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Children And Youth A Resource Guide For World Bank Staff


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The majority of the developing world\'s poor are under the age of 25. Although significant
progress has been made in reducing income poverty worldwide, the fact remains that most
of the Millennium Development Goal (MDG) outcomes directly targeting the young are
not likely to be met unless greater attention is paid to the next generation.
The demand for World Bank support in addressing these challenges is growing. In responding to
the needs of children (0-14), we know much of what works and we know the powerful
economic and social justifications for early investment. How then can we assist countries to
scale up action swiftly and significantly? How do we address those who continue to fall
through the cracks?
Tackling the needs of youth (15-24) is more complex. The series of transitions they face —
from moving out of school and into their own families or finding employment — remain
extremely challenging for young people and policymakers alike. How can we deepen
global knowledge on those issues which prove hardest to solve? How can the potential 
of youth be tapped to contribute to development at the individual, community and
national levels?
This Resource Guide is a companion volume to Children & Youth: A Framework for Action,
which outlines a vigorous course for the Bank to place outcomes for children and youth
more centrally across all of our work. The Guide is intended as an evolving tookit, building
on the work of the Bank and its partners. As new data and evidence of good practice is
generated, the Resource Guide will be updated on the Children and Youth Web site

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Children And Youth A Resource Guide For World Bank Staff

  1. 1. HDNCY No. 2The majority of the developing worlds poor are under the age of 25. Although significantprogress has been made in reducing income poverty worldwide, the fact remains that mostof the Millennium Development Goal (MDG) outcomes directly targeting the young arenot likely to be met unless greater attention is paid to the next generation.The demand for Bank support in addressing these challenges is growing. In responding tothe needs of children (0-14), we know much of what works and we know the powerfuleconomic and social justifications for early investment. How then can we assist countries toscale up action swiftly and significantly? How do we address those who continue to fallthrough the cracks?Tackling the needs of youth (15-24) is more complex. The series of transitions they face — Childrenfrom moving out of school and into their own families or finding employment — remainextremely challenging for young people and policymakers alike. How can we deepenglobal knowledge on those issues which prove hardest to solve? How can the potentialof youth be tapped to contribute to development at the individual, community and & Youth:national levels?This Resource Guide is a companion volume to Children & Youth: A Framework for Action,which outlines a vigorous course for the Bank to place outcomes for children and youthmore centrally across all of our work. The Guide is intended as an evolving tookit, buildingon the work of the Bank and its partners. As new data and evidence of good practice isgenerated, the Resource Guide will be updated on the Children and Youth Web site( A Resource Guide for World Bank Staff “Our work will fall short if we cannot provide these young people with the opportunity to build a better tomorrow. That means we must do more and do it better to reach them now.” — James D. Wolfensohn The World Bank Children and Youth Unit Human Development Network 1818 H Street, NW Washington DC 20433 USA
  2. 2. Children & Youth:A Resource Guide
  3. 3. The World BankWashington, D.C.Copyright © 2005The International Bank for Reconstruction and Development / The World Bank1818 H Street, NWWashington, DC 20433Telephone: 202-473-1000Internet: www.worldbank.orgE-mail: childrenandyouth@worldbank.orgAll rights reserved.This is a product of the staff of the World Bank. The findings, interpretations, and conclusions expressedherein do not necessarily reflect the views of the Board of Executive Directors of the World Bank or thegovernments they represent.The World Bank does not guarantee the accuracy of the data included in this work. The boundaries,colors, denominations, and other information shown on any map in this work do not imply any judg-ment on the part of the World Bank concerning the legal status of any territory or the endorsement oracceptance of such boundaries.Photo credits: Curt Carnemark (pages i, viii, 15, 16, 50, 65, 86, 150); Ami Vitale (page vi); Tran Tri Hoa(page xii); Edwin G. Huffman (page xvi); Julio Etchart (page 34); Yosef Hadar (pages 57, 132); YuriMechitov (page 58); Ray Witlin (page 183).Rights and PermissionsThe material in this work is copyrighted. Copying and/or transmitting portions or all of this work with-out permission may be a violation of applicable law. The World Bank encourages dissemination of itswork and will normally grant permission promptly.All other queries on rights and licenses, including subsidiary rights, should be addressed to the Officeof the Publisher, World Bank, 1818 H Street, NW, Washington, DC 20433, USA, fax 202-522-2422,e-mail
  4. 4. The Child’s Name is ‘Today’ We are guilty Of many errors and many faults, But our worst crime Is abandoning the children, Neglecting the fountain of life. Many of the things we need can wait. The child cannot. Right now is the time Bones are being formed, Blood is being made, Senses are being developed. To the child we cannot answer “Tomorrow.” The child’s name is “Today.” —Gabriela Mistral, Chilean Nobel Laureate Poet
  5. 5. ContentsForeword n vPreface n viiAcknowledgments n ixAcronyms n xiExecutive Summary n xiiiChapter 1 Overview n 1 1.1 Why Invest More in Children and Youth? n 1 1.2 A Single Framework for Children and Youth n 2 1.3 The Life Cycle Approach n 5 1.4 Building Blocks for Integrated Investments n 7 1.5 World Bank Lending for Children and Youth: A Shift in Approach n 10 1.6 Priority Areas for Increased Concentration n 12Chapter 2 Children (0–14): Windows of Opportunity n 17 2.1 Challenges Facing Children: Cause for Serious Concern n 18 2.2 Scaling Up What We Know Works n 22 2.3 Moving Forward n 33Chapter 3 Youth (15–24): Integrating a Neglected Constituency n 35 3.1 Status of Youth: Rising Urgency n 37 3.2 Youth Development: Key Strategic Directions n 41 3.3 Taking Stock of Bank Work n 43 3.4 Moving Forward n 45Chapter 4 Addressing the Needs of the Most Vulnerable Children and Youth n 51 4.1 Status and Scale of the Most Vulnerable n 52 4.2 What Is the Bank’s Role? n 54 4.2 Moving Forward n 55Chapter 5 Next Steps: Applying a Children and/or Youth Lens n 59 5.1 In Operations n 59 5.2 In Analysis n 61 5.3 In Participation n 62 5.4 In Partnerships n 63 5.5 In Staff Support: Financial and Technical n 63 5.6 Conclusion n 63Annexes A Overview: Children and Youth n 67 B Children: Windows of Opportunity n 79 C Youth: Integrating the Neglected Constituency n 91 D Healthy Behaviors Strategy for Youth n 129 E Addressing the Most Vulnerable n 137References n 155 n  
