Education In Low-income Countries Research Articles

Pathways to progress: The complementarity of bicycles and road infrastructure for girls’ education

In which settings can bicycles help to improve girls’ education in low-income countries? This paper analyzes the complementarity between all-weather roads and a bicycle program in India aimed at increasing girls’ secondary school enrollment. Using a triple-difference strategy, I find that the program benefits girls living 3–10 km away from schools with all-weather road connections, increasing their enrollment by 60 percent and reducing the gender enrollment gap by 51 percent. There are no effects for girls in villages without all-weather roads or girls living more than 10 km from school. The findings emphasize the importance and interdependence of road infrastructure, mode of transport, and distance to school for improving girls’ education in India.

Beyond academic outcomes: The role of social and emotional learning in rethinking quality education in low-income countries

Beyond academic outcomes: The role of social and emotional learning in rethinking quality education in low-income countries

Learning, Marginalization, and Improving the Quality of Education in Low-Income Countries

Learning, Marginalization, and Improving the Quality of Education in Low-Income Countries

Using a consensus meeting to enhance fracture care education in low income countries

BackgroundA key strategy to building surgical capacity in low income countries involves training care providers, particularly in the interventions highlighted by the Lancet Commission for Global Surgery, including the management of open fractures. This is a common injury, especially in areas with a high incidence of road traffic incidents. The aim of this study was to use a nominal group consensus method to design a course on open fracture management for clinical officers in Malawi.MethodsThe nominal group meeting was held over two days, including clinical officers and surgeons from Malawi and the UK with various levels of expertise in the fields of global surgery, orthopaedics and education. The group was posed with questions on course content, delivery and evaluation. Each participant was encouraged to suggest an answer and the advantages and disadvantages of each suggestion were discussed before voting through an anonymous online platform. Voting included use of a Likert scale or ranking available options. Ethical approval for this process was obtained from the College of Medicine Research and Ethics Committee Malawi and the Liverpool School of Tropical Medicine.ResultsAll suggested course topics received an average score of greater than 8 out of 10 on a Likert scale and were included in the final programme. Videos was the highest ranking option as a method for delivering pre-course material. The highest ranking methods for each course topic included lectures, videos and practicals. When asked what practical skill should be tested at the end of the course, the highest ranking option was “initial assessment”.ConclusionThis work outlines how a consensus meeting can be used to design an educational intervention to improve patient care and outcomes. Through combining the perspectives of both the trainer and trainee, the course aligns both agendas so that it is relevant and sustainable.

Challenges and strategies for the internationalization of higher education in low-income East African countries

As it becomes more crucial to push the boundaries of science to develop new technologies and important global initiatives, internationalization can be instrumental in helping underdeveloped countries overcome challenges such as poverty, climate change, and educational inequalities. Higher education institutions have always faced challenges in the process of internationalization, which have occupied scholarly attention in recent decades, but little research has been conducted on the internationalization of higher education in less developed African countries. This qualitative study aims to shed light on the challenges of internationalization of higher education in low-income countries in East Africa. After reviewing the literature and interviewing academics, the obtained data were thematically analyzed. The results suggested 12 main challenges, which were classified into four major categories. The challenges include a lack of clear policies and guidelines; the inefficiency of the organizational structure of internationalization; financial, infrastructure, and equipment problems; weaknesses in scientific, skill, and language competences; cultural differences; non-reciprocal relationships; and a brain drain. Finally, strategies for responding to these challenges with regard to the internal and external environments of higher education institutions were proposed. Among the internal strategies of higher education institutions are the development of clear policies and visions, planning for the development of human resources, and sustainable budgeting for internationalization programs. External strategies emphasize the development of national policies and laws based on contextual and environmental conditions, as well as interaction and participation in international meetings to expand communication and use the scientific and economic capacities of international agencies and institutions.

A mobile learning framework for higher education in resource constrained environments

It is well documented that learning oppourtunities afforded by mobile technology (m-learning) holds great potential to enhance technology-enhanced learning in countries and communities with low socio-economic conditions where web-based e-learning has failed because of limited infrastructure and resources. Despite the potential for m-learning, its actual uptake has been low. The extant literature in this sphere provides some theoretical insight, with evidence of limited on-the-ground practical studies that often do not progress beyond the pilot phase. Failure to embed sustainable learning opportunities has been attributed to the absence of a contextual framework suitable for the heterogeneous nature of many developing countries. This paper thus presents an m-learning framework that considers the sociocultural and socio-economic contexts of low-income economies. The framework is based on a range of studies conducted over four years, including the outcome of two empirical studies conducted in a Nigerian university. Documenting the research underpinning the design provides practitioners and policymakers with a framework for a potentially sustainable strategy for long-term mainstream m-learning integration in higher education in low-income countries.

