Overcoming the adolescent financing gap:
The Burundi investment case
Adolescence (10-19 years) is a make or break period when individuals begin to consolidate their physical, cognitive, emotional and socio-economic foundations that will shape their lives. Adolescence is a critical period as many individuals never fully recover from any developmental shortcomings they experience. Yet in today’s world, many adolescents lack access to critical services in health, education, psycho-social support, parental guidance and an enabling environment that would adequately prepare them for a safe transition to adulthood.
The World Bank Human Capital Project and the African Union roadmap on taking full advantage of the demographic dividend recognize the importance of investing in young people as a necessary condition for the realization of several national goals and the SDGs. Nonetheless, a yawning gap exists between this understanding and the reality in several countries. Expenditure on social services are widely perceived as costs with no tangible public returns, at least in the short run. As a result, there is usually a tendency to underinvest in building human capital in favor of items such as roads or bridges for which benefits are more tangible and immediate, and which also tend to be politically more expedient.
In an effort to draw attention to this investment gap and the practical implications of the lack of investment, the UNICEF Country Office in Burundi, working in coordination with government ministries (under the leadership of the Ministry of Youth, Posts and Information Technology) and other development partners (UNFPA, UN Women and UNDP) have recently undertaken an investment case for adolescents in the country.
Burundi currently faces many challenging socio-economic conditions as it recovers from a period of social and political instability. GDP per capita was estimated at about $262 in 2019, down from $305 in 2015 (WB, 2020). Burundi is ranked 185 out of 189 countries on the UNDP Human Development Index of 2019; and ranked 138 out of 157 on World Bank Human Capital Index of 2018. Adolescents make up about 25 per cent of the population, of which about 30 per cent are already out of school. Only 10 per cent of the relevant age cohort complete secondary education, and there are many issues relating to the quality of education. Adolescent mortality rate is 277 per 100,000, ranking 172 out of 183 countries by WHO in 2017. Malaria and tuberculosis account for 27 per cent and 25 per cent respectively of these deaths. Among males, the death rate due to road accident is 24 per 100,000. About 9 per cent of girls 15-19 are mothers with an unmet need for family planning at 55 per cent and maternal conditons account for 21 deaths per 100,000 girls of ages 15-19.
Burundi’s investment case focuses on interventions aimed at improving the health and education/skills acquisition of adolescent girls and boys. The health interventions include preventive and curative strategies relating to reproductive health, maternal and child health, malaria, mental helath, HIV/AIDS, tuberculosis, human papillomavirus (HPV), and road accidents. The education interventions include those targeted at formal education: teaching and learning, school infrastrucuture and cash for the poorest students; and those targeted at non-formal education: social innovation and entrepreneurship, trade certificates and professional training.
Direct benefits of the health interventions are estimated using the OneHealth Tool which takes into account current prevalence of each condition and the morbidity and mortality that can be averted by adopting various tested interventions[i]. All together, the health intervenitons are expected to lead to:
- a reduction in the adolescent fertility rate by 23.7 per cent resulting in 25,817 fewer (usually unplanned) births;
- 1,361 stillbirths and 1,580 newborn deaths to adolescent mothers averted;
- 75 maternal deaths of adolescents averted;
- 15,157 fewer children of adolescents stunted;
- 6,300 adolescents lives saved from tuberculosis;
- 1,500 adolescent lives saved from road traffic injuries;
- 5,798 adolescents saved from serious disability from road traffic crashes; and
- 16,842 lives saved form cervical cancer over the lifetime of the targeted cohort.
The education interventions, compared to following the status-quo, are projected to achieve:
- Increase in school enrolment of adolescents (15-19) from a current level of 55 per cent to 71 per cent by 2030;
- Reduction from 30 per cent to 11 per cent of students leaving school with only primary education;
- 350,000 additional beneficiaries acquire a trade certificate;
- 40,000 adolescents acquire vocational training; and
- productivity of males aged 20-24 in 2050 increased by 85.9 per cent while that of females aged 20-24 in the same year is increased by 102.2 per cent.
Put together, the health and education interventions would inevitably result in a healthier and more productive labour force that can transform the economic fortunes of the country in the coming decades. The total (cumulative) cost for financing all the proposed interventions up to 2030 is about USD 1.2 billion (approximately $124 million per annum), which is modest compared to all the immediate benefits enumerated above. What is even more reassuring is the fact that the estimated economic value and social benefits from these investments are more than tenfold the cost.
The results of the modeling framework show that, an annual investment of $8.8 million in the health interventions over the period 2019 – 2030 would accrue social and economic benefits of magnitude that translate to a benefit-to-cost (BCR) ratio of 16.4. Similarly, investments of $115.2 million per annum in the education interventions over the period 2019 – 2030 is expected to provide a BCR of 9.7. The full report is available here.[ii] The economic benefits are realized from the output of people who would otherwise be dead or serverly disabled, and from the increased productivity from a more skilled and healthier workforce.
Analysis of recent budgets of the Burundi government shows an already high commitment to education and health (about 30 per cent in 2018/2019 budget) leaving limited fiscal space for these additional expenses to be borne by the Government. There may be some room for increasing tax revenues and increasing the efficiency of public spending, but the key to bridging the financing gap lies in increased overseas development assistance and innovative financing schemes such as the Global Financing Facility, the Global Fund to fight HIV/AIDS, Malaria and TB, and GAVI.
The fallout of the COVID pandemic will likely put more adolescents at risk of missing out on key development milestones and government budgets will likely become overstretched as the effects of the global economic slowdown continue to bite. As noted by the Executive Director of UNICEF at the launch of the Generation Unlimited initiative in 2018,
“The change in demographics the world is experiencing, coupled with fast-moving technological advances, presents a critical moment in history. If we act wisely and urgently, we can create a skilled cohort of young people better prepared to create sustainable economies, and peaceful and prosperous societies. Young people may represent 25 per cent of the global population, but they account for 100 per cent of the future. We cannot afford to fail them”
[i] Models take account of the effectiveness of interventions and potential uptake where necessary
[ii] Future costs and benefits are discounted as appropriate.