  6. 6. Figures ES.1. Population by Sex and Age Group, Less Developed Countries, 2004 n xiii ES.2. Population by Sex and Age Group, More Developed Countries, 2004 n xiv 1.1. Distribution of Risk Along the Life Stages n 4 1.2. Building Blocks for Integrated Investments in Children and Youth n 7 Over the Life Cycle 1.3. Education, Health and Social Protection as a Share of Total n 10 Bank Lending (1990–2004) 1.4. Projects with Youth Components FY1995–2004: Global Summary n 11 1.5. Projects with Youth Components FY1995–2005, by Regions n 12 2.1. Building Blocks for Integrated Investments in Children (0–14) n 17 2.2. Reaching the Child MDGs: Reducing Child Mortality n 19 2.3. Reaching the Child MDGs: Universal Primary Education n 21 2.4. Reaching the Child MDGs: Safe Water and Basic Sanitation n 22 2.5. Investments in the Early Years (0–5) n 23 2.6. Rates of Return to Human Capital Investment Initially Setting n 24 Investment to be Equal Across All Ages 2.7. Cumulative Lending for ECD, 1990–2005 n 24 (Amount of lending in the year of project effectiveness) 2.8. Integrated Management of Childhood Illness (IMCI) n 26 2.9. Building Blocks for Integrated Investments in Children n 29 2.10. Enabling Environment: Supportive Families and Communities n 31 3.1. Building Blocks for Integrated Investments in Youth n 35 3.2. Population Aged 15–24, by Region, 1950–2010 (thousands) n 38 3.3. Gross Secondary Enrollment by Region, 2001 n 38 4.1. Building Blocks for Investments in the Most Vulnerable n 51 B.1. Co-Targeting of Investments and Reaching the Child Mortality MDG n 80 Boxes 1.1. MDG Indicators Targeting Children and Youth n 2 1.2. Issues Facing Children n 3 1.3. Issues Facing Youth n 3 1.4. Creating Incentives for the Poor: Conditional Cash Transfer Programs n 9 2.1. Mobilizing Funds to Reach the Goal of Universal Primary n 30 Education by 2015 3.1. Defining Youth n 36 3.2. Youth (15–24) Unemployment Statistics* n 39 3.3. Creating National Profiles of Youth n 47 4.1. The Most Vulnerable Children and Youth: A Few Definitions n 52 4.2. Orphans and Vulnerable Children Toolkit for Sub-Saharan Africa n 54 4.3. Changing Minds, Policies, and Lives: Improving Protection of n 55 Vulnerable Children in Europe and Central Asia 4.4. Operational Guidelines for Multisectoral HIV/AIDS Programs n 56 in Sub-Saharan Africa 5.1. Mainstreaming Children and Youth into a Country n 60 Development Framework A.1. Reaching Africa’s Young n 68 A.2. Yemen’s National Children and Youth Strategy n 70 A.3. Preliminary Stocktaking of Bank Projects with Youth Components n 72 A.4. Criteria for Prioritizing Investments in Children and Youth n 73 A.5. Rationale for Focusing on Gender Issues in Children and Youth Work n 74ii   n   Children Youth: A Resource Guide
  7. 7. A.6. The Macedonia Children and Youth Development Project, n 78 2001–2006 B.1. The Rights of Every Child Count n 79 B.2. Why Invest in Early Child Development? n 81 B.3. Scaling Up Early Child Development in Post-Conflict n 82 Countries: Burundi B.4. Adopting a Multisectoral Approach to Integrated Child n 83 Development in Bolivia B.5. Improving Child Nutrition in Madagascar and Senegal n 84 B.6. IMCI—Documenting Results n 86 B.7. Accelerating the Education Sector Response to HIV/AIDS n 88 B.8. Girls’ Education: Impact and Challenges n 89 C.1. The Costs of Not Investing in Youth in Kosovo n 91 C.2. The Costs of Not Investing in Youth in the Caribbean n 92 C.3. Youth Voices Initiative in Georgia n 93 C.4. Youth in Bank Operations in the Europe and Central Asia n 94 Region (ECA) C.5. Youth in Bank Operations in the Latin America and n 96 the Caribbean Region C.6. Youth in Bank Operations in the Africa Region n 98 C.7. Youth in Bank Operations in the Middle East and n 100 North Africa Region C.8. Youth in Bank Operations in the East Asia and the Pacific Region n 102 C.9. Youth in Bank Operations in the South Asia Region n 103 C.10. Developing and Implementing Employment Strategies: n 104 The Youth Employment Network C.11. Youth and the Environment in Indonesia n 105 C.12. The World Programme of Action for Youth and the n 106 UN World Youth Report 2005 C.13. The Youth Agenda in Brazil: Working across Sectors n 107 C.14. Peru’s Voces Nuevas Program n 108 C.15. Skills Development in Sub-Saharan Africa n 109 C.16. Bangladesh’s Female Secondary School Assistance Program n 110 C.17. World Links: Changing the Lives of Youth n 111 C.18. Improving the Health of Youth n 112 C.19. Sharpening the Youth Focus of HIV/AIDS Programs through n 117 Multi-Country AIDS Programs (MAPs) C.20. Young People in South Eastern Europe: From Risk n 118 to Empowerment C.21. Youth Development in Colombia, 1999–2003 n 119 C.22. The Education-Employment Nexus n 120 C.23. Including Youth in the Poverty Reduction Strategy Paper n 122 Process in Moldova C.24. Incorporating Youth in the Dominican Republic’s Country n 123 Assistance Strategy C.25. Increasing Youth Inclusion in the Middle East and North Africa n 124 C.26. Youth the Environment: ESSD Operational Highlights n 126 C.27. Caribbean Youth Development n 128 D.1. Supporting AIDS Orphans in Uganda n 131 Table of Contents   n   iii
  8. 8. D.2. Social Funds for Children and Youth in Post-Conflict Countries n 133 in Africa D.3. Integrating Youth with Disabilities into the Mainstream n 135 Development Agenda E.1. Mission and Services of the World Bank’s Children and n 137 Youth Unit E.2. Children and Youth Knowledge Products Supported by n 138 the President’s Contingency Fund (2003–04) E.3. The Alliance of Youth CEOs (of the world’s largest n 140 youth-serving organizations) E.4. The World Bank Youth to Youth Community: Y2Y n 142 E.5. National Youth Policies in the Caribbean n 143 E.6. World Bank Institute (WBI) Training Programs for Children and Youth n 144 E.7. World Bank Partners in Children and Youth Work n 146 E.8. Financial, Technical, and Capacity Building Support to n 151 World Bank Staff Tables 1.1. Key Vulnerabilities of Children and Youth and Their Impact n 6 Over the Life Cycle 3.1. Estimated Number of Women and Men Aged 15–24 Years Living n 39 with HIV/AIDS, December 2001 (thousands) 3.3. World Bank Lending with Youth Components, 1995–2005, n 44 by Sector (in million US$) 4.1. Scale of OVC in Africa n 53 A.1. Cross-Sectoral Synergies in Improving Outcomes n 67 for Children and Youth A.2. Applying the Life Cycle Framework in Argentina n 69 A.3. Demographics and Risks at Various Stages of the Life Cycle n 70 in Ethiopia A.4. Gender-Related Vulnerabilities over the Life Cycle n 75 B.1. Bank Lending to Child Health, 1990–2004 n 85 D.1. Child Protection Indicators, by Country, 1999–2003 n 129 D.2. UNICEF OVC Indicators by Strategic Approach and Tools n 132 for Measurement D.3. OVC: A Multisectoral Approach n 134 Maps 3.1. Young Adults (15–29) as Proportion of All Adults (15 and older), 2005 n 40 iv   n   Children Youth: A Resource Guide
