‘High achievers’ prioritise social policy

Costa Rica, Cuba, Barbados, Sri Lanka, South Korea, Malaysia, Mauritius, Botswana, Zimbabwe and Kerala (India) have succeeded in improving child welfare to a much higher level than might be expected given their national wealth. They are 'high-achievers' in social policy: in 50 years they have made advances in health and education that took 200 years in the industrialised world.

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Research from the United Nations Development Programme (UNDP) asks what lessons can these countries offer other low-income nations. As the UNDP's Human Development Indicators show, these ten countries have comparable indicators to those of developed countries. They reduced non-income poverty by improving child health and education early in their development despite the fact that incomes were not growing rapidly at the same time. Countries such as South Korea, Malaysia, Mauritius and Costa Rica sustained social investment at relatively high levels - even during the economic crisis in the early 1980s and the structural adjustment period. Also, defence expenditure was low between 1978 and 1993, freeing up resources for social investment.

Although economic growth is a necessary condition for sustained improvement in health and education levels and quality of social services, it is neither a necessary nor sufficient condition for the 'take-off' in social development. For instance, Brazil's per capita income is much higher than China's or Sri Lanka's but it has a much lower life expectancy. Macroeconomic policy cannot be determined first with social policy left to take care of its human consequences. Furthermore, evidence from South Korea, Malaysia and Mauritius shows social investment underpins economic growth and that broad-based poverty-reducing growth without basic social services is rare.

Countries could improve child welfare by following the six policy principles common to the high-achieving countries:

• Integrated approaches in health, nutrition, water and sanitation, fertility control and education complement each other and help to achieve higher well-being. In a Nigerian village, for example, life expectancy at birth improved between 20 to 33 percent when illiterate mothers could access either health or educational facilities but it improved by 87 percent when both health and education were provided.
• Sequencing social investment improves its effectiveness: educational achievement that precedes or happens at the same time as health interventions ensures that people demand and use health services widely. South Korea did not have a public health system before 1976, but its literacy rate was already at 90 percent by 1970. Following investment in public health, infant mortality rate dropped from 53 in 1970 to 17 by 1980.
• A strong role by the state and a vibrant civil society helps to reduce child poverty. In one-party Cuba, social mobilisation - particularly by women's groups - was key to the country's social progress. While democracy is not a necessary condition for social progress, it does help and it is critical to have a mechanism for people to express themselves.
• Equitable spending within each social sector is as important as maintaining high levels of social spending: allocating sufficient resources to primary and preventive health care, primary education and rural areas was a key feature in all the high-achievers in contrast to most developing countries where referral and teaching hospitals or higher education are prioritised.
• Human and financial resources have to be used efficiently to prevent social spending from creating fiscal burdens. Zimbabwe met its shortage of teachers by having trainee teachers spend training period actually teaching in schools.
• Women's role as active agents of change has to be encouraged to improve children's health and education. Women's freedom to work outside the home, earn an independent income, have ownership rights and be educated leads, for example, to more female health workers and teachers, which in turn increases the number of women and girls using these services.

Santosh Mehrotra
Regional Centre for Asia
United Nations Development Programme
UN Building
Bangkok
Thailand
T +66 (0)2 288 2736
F +66 (0)2 288 3032
santosh.mehrotra@undp.org

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