment: Eastern Europedur-
ingthe1989-94 Transition. Giovanni Andrea Cornia and Renato Pan-
icci. (July 1995).
EPS 50 Market Reformsand Social Welfarein theCzech Republic: A TrueSuccess
Story? Miroslav Hirsl, Jir Rusnok and Martin Fassmann. (August
1995).
EPS 51 TheWindingRoad to theMarket: Transition and theSituation of Children
in Bulgaria. Theodora Ivanova Noncheva. (August 1995).
EPS 52 Child Institutionalization and Child Protection in Central and Eastern
Europe. Mary Anne Burke. (September 1995).
EPS 53 Economic Transition in theBaltics: Independence, Market Reformsand
Child Well-beingin Lithuania. Romas Lazutka and Zita Sniukstiene.
(September 1995).
39
3
a
3
a
EPS 54 Economic Reforms and Family Well-being in Belarus: Caught between
Legacies and Prospects. Galina I. Gasyuk and Antonina P. Morova.
(December 1995).
EPS 55 The Transition in Georgia: From Collapse to Optimism. Teimuraz
Gogishvili, Joseph Gogodze and Amiran Tsakadze. (September 1996).
EPS 56 Children at Risk in Romania: ProblemsOld and New. Elena Zamfir and
Catalin Zamfir. (September 1996).
EPS 57 Children in Difficult Circumstancesin Poland. Stanislawa Golinowska,
Boz
.
ena Balcerzak-Paradowska, Boz
.
ena Kolaczek and Dorota Glogosz.
(December 1996).
EPS 58 TheImplicationsof ExhaustingUnemployment InsuranceEntitlement in
Hungary. John Micklewright and Gyula Nagy. (September 1997).
EPS 59 Are Intergovernmental Transfers in Russia Equalizing? Kitty Stewart.
(September 1997).
EPS 60 Marital Splitsand IncomeChanges: Evidencefor Britain. Sarah Jarvis and
Stephen P. Jenkins. (September 1997).
EPS 61 Decentralization: A Survey from a Child WelfarePerspective. Jeni Klug-
man. (September 1997).
EPS 62 LivingStandardsand Public Policy in Central Asia: What Can BeLearned
from Child Anthropometry? Suraiya Ismail and John Micklewright.
(November 1997).
EPS 63 Targeting Social Assistancein a Transition Economy: TheMahallas in
Uzbekistan. Aline Coudouel, Sheila Marnie and John Micklewright.
(August 1998).
EPS 64 Income Inequality and Mobility in Hungary, 1992-96. Pter Galasi.
(August 1998).
EPS 65 Accountingfor theFamily: TheTreatment of Marriageand Children in
European IncomeTax Systems. Cathal ODonoghue and Holly Suther-
land. (September 1998).
EPS 66 Child Poverty in Spain: What Can BeSaid?Olga Cant-Snchez and
Magda Mercader-Prats. (September 1998).
EPS 67 TheEducation of Children with Special Needs: Barriersand Opportunities
in Central and Eastern Europe. Mel Ainscow and Memmenasha Haile-
Giorgis. (September 1998).
EPS 68 EMU, Macroeconomicsand Children. A.B. Atkinson. (December 1998).
EPS 69 IsChild WelfareConvergingin theEuropean Union?John Micklewright
and Kitty Stewart. (May 1999).
EPS 70 IncomeDistribution, Economic Systemsand Transition. John Flemming
and John Micklewright. (May 1999).
EPS 71 Child Poverty acrossIndustrialized Nations. Bruce Bradbury and Markus
Jntti. (September 1999).
IWP 72 Regional Monitoring of Child and Family Well-Being: UNICEFs
MONEE Project in CEE and the CIS in a Comparative Perspective.
Gspr Fajth (January 2000).
40
IWP 73 Macroeconomics and Data on Children. John Micklewright. (January
2000). Available as a .pdf file only from http://www.unicef-icdc.org
IWP 74 Education, Inequality and Transition. John Micklewright. (January
2000). Available as a .pdf file only from http://www.unicef-icdc.org
IWP 75 Child Well-Beingin theEU and Enlargement to theEast. John Mick-
lewright and Kitty Stewart. (February 2000).
IWP 76 From Security to Uncertainty: TheImpact of Economic Changeon Child
Welfarein Central Asia. Jane Falkingham. (May 2000).
IWP 77 How EffectiveistheBritish GovernmentsAttempt to ReduceChild Pover-
ty? David Piachaud and Holly Sutherland. (June 2000).
IWP 78 Child Poverty Dynamics in Seven Nations. Bruce Bradbury, Stephen
Jenkins and John Micklewright. (June 2000).
IWP 79 What istheEffect of Child Labour on LearningAchievement? Evidence
from Ghana. Christopher Heady (October 2000).
IWP 80 Integrating Economic and Social Policy: Good Practices from High-
AchievingCountries. Santosh Mehrotra (October 2000).
41
3
a
A
FRO
I
INTEGRATING ECONOMIC
AND SOCIAL POLICY:
GOOD PRACTICES FROM
HIGH-ACHIEVING COUNTRIES
This paper examines the successes of ten high-
achievers countries with social indicators far high-
er than might be expected given their national
wealth. Their progress in such fields as education and
health offers lessons for social policy elsewhere in the
developing world. Based on UNICEF-supported
studies in each country, the paper shows how, in the
space of fifty years, these high-achievers have made
advances in health and education that took nearly
200 years in the industrialized world. It pinpoints the
policies that have contributed to this success poli-
cies that could be replicated elsewhere.
UNICEF Innocenti Research Centre
Piazza SS. Annunziata, 12
50122 Florence, Italy
Tel.: +39 055 203 30
Fax: +39 055 244 817
E-mail (general information): [email protected]
E-mail (publication orders): [email protected]
Website: www.unicef-icdc.org
ISSN: 1014-7837

Integrating Economic and Social Policy: Good Practices From High-Achieving Countries

Uploaded by

Copyright:

Available Formats

Integrating Economic and Social Policy: Good Practices From High-Achieving Countries

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Integrating Economic and Social Policy: Good Practices From High-Achieving Countries

Uploaded by

Copyright:

Available Formats

INTEGRATING

You might also like