  9. 9. Foreword“Young people are not just the future. They are also the present.”T oday’s children and youth are growing up in a world that is vastly different from that of previous generations. More than ever,our world is linked—by trade, by finance, byinformation, by the environment that we share. It been achieved, there is much more to do. In a world that has grown increasingly insecure, it is ever more vital to focus on some of the most critical causes of insecurity: poverty, alienation, and a lack of hope. Nowhere is this more impor-is also linked by disease, crime, drugs, war, and tant than among those who will lead the worlddisasters, both natural and man-made. into the future. Consider that 2.8 billion people on our planet Together with young people themselvestoday are under 25 years old. Over the course and country leaders, we can do accelerate thisof the next 25 years, the world will add another progress if we scale up our efforts to assist the2 billion people, only a fraction of whom—50 most vulnerable, whether they be children in themillion—will have the luxury of growing up in early years of life (0–5), or adolescents and youngwell-off countries. If today’s inequalities are any adults as they move from dependence to inde-indication of what the future may bring, these pendence. We must intensify our efforts to reachsurging numbers of children and youth will in- the youngest with appropriate early childhoodherit a world in which one child in six never lives interventions to ensure that they have the neces-to see his or her fifth birthday. Of those fortunate sary foundations upon which to build a healthyenough to survive, many will never complete and productive future. We must also deepen ourprimary school. They will face a world where knowledge about the most effective means toadolescents and young adults feel excluded from address the multitude of challenges facing poorhaving any say in decisions that will greatly affect youth, from lack of marketable skills and employ-their own futures, not to mention those of their ment prospects to violence and crime, from earlycommunities or countries. When young people pregnancy to high rates of HIV/AIDS.feel hopeless, they risk doing desperate things Above all, it means placing children and youththat are costly to them and to society at large. at the center of what we do. We must see how Our work will fall short if we cannot provide we can leverage all our forms of assistance—these young people with the opportunity to knowledge, policy advice, lending, grants—tobuild a better tomorrow. That means we must do move more rapidly and more effectively towardmore—and do it better—to reach them now. It achieving the results that we have all agreed tomeans we need to incorporate their perspectives, so widely in the Millennium Development Goals.their ideas, and their energy, not just as benefi- But it also means seeking out the participation ofciaries of programs but also as active participants young people in deciding and shaping what bestin defining and carrying out such programs. helps them meet their unique challenges. My ex- The World Bank has invested billions of dol- perience has taught me that the transformationallars over the past decades in expanding oppor- power of development lies in giving people atunities for young people—through education, chance to participate in their own future. Andhealth, social protection, the environment, and that future is now.economic growth. Though much progress has —James D. Wolfensohn World Bank President n  
  10. 10. PrefaceL istening to the voices of poor people, as well as country clients and partners, has been the hallmark of the World Bank’smore comprehensive approach to reducing pov-erty over the past 10 years. This holistic strategy from pioneering work within the Bank. It reflects the fact that the evidence for successful policy dialogue varies considerably across age groups and across countries. In some areas, the Resource Guide outlinesis built on two pillars: (i) improving the invest- gaps—areas reflecting where we must stillment climate to accelerate growth and (ii) invest- develop evidence and experience that will allowing in and empowering people. us to respond to the questions we receive from Improving human development outcomes our partner countries. To name a few of themore quickly is now central to all of our work. challenges:Among numerous challenges, it requires that n For early childhood, evidence of the extremewe have the tools and knowledge to place the importance of early interventions abound,prospects and well-being of children and youth but often these programs have difficulty insquarely in the vanguard of its work. While it is getting “traction” on the ground. Why? Whatclear that the Bank has many years of experience are the most effective means of scaling up inin focusing on the needs of young people, par- a sustainable way?ticularly those of primary school age, it is equally n For children in their primary school years,clear that much more remains to be done if we what can be done to ensure sufficient fi-are to effectively assist our client countries reach nancing for the Education for All: Fast-Trackthe Millennium Development Goals. Initiative to enable it to meet its goals? What This Resource Guide is intended primarily for can be done to ensure inclusion of the mostBank staff and country partners on the ground. It vulnerable, who continue to fall through theis a companion volume to Children Youth: A cracks?Framework for Action, which charts a vigorous n For youth, issues relating to the series of tran-course for the Bank in helping developing coun- sitions they face—from moving out of schooltries improve today the lives today of those who and into starting their own families or findingwill inherit the planet from us tomorrow. Both employment—remain extremely challeng-documents respond to the demands of country ing for young people and policymakers alike.leaders, partners, and youth organizations world- What policies and programs have provenwide for the Bank to generate new evidence- effective in addressing these challenges? Howbased knowledge for the benefit of children and best can the potential of youth be tapped toyouth—especially in the areas of economic and contribute to development at the individual,social benefits, costs, and the impact of invest- community and national levels?ment—and to shape subsequent policy responsesacross the development spectrum. Through wide The Resource Guide cannot and does not aim toconsultation at the country, regional, and global provide all the solutions. It is a living documentlevels, both documents also reflect the priorities to be enriched by each and every one of us as weidentified by young people from every continent. learn and make progress in our understanding of The challenges facing policymakers today the policies and programs that work. These issuesregarding young people vary widely, depending cut across sectors and disciplines and requireon the nature of the demographic changes they fresh and innovative thinking. The Guide outlinesare facing, as well as the social and economic resources—technical, financial, and others—thatcontext in which those challenges are occurring. will help Bank staff move forward. I hope youThe Resource Guide is a compendium of what will find it a useful instrument and contribute towe know today; it also identifies where chal- its constant improvement.lenges exist that will require further work. It is anevolving toolkit, drawn from a range of experi- —Jean-Louis Sarbibences from partners around the globe, as well as Sr. Vice President for Human Development n   vii
  11. 11. AcknowledgmentsT his report and the accompanying Children Youth: A Framework for Action are the result of a collective effort of a multi-sectoral World Bank team coordinated by theChildren and Youth Unit of the Human Develop- Joop Thieunissen, Zafiris Tzannatos, Maurizia Tovo, Andrea Vermehren, Cecilia Valdivieso, Dominique Van de Walle, Maj-Lis A. Voss, Mary Eming Young, Debrework Zewedie, and many other colleagues, who supported the work withment Network. The principal authors were Linda their insights and experience. Liisa Hietala, PeterMcGinnis, Viviana Mangiaterra, and Juan Felipe Holland, Minna Mattero, Nancy Rodriguez,Sanchez. Amina Semlali, and Gerold Vollmer provided im- The report benefited immensely from the portant perspectives as members of the Childrengenerous sectoral and regional contributions and Youth team.provided by Arvil Van Adams, Pedro Alba, Harold Among the many partner agencies that gener-H. Alderman, Christine Allison, Richard Amalvy, ously contributed time, input, and perspective,Florence Baingana, Ian Bannon, Jean-Christophe we would like to recognize DANIDA, GTZ, theBas, Rosemary Bellew, Regina Bendokatt, Antho- European Youth Forum, Finnish Cooperation, theny Bloome, Barbara Bruns, Donald Bundy, Flavia International Awards Association, the Interna-Bustreo, Danielle Carbonneau, Roelof C. Carri- tional Federation of Red Cross and Red Crescentere, Dov Chernichovsky, Mariam Claeson, Maria Societies, the International Food Policy ResearchDonoso Clark, Carine Clert, Stephen Commins, Institute, the International Labour Organization,Maria Correia, Diane Coury, Wendy Cunning- the International Youth Foundation, Italian Co-ham, Carlos Del Ninno, Annette Dixon, Pamela operation, Plan International, Save the Children,Dudzik, Erika Dunkelberg, A. Edward Elmendorf, Swedish International Cooperation, Understand-Janet Entwistle, Wolfgang Essen, Warren Evans, ing Children’s Work, UNICEF, the Unit for HealthJean Fares, Giacomo Filibeck, Anthony A. Gaeta, Research and the International Health InstitutoMarito Garcia, Pierre Girardier, Margaret Ellen Burlo Garofolo (Trieste), the United Nations Divi-Grosh, Dominic S. Haazen, Keith Hansen, Rob- sion for Economic and Social Affairs, the Worldert J. Hawkins, Phillip Hay, Judith E. Heumann, Alliance of the YMCA, the World Association ofEmmanuel Jimenez, Arun Joshi, Ruth Kagia, Girl Guides and Girl Scouts, the World Organi-Orsalia Kalantzopoulos, Ann Kielland, Elizabeth zation of the Scout Movement, the World YWCA,King, Alex Kolev, Ekta Kothari, Gloria La Cava, and the Youth Employment Network. ParticularElizabeth Lule, Niels Lund, Oey Meesok, Phil appreciation is also owed to the numerous youthMusgrove, Miquel de Paladella, Pawan Patil, Pia organizations that contributed to the develop-Peeters, Djordjija Petkoski, Aleksandra Posorak, ment of the Framework.Menahem M. Prywes, Egbe Osifo-Dawodu, Aze- Finally, the team would like to thank Jean-dine Ouerghi, Zeynep Ozbil, Mansoora Rashid, Louis Sarbib, Robert Holzmann, Nick Krafft,Laura B. Rawlings, Helena Ribe, Khama Odera and Xavier Coll for their ongoing leadership inRogo, Furio Rosati, Jim Rosen, Junko Saito, supporting and guiding the process. It also thanksStefano Scarpetta, George Schieber, Lynne Sher- President Wolfensohn, who for the past decadeburne-Benz, Yumi Sera, Ricardo Rocha Silveira, has provided the vision, voice, and path for theLeigh Ellen Sontheimer, Diane E. Steele, Kalani- World Bank to continuously seek to improve thedhi Subarao, Giorgio Tamburlini, Aida Tapalova, lives and prospects of the world’s young people. n   ix
  12. 12. AcronymsAAA Analytical and Advisory AssistanceAFR Africa RegionAIDS Acquired Immunodeficiency SyndromeCY Children and YouthCCT Conditional Cash TransferCAS Country Assistance StrategyCIDA Canadian International Development AgencyEAP East Asia and Pacific RegionECA Europe and Central Asia RegionECD Early child developmentESW Economic and Sector WorkFTI Fast Track InitiativeGTZ Deutsche Gesellschaft für Technische Zusammenarbeit GmbHGMR Global Monitoring ReportHD Human DevelopmentHDNCY Human Development Network—Children and YouthHIV Human Immunodeficiency VirusHNP Health, Nutrition and Population sectorsICT Information and Communication TechnologyILO International Labor OrganizationIMCI Integrated Management of Childhood IllnessLCR Latin America and Caribbean RegionLICUS Low Income Countries Under StressMAP Multicountry AIDS ProgramMCH Maternal Child HealthMDG Millennium Development GoalsMNA Middle East and North AfricaOVC Orphans and other Vulnerable ChildrenPER Public Expenditure ReviewPREM Poverty Reduction Economic Management sectorPRSP Poverty Reduction Strategy PaperSAR South Asia RegionSP Social ProtectionSSA Sub Saharan AfricaSTD Sexually Transmitted DiseaseUN United NationsUNDP United Nations Development ProgramUNHCR United Nations High Commissioner for RefugeesUNICEF United Nations Children’s FundUSAID United States Agency for International DevelopmentWBI World Bank InstituteWHO World Health Organization n   xi
  13. 13. We can give our children and youth a more peaceful and equitable world. One where suf- fering will be reduced. Where opportunities and hope are within every young person’s reach. Where they are empowered to be agents of their own development. This is not just a dream. It is our responsibility. —James D. WolfensohnExecutive World Bank PresidentSummaryN early half the people in the world today are under 25 years old. Nine out of ten of them live in developing countries,where the majority of the poor are children andyouth (figures 1 and 2).1 A billion of them will powerful economic and social justifications for early investment. Yet progress toward meeting the MDGs, particularly for the youngest children (0–5), will require a broad range of actions that go beyond the already substantial efforts made by theneed jobs in the next decade. Although signifi- Bank and its partners. The challenge is to under-cant progress has been made in reducing income stand how to effectively scale up programs givenpoverty worldwide—thanks in part to stronger the scarce resource environment confronting oureconomic growth—the fact remains that most of client countries. This will call for a careful assess-the Millennium Development Goal (MDG) out-comes directly targeting the young are not likely Figure ES.1. Population by Sex and Ageto be met unless greater attention is paid to the Group, Less Developed Countries, 2004next generation. The Bank is the world’s largest external 85+ 80–84 Male Femalefunder to developing countries for the two sec- 75–79tors most directly related to children and youth 70–74 65–69outcomes—education and health. It has made 60–64significant contributions to reducing poverty and 55–59 50–54HIV infection, improving nutrition, increasing 45–49social protection, and supporting environmen- 40–44 35–39tally and socially sustainable development, all of 30–34 25–29which affect the lives of young people. How can 20–24the Bank build on this experience to respond to 15–19 10–14the clear message of the MDG Global Monitoring 5– 9Report that action needs to be scaled up signifi- 0– 4cantly and swiftly? (World Bank 2005b) 300 100 100 300 Population (millions) In addressing the needs of children (0–14),we know much of what works and we know the Source: UN Population Division 2004.1. Definitions of children (0–14) and youth (15–24) are based on those employed by the MDG framework. There is strong evidence that poorerfamilies have more children, increasing the incidence of poverty among children and youth. n   xiii
  14. 14. Figure ES.2. Population by Sex and Age addressing the needs of youth is growing, but Group, More Developed Countries, 2004 there is very little international work on the cost-effectiveness of most youth interventions 85+ 80–84 Female to help policymakers make difficult investment Male 75–79 decisions in a resource-constrained environ- 70–74 65–69 ment. The challenge will be to move the agenda 60–64 from advocacy to evidence and from evidence 55–59 50–54 to action. And while there is considerable room 45–49 for learning from existing experience, appropri- 40–44 35–39 ate policies and interventions are sure to differ 30–34 widely from country to country, depending on 25–29 20–24 the social, economic, and demographic context 15–19 10–14 of each. 5– 9 This Resource Guide is a companion volume 0– 4 to Children Youth: A Framework for Action. It is 300 100 100 300 intended as an evolving toolkit to assist Bank staff Population (millions) in intensifying our focus on children and youth Source: UN Population Division 2004. outcomes in all Bank operations. The Guide provides data, examples of good practice, in- ment of different approaches to scaling up. It will novations, and guidance on technical, financial, also require placing children even more centrally training, and other types of available support, in our policy dialogue—from the macro to the including links to other documents and organi- micro levels—with greater attention to intersec- zations. It builds on the important work of the toral approaches in order to focus all sectors on Bank and its partners to date, and highlights both outcomes for children. For the most vulnerable pioneering new research and initiatives as well children—orphans, children infected with and as areas in which there is a need to deepen our affected by HIV/AIDS, child workers, child pros- knowledge and evidence base. The Guide will titutes, children with disabilities, children in con- be updated regularly on the Children and Youth flict countries—who continue to fall through the Web site ( cracks, the challenge is to build upon the work as new evidence becomes available, and will already started in the Africa Region and elsewhere contribute to the preparation of The World Devel- in order to better identify and target their unique opment Report 2007: Development for (and by) needs with cost-effective interventions. the Next Generation. Tackling the needs of youth (15–24) is more challenging. Today’s youth represent the largest Chapter 1 provides an overview of the general cohort ever to enter the transition into adult- framework. It lays out the business case for a hood. The issues they face—unemployment, sharper focus on children and youth, particularly lack of schooling and skills, risk-taking behav- in the context of the MDGs. While recognizing iors, and violence, among others—represent that issues and solutions differ significantly for enormous economic and social costs to society. both groups, it also underscores how they are Yet they have little or no voice in current strate- integrally linked along the life cycle. The chap- gies for development, leaving them susceptible ter presents a conceptual framework to assist to politically and economically disruptive activi- countries in systematically identifying gaps and ties. While youth development has emerged as strategic opportunities for scaling up investment a new focus for Bank work in certain regions— in children, youth, or both across sectors. It re- most notably pioneering work in Latin Ameri- views the trends in Bank operations for children can and the Caribbean and Europe and Central and youth, and highlights an important shift in Asia—this segment of the population remains a approach in recent years, particularly for youth, largely neglected constituency. Demand from with both sharp increases in lending and more clients and partners for the Bank’s support in multisectoral approaches.xiv   n   Children Youth: A Resource Guide
  15. 15. Chapter 1 recommends three priority areas Chapter 5 summarizes the next steps in apply-for increased concentration of analytical and ing a children and/or youth lens to our work.operational resources. The first is gaining traction It recognizes that approaches will vary widelyin programs for young children (0–5) and scaling across regions and countries, depending on theirup a range of early child development initiatives. demographic, economic, and social contexts.The second involves moving toward an evi- While some countries may place more emphasisdence-based approach to interventions for youth on one aspect of the strategy than another, many(15–24), by deepening analytical work and pilot- others are interested in intensifying the focus oning new initiatives with youth themselves. The children and youth across all sectors in a morethird is determining how to tailor our approach to integrated way, particularly given the difficulty inthe unique set of needs and vulnerabilities of the meeting many of the MDGs related to those un-most vulnerable, who continue to fall through der the age of 25. This chapter outlines possiblethe cracks. In each of these areas, particular next steps and existing resources with whichattention is given to incentives that guide poor Bank staff can assist countries in this effort acrosshouseholds’ decisions to invest in their young. five categories of action: i) operations, ii) analy- sis, iii) participation of young people, iv) partner-Chapters 2–4 are arranged in a similar man- ships, and v) staff support.ner and can be used separately or as part of thewhole document. They are designed to enable The appendixes contain case studies, examples ofreaders who are interested in just one age group innovative polices and programs, data, and otheror topic to delve further into the relevant section, useful material that support the main text. Eachand to consult the parallel sections in the Appen- appendix corresponds to a particular chapter ofdixes for case studies and examples of key points the report, but much of the information applies toin the main text. Each section begins by present- other chapters as well. In sum, the Framework foring an overview of the status, scale, and trends of Action and the Resource Guide are first steps inthe issues for children (0–14) in chapter 2, youth the creation of an evolving toolkit to assist staff and(15–24) in chapter 3, and the most vulnerable clients in learning from the experiences of others.(including orphans, child workers, children with They do not and cannot provide ready-made solu-disabilities, children living in conflict countries, tions to development questions that have eludedand other children living in exceptional circum- policymakers in developing and “developed”stances) in chapter 4. Each chapter highlights countries alike. Rather, they present a lens throughspecific policies, programs, and strategies that which to view relevant issues, measure our ac-are underway and describes areas in which tions, and deepen our collective impact in accel-greater emphasis is needed. They conclude with erating efforts to improve the lives today of thosea discussion of where to go from here. who will inherit the planet from us tomorrow. Executive Summary   n   xv
  16. 16. Chapter 1OverviewT his chapter presents the framework for in- tensifying the focus on children and youth in Bank work across all sectors. It beginsby making the business case for increased atten-tion to young people in the context of the MDGs. developing countries the proportion of young people is growing. Already there are 1.1 billion youth (15–24) in the world—the largest cohort ever to enter the transition to adulthood—most of them in need of jobs. By 2015 the world will haveWhile recognizing that issues and interventions 3 billion young people, 2.5 billion of them livingdiffer significantly for children and youth—as in developing countries. The consequences ofwell as in different country contexts—it pres- these trends will affect all productive and socialents a conceptual framework to assist countries sectors, straining governments’ capacity to pro-systematically identify gaps and strategic oppor- vide basic public services. (World Developmenttunities for scaling up investment in children and Indicators 2003, US Census Bureau Internationalyouth across sectors. The chapter also reviews Database 2004 and La Cava 2004)trends in Bank operations for children and youth The Millennium Development Goals. Theand highlights an important shift in approach in MDG outcome indicators for children (0–14) andrecent years, particularly as it relates to youth, youth (15–24) (box 1.1) have shown some of thewith both sharp increases in lending and more weakest progress of all indicators. If actions aremulti-sectoral approaches. It closes by identifying not scaled up rapidly and focused more sharplythree priority areas for increased concentration of on the next generation, these outcomes will notthe Bank’s analytical and operational resources, be met.which reflect the periods of greatest vulnerability Economic efficiency. Children represent thealong the life cycle. greatest leverage point for investments to build hu- man and social capital: the earlier the investment,1.1 Why Invest More in Children the longer the benefits and, usually, the lower theand Youth? costs. Investments in youth preserve the benefits of investments in children, counteract the lack ofDemographic urgency. Nearly half of the world’s earlier investments, and have the added value ofpopulation and the majority of the poor in devel- immediate intergenerational effects, as youth be-oping countries are under the age of 25. Children come new parents. Moreover, evidence is increas-and youth represent more than 60 percent of the ingly demonstrating that the political and econom-population in Africa and South Asia, and in most ic costs of not investing in youth are staggering.22. See box C.1: The Costs of Not Investing in Youth in Kosovo; and box C.3: The Costs of Not Investing in Youth in the Caribbean. n  
  17. 17. For the poor in particular, capital market failures leading to continued suboptimal investment in Box 1.1. MDG Indicators Targeting Children human capital, such as schooling and health care, and Youth perpetuate the vicious cycle of poverty—a key argument for increasing public investment. Children (0–14) Political imperative. Youth are a large, politi- Goal 1: Eradicate extreme poverty and hunger (4)* Prevalence of underweight children cally visible, and sensitive group with no formal under 5 voice, leaving them susceptible to disruptive Goal 2: Achieve universal primary education activities that are costly to society and reduce (6) Net enrollment ratio in primary economic growth. By contrast, if integrated into education the development process, they can be a positive (7a) Percentage of pupils starting grade 1 who reach grade 5 force for change.3 (7b)** Primary completion rate Demand. Client countries and partners are in- Goal 3: Promote gender equality and empower creasingly requesting Bank technical and financial women support in addressing the most intransigent issues (9) Ratio of girls to boys in primary facing young people today. Given the failure of education most regions to progress sufficiently in meeting Goal 4: Reduce child mortality (13) Under-5 mortality rate many of the MDG targets for children and youth, (14) Infant mortality rate there is considerable demand for Bank assistance (15) Proportion of 1-year-olds in scaling up interventions focusing on the young. immunized against measles There is also a need for the Bank to use its com- Goal 5: Improve maternal health parative advantage to generate evidence-based (16) Maternal mortality ratio (17) Percentage of births attended by analysis—particularly as it relates to economic skilled health personnel and social benefits, costs, and the impact of in- vestments—to provide stronger policy advice and Youth (15–24) financial support in addressing the critical and Goal 2: Achieve universal primary education growing number of issues facing youth. (8) Literacy rates among 15- to Development success generates new chal- 24-year-olds Goal 3: Promote gender equality and empower lenges. Progress toward achieving key develop- women ment goals, such as universal primary education, (9) Ratio of girls to boys in secondary has presented a new set of development challeng- and tertiary education es, such as an imminent explosion in demand for (10) Ratio of literate females to males access to relevant, good-quality secondary and 15–24 tertiary education. This requires a shift in empha- Goal 6: Combat HIV/AIDS, malaria, and other diseases sis in strategic investments without losing ground (18) HIV prevalence among pregnant on the important gains made in recent years. women (15–24) (19)** Percentage of population 15–24 1.2 A Single Framework for with comprehensive correct knowledge of HIV/AIDS Children and Youth Goal 8: Develop a global partnership for development The issues, risks, and solutions to the problems (45) Unemployment rate among 15–24 facing children and youth differ significantly (boxes 1.2 and 1.3). For children, we know much * Parentheses designate the number of the MDG indicator. ** Proposed but not yet adopted as additional MDG indicator. of what works, so how do we better assist coun- Source: United Nations 2003. tries to scale up effectively and selectively? How do we address those who continue to fall through 3. See box C.3: Youth Voices Initiative in Georgia; box C.14: Peru’s Voces Nuevas Program; and box C.23: Including Youth in the PRSP Process in Moldova.   n   Children Youth: A Resource Guide
  18. 18. Box 1.2. Issues Facing Children Box 1.3. Issues Facing Youth Malnutrition Unemployment n Twenty-three percent of all children under 5—140 n Globally, youth represent 47 percent million children—are malnourished. of all unemployment. Infant mortality n Unemployment rates for youth are n Four million infants a year die in the first month of more than three times as high as those life. for adults. Childhood mortality Lack of access to and retention in school n One in six children dies before reaching the age of n Throughout the world, 133 million 5, most from communicable diseases youth are illiterate. Maternal mortality n In Sub-Saharan Africa less than 20 n Half a million women die every year in childbirth. percent of youth complete secondary Lack of access to and retention in school school. n More than 100 million school-age children are out n In Latin America and the Caribbean, of school in developing countries, two-thirds of the net secondary enrollment rate is them girls. just 62 percent. n Of those who enter school, one in four drops out Risky behaviors before learning to read. n Every year, 13 million girls between n Less than 60 percent of children in Sub-Saharan the ages of 15 and 19 give birth. Africa complete primary school. n Youth account for almost half of all n The average gross enrollment rate in early childhood new HIV infections. development programs in developing countries is n Countries in which 15- to 29-year- just 35 percent. In Sub-Saharan Africa only 5.8 per- olds represent 40 percent or more of cent of children are enrolled in such programs. the population were twice as likely as Unsafe home environment other countries to break out in civil n 30 percent of children in developing countries conflict in 1990s. (more than 500,000) lack access to any sanita- n Substance abuse poses a major risk in tion facilities whatsoever, and nearly 20 percent all regions (400,000) lack access to safe water; these conditions No skills, no voice, no prospects are far worse for poor children. n Education in many countries fails to Orphans and vulnerable children provide youth with marketable skills. n More than 143 million orphans under 18 in 93 n Lack of participation in development countries in Africa, Asia and LCR. policies and process leave youth mar- n Africa alone has 60 million vulnerable children. ginalized from society. Child labor Compiled by HDNCY from ILO 2004, World Bank n Worldwide almost 190 million children work. 2005b, 2005d, 2004b, 2004e; WHO 2004; UNICEF 2005, 2004b; UN Secretariat 2005; IPEC-ILO 2003; Compiled by HDNCY from ILO 2004, World Bank 2005b, 2005d, Bartlett 1999. 2004b, 2004e; WHO 2004; UNICEF 2005, 2004b; UN Secretariat 2005; IPEC-ILO 2003; Bartlett 1999.the cracks—the most vulnerable? For youth, The agents of analysis and intervention mayexperience and analytic underpinnings are new also differ when addressing the needs of chil-and uneven, while demand for the Bank’s solid dren and youth. For children the agent will mosteconomic analysis is high. How can we build on often be the household in which the child lives,pioneering work done within the Bank and by its thereby raising the issue of how best to reach thepartners? How can the Bank move from advo- child through the household members. For youthcacy to evidence? How can we integrate youth the agent may often be individuals themselves,perspectives and participation into all levels of who are no longer living with their families or forour work? whom direct intervention may be more effec- Overview   n  
  19. 19. tive. Given that the needs of children and youth most susceptible to increased vulnerability during differ, why should they be treated within a single periods of economic downturn and other external framework? shocks—as indicated by increased rates of mal- Children and youth are disproportionately nutrition, school dropout, youth unemployment, poor. Many income and nonincome poverty and violent and risky behavior, for example. indicators are much worse among children and Children and youth face the highest physi- youth—two groups that together represent the ological and social risks. Children are more vul- majority of the developing world’s poor.4 Strate- nerable to malnutrition, disease, and death than gies that focus on investing broadly in children other age groups. Adolescents and young adults and youth are doubly pro-poor, because they are more likely to engage in risky sexual behavior, reach today’s poor while reducing future poverty. become victims of maternal mortality, contract Children and youth are uniquely vulnerable. HIV/AIDS, be perpetrators or victims of crime or Among the poor, children and youth are the violence, and belong to gangs (figure 1.1). From Figure 1.1. Distribution of Risk Along the Life Stages Compiled by HDNCY 2005. 4. There is strong evidence that poorer families have greater numbers of children, thereby increasing the incidence of poverty among children and youth. See, for example, World Bank 2005e and UN Secretariat 2004.   n   Children Youth: A Resource Guide
  20. 20. a preventive risk management perspective, these n It provides an important diagnostic tool withare the two most productive and efficient periods which to assess the status, trends, and scale offor investing in human capital development. children and youth issues across ages, sectors, Investments—or underinvestments—in poverty status, and other dimensions, high-children and youth are integrally linked along lighting areas warranting greatest attention andthe life cycle. If investments are not made in the for which market failures are most evident.early years, the costs and consequences become n It identifies age-specific vulnerabilities, risks,particularly evident in adolescence and early gaps, and opportunities for investment, high-adulthood. If the lack of investment is not com- lighting the importance of the right timing andpensated for at this stage, the costs to society can nature of staggering, not just for the current generation n It illustrates positive and negative intergenera-but for the next as well, as children born to young tional effects and linkages.disadvantaged parents perpetuate the cycle of n It facilitates co-targeting of interventions andpoverty. the improving synergies across sectors and ages in meeting common goals. Examples1.3 The Life Cycle Approach include targeting transportation investments together with those in education and health toThe life cycle framework is a potentially powerful increase access to schools and health centerstool to provide country teams and policymak- in disadvantaged areas; linking private sectorers alike with the means to place children and development investments to those designedyouth outcomes more centrally as measures of to improve marketable skills of youth throughsuccess of a country program. The importance of internships; or designing water and sanitationassessing and addressing the various dimensions programs to take into account their linkages toof poverty early on in the life cycle is gaining increasing girls’ school enrollment.5recognition, as policymakers appreciate that risks n It enables monitoring of the impact ofare not homogeneously distributed along the life interventions on specific children and youthcycle but are typically higher in earlier stages of outcomes over, with important long-term and sometimes irre- n If used globally, regionally, and subregionally,versible consequences at later stages of life. Risks it can provide countries with useful bench-are extremely high during the first five years of mark information and identify outliers thatlife and again during adolescence and youth (see deserve specific attention.figure 1.1), a period that can have an immediateimpact on the next generation. These risks have Applying a life cycle framework to a specificboth short- and long-term outcomes that have a country context will enable country teams todirect impact on subsequent life stages (table 1.1). prioritize interventions based on the scale of Definitions of life stages vary from culture to identified gaps and target populations and theculture and across sectors of interventions, but projected impact on outcomes. In a resource-there are physiological commonalities across all constrained environment, this may mean thatcultures. Understanding the multiple channels of emphasis in some lower-income countries ininfluence along the life cycle and their interrela- Sub-Saharan Africa, South Asia, and the Middletionship is, thus, critical to guiding policymakers East and North Africa will be placed on scalingin determining where investments in human capi- up efforts to improve especially weak health,tal formation will have the greatest impact. The nutrition, and education indicators for early child-benefits of using a life-cycle approach in evaluat- hood and primary school–age children.6 For someing and developing country programs include the middle-income countries that have achievedfollowing: adequate outcomes in basic nutrition, health, and5. See table A.1: Cross-Sectoral Synergies in Improving Outcomes for CY.6. See box A.1: Reaching Africa’s Young; box A.2: Yemen’s National CY Strategy; and box C.27: Caribbean Youth Development. Overview   n  
  21. 21. Table 1.1. Key Vulnerabilities of Children and Youth and Their Impact Over the Life Cycle Age Group Vulnerabilities Short-term Outcomes Long-term Outcomes In utero and In utero exposure to maternal Increased risk of maternal Severe, potentially irrevers- at birth infections, nutritional defi- mortality, premature birth, ible consequences for physi- ciencies, and environmental birth defects, low birth cal and cognitive growth and toxins, as well as poor care weight, and neonatal death. development. Most perma- around the time of birth, may Low birth weight is the single nent disabilities have their lead to severe and irrevers- most important cause of origin in neonatal disease. ible damage to the brain and infant mortality. other organs. Early child- Development of basic cogni- Increased risk of infant and Irreversible effects on physi- hood tive and social abilities occurs child morbidity and mortal- cal and cognitive growth and (0–5 years) in the first few years of life. ity; stunting, slow physical development; increased like- Adverse factors—poor diets, growth, and other manifes- lihood of learning disabilities, infections, disease, lack of tations of early childhood delayed school entry, poor cognitive stimulation—can malnutrition; and lack of school performance, early cause slow physical and intel- socialization or acquisition of drop-out, and lower grade lectual growth. psychosocial skills. attainment. School-age Family resource constraints, Failure to enroll, delayed Loss of human capital devel- children gender bias, and inadequate enrollment, grade repetition, opment and capacities, per- (6–14 years) infrastructure and public reduced school performance, sistence of gender inequali- services prevent school at- and early dropout; increased ties, and social exclusion. tendance and the provision of risk of going to work or health services. becoming a child soldiers; and increased risk of early pregnancy and marriage. Adolescence Youth lack opportunities to Inadequate skills develop- Long-term unemployment or and youth access and complete primary ment and poor prospects for low-wage employment; intra- (15–24 years) and secondary schooling; employment; risky behaviors and intergenerational trans- receive relevant nonformal (early pregnancies, substance mission of poor health and education, including life, live-abuse, sexually transmit- its consequences (low birth lihood, and marketable skills; ted infections, violence, weight, vertical transmission and access relevant health criminal and gang activi- of HIV/AIDS); reduced pro- services and reproductive ties, and premature death); ductivity; intergenerational health information. unemployment, hazardous transmission of household Poor job market opportunities employment, or exploitative and community violence; employment; child soldier- high economic costs of risky are magnified by reluctance of employers to hire first-time ing; exclusion from deci- behaviors and forgone assets job seekers. Adolescents and sionmaking, often leading to for development; lost oppor- civil unrest or increased risky tunities for involving youth as youth do not participate in behavior. agents of better governance, decisions and policies that accountability, and develop- affect their lives. ment of democracy. Source: The World Bank 2004d. education for children, the emphasis may fall on for the poorest to ensure that they are prepared improving both access to and quality of second- to enter school.7 In most Low-Income Countries ary and tertiary education, reducing risk taking Under Stress (LICUS), where central and local behavior of youth, and very targeted interventions government services have broken down and sig- 7. See table A.2: Applying the Life-Cycle Framework in Argentina; box C.21: Youth Development in Colombia 1999–2003; box C.13: The Youth Agenda in Brazil: Working Across Sectors; box C.5: Youth in Bank Operations in LCR; box C.8: Youth in Bank Operations in EAP; box C.27: Carib- bean Youth Development.   n   Children Youth: A Resource Guide
  22. 22. nificant numbers of children and Figure 1.2. Building Blocks for Integrated Investments inyouth are orphaned or extremely Children and Youth Over the Life Cyclevulnerable, emphasis will neces-sarily focus on strategies to ad-dress their unique vulnerabilities Ageand the weaknesses of traditional 24social service delivery.8 Finally, En t Livelihoods enfor transition countries, where ab Employment rm linmany youth indicators, including we g 18 Po Informal po licsecondary school enrollment, Nonformal Em ies Education Healthy ndyouth unemployment, and the 14 an Secondary Behaviors na d Tertiary Insprevalence of HIV/AIDS, are (reproductive tio health, HIV/AIDS Education titu ipa substance abuse, violence)actually worsening, there is tio tic Primary Protection of n Par sincreasing urgency to address Education the most vulnerable Child Safe (EFA/FTI)critical youth issues while also 5 Healthy Early (OVC) Health Environment Childhood focusing on institutionalized (water, sanitation housing) Development Nutrition 0children.9 Supportive Families and Communities1.4 Building Blocks forIntegrated Investments most from preventable causes that are rareIf the life-cycle approach to children and youth in wealthier countries. This building blockrisks is applied Bankwide, a broad strategy for addresses policies and programs ranging fromintegrated investments emerges. Investments integrated management of childhood illness toin children and youth are integrally linked and maternal-child health programs. The effective-cumulative. These investments can be viewed as ness of these interventions will be enhancedbuilding blocks that represent the foundations on significantly by co-targeting other sectoralwhich all young people need to build their hu- investments (providing adequate infrastructureman capital (figure 1.2). If risks are not addressed to access health and nutritional services, forthrough investments in the early years, their im- example, ensuring food security, and improv-pact will be more costly to redress in later years. ing the quality and efficiency of health service delivery).For ages 0–5, the building blocks focus on in- n Early child development. The effects ofterventions that will ensure that a child survives proper health care, nutrition and mentalinfancy and early childhood, while also contrib- stimulation on a child’s mental, physical anduting to the necessary elements they and their emotional growth are synergistic and are par-families need to ensure entry into and success ticularly important for children born into pov-in school and later life. Neglecting to invest ef- erty where many of their basic needs cannotfectively in these critical years can yield adverse be met by the household. Integrated programsoutcomes, which can be severe, long-lasting, and seek to address a full range of a child’s basicirreversible. Given the projected failure of most needs. In addition to food, protection andcountries to meet the key MDG objectives for health care, ECD must also provide affectionyoung children, the building blocks pay particu- and supportive human interaction, intellectuallar attention to cross-sectoral interventions. stimulation through activities that promoten Child health and nutrition. Every year more learning, and support to caregivers regarding than 10 million children in developing coun- parenting and childcare skills. tries die before they reach the age of five,8. See box D.2: Social Funds for CY in Post Conflict Countries in Africa; box D.1: Supporting AIDS Orphans in Uganda.9. See box C.20: Young People in SEE: From Risk to Empowerment; box A.6: The Macedonia CY Development Project. Overview   n