Book Review: Learning, Marginalization, and Improving the Quality of Education in Low-income Countries edited by Daniel A. Wagner, Nathan M. Castillo, and Suzanne Grant Lewis

Book Review: Learning, Marginalization, and Improving the Quality of Education in Low-income Countries edited by Daniel A. Wagner, Nathan M. Castillo, and Suzanne Grant Lewis

A review of the factors affecting children with disabilities successful transition to early childhood care and primary education in sub-Saharan Africa

Whilst transition to primary school is a commonly experienced phenomenon for most children, some groups of children, including those with disabilities, are less likely to engage in the process because it can be very challenging for them and their families. This article presents evidence from a review of research looking at the transition of children with disabilities within early childhood and primary education in low income countries in Sub-Saharan Africa. From the meta-aggregation, three central areas were identified within the topic of transition of children with disabilities to primary school in sub-Saharan Africa: key actors, obstacles and enablers. Although this review identified some of the main obstacles to transition related to finance, it has highlighted the fact that many children with disabilities and their parents wish to attend school, and there are a number of ways to support and enable successful transition from home to school.

Challenges of education in Low Income Countries (LICs)

As globalization is increasingly affecting both Low Income Countries (LICs) and high income countries (HICs), the formation of mixed markets emphasizes the importance of private education. Functionalists, for example, highlight privately owned institutions as higher quality ones, as the competitive market forces them to innovate and follow the rapid technological improvements, to respond to customers’ demand. Higher education is becoming a necessity in LICs, as well. This is because it is much easier nowadays to “import” the workforce from another country. On the other hand, factories of transnational corporations are getting established in LICs. In this case, higher knowledge is not required, as the emphasis is placed on repetitive tasks and division of labor. The aim of this work is to provide a relevant analysis of scientific approach of various stand points in regards to different functions and applicability of knowledge, while considering the external factors, such as economic status of the country, to define the key challenges. Still, as the country progresses economically, the sector of production is likely to shift from primary (fishing, farming, agriculture) to the third one (services). As a result, LICs who aim to progress in an economical sense, must place greater emphasis on higher education, and align the educational process with the economic demand.

Sustainable development goals and higher education: leaving many behind

This paper critically interrogates the Sustainable Development Goals (SDGs) in relation to higher education in low-income countries. While the SDG Goal 4, Target 4.3, calls for ensuring ‘equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university’ around the world by 2030, the SDGs lack targets that would make this a reality in many countries where higher education requires reform and rebuilding. Instead of providing assistance to these countries to (re)build and strengthen their fragile higher education systems and institutions, the SDGs, as expressed in Target 4.7, aim to only provide opportunities to a select group of individuals to study at universities in developed and some developing countries. This approach has failed in the past and will only lead to the creation of dependency on foreign aid and assistance and continuation of chronic lack of capacity in many countries. This paper will show that despite the rhetoric about leaving no one behind, the SDGs will leave many behind through the neglect of higher education in low-income countries. Building local institutional and other forms of capacity in the higher education sector in low-income countries should have been one of the priorities in the SDGs. This way countries would be able to develop and strengthen universities and other institutions of higher learning and deliver quality education to their populations. The paper will map out a possible way forward for those interested in assisting low-income countries to strengthen their higher education systems and institutions as this is a prerequisite for inclusive socio-economic development and environmental sustainability.

Response to COVID-19 pandemic: Beyond medical education in Brazil.

We received a response to our Editorial from a group in Brazil that raised valuable concerns about the struggles in transforming medical education in low‐income countries. Here, we address the concerns they raised that reinforce the global need for a "Coalition for Medical Education."

Technology in education in low-income countries: Problem analysis and focus of the Hub's work

Technology in education in low-income countries: Problem analysis and focus of the Hub's work

Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study

Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status-wealth and education-differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management. In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family. Recruitment to the study began on Jan 12, 2001, with most participants enrolled between Jan 6, 2005, and Dec 4, 2014. 160 299 (87·9%) of 182 375 participants with baseline data had available follow-up event data and were eligible for inclusion. After exclusion of 6130 (3·8%) participants without complete baseline or follow-up data, 154 169 individuals remained for analysis, from five low-income, 11 middle-income, and four high-income countries. Participants were followed-up for a mean of 7·5 years. Major cardiovascular events were more common among those with low levels of education in all types of country studied, but much more so in low-income countries. After adjustment for wealth and other factors, the HR (low level of education vs high level of education) was 1·23 (95% CI 0·96-1·58) for high-income countries, 1·59 (1·42-1·78) in middle-income countries, and 2·23 (1·79-2·77) in low-income countries (pinteraction<0·0001). We observed similar results for all-cause mortality, with HRs of 1·50 (1·14-1·98) for high-income countries, 1·80 (1·58-2·06) in middle-income countries, and 2·76 (2·29-3·31) in low-income countries (pinteraction<0·0001). By contrast, we found no or weak associations between wealth and these two outcomes. Differences in outcomes between educational groups were not explained by differences in risk factors, which decreased as the level of education increased in high-income countries, but increased as the level of education increased in low-income countries (pinteraction<0·0001). Medical care (eg, management of hypertension, diabetes, and secondary prevention) seemed to play an important part in adverse cardiovascular disease outcomes because such care is likely to be poorer in people with the lowest levels of education compared to those with higher levels of education in low-income countries; however, we observed less marked differences in care based on level of education in middle-income countries and no or minor differences in high-income countries. Although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education. Full funding sources are listed at the end of the paper (see Acknowledgments).

Closing the Gaps on Medical Education in Low-Income Countries Through Information & Communication Technologies: The Mozambique Experience.

Medical training in developing countries has continuously faced challenges to produce the needed number of cadres and maintain the needed quality standards. Mozambique, a low-income country in Southern Africa, has a major disparity in distribution of medical doctors in the country and only a small proportion are trained as specialists and/or retained as faculty. In this context, we thought that Information and Communication Technologies (ICT) are an attractive tool to support expansion of medical training and residency programs and designed a strategy for its use to promote changes in the learning environment of a university teaching hospital in this country. Beginning in 2010-under the Medical Education Partnership Initiative between Universidad Eduardo Mondlane, Mozambique, and University of California San Diego, United States of America - we conducted extensive interviews to 21 UEM faculty and medical trainees to assess barriers to education and medical care at the major referral hospital in Mozambique. Then, changes were made to address the issues raised mainly through building an ICT infrastructure to improve connectivity, improving access to medical information, distributing communication and mobile medical devices, as well as fostering exchange between students, residents and faculty members. These changes were tracked years after to evaluate adoption. Internet access with large bandwidth and devices such as tablets and computers were distributed to increase access to medical information. The students: resident ratio improved from 13:1 to 5:1 at the end of the project. Additional 25 new faculty members were involved in clinical training, mainly through incentives such as faculty development courses and research training. Teleconferences and other exchanges using ICT have evolved from being used as a platform for weekly clinical rounds and case discussions, to become a day-to-day tool for implementation of quality improvement processes and research projects. New exchange programs between local and foreign institutions were fostered to create a growing network with over 20 institutions at the end of the program. Importantly, these changes persisted beyond the project, and constituted a driver for transformative education and distance learning. Context-tailored use of ICT and mobile medical devices transformed medical education by improving the learning environment, addressing scarcity and low quality of trained doctors in a low-income setting of Africa. This strategy has the potential to reduce health disparities and contribute to achieving universal health coverage. Efforts to guaranty sustainability and health professional's retention are warranted.

Inequality of Opportunity in Education: Accounting for the Contributions of Sibs, Schools and Sorting Across East Africa

Inequalities in the opportunity to obtain a good education in low-income countries are widely understood to be related to household resources and schooling quality. Yet, to date, most researchers have investigated the contributions of these two factors separately. This paper considers them jointly, paying special attention to their covariation, which indicates whether schools exacerbate or compensate for existing household-based inequalities. The paper develops a new variance decomposition framework and applies it to data on more than one million children in three low-income East African countries. The empirical results show that although household factors account for a significant share of total test score variation, variation in school quality and positive sorting between households and schools are, together, no less important. The analysis also finds evidence of substantial geographical heterogeneity in schooling quality. The paper concludes that promoting equity in education in East Africa requires policies that go beyond raising average school quality and should attend to the distribution of school quality as well as assortative matching between households and schools.

The health benefits of secondary education in adolescents and young adults: An international analysis in 186 low-, middle- and high-income countries from 1990 to 2013

BackgroundThe health benefits of secondary education have been little studied. We undertook country-level longitudinal analyses of the impact of lengthening secondary education on health outcomes amongst 15-24 year olds. MethodsExposures: average length of secondary and primary education from 1980 to 2013.Data/Outcomes: Country level adolescent fertility rate (AFR), HIV prevalence and mortality rate from 1989/90 to 2013 across 186 low-, middle- and high-income countries.Analysis: Longitudinal mixed effects models, entering secondary and primary education together, adjusted for time varying GDP and country income status. Longitudinal structural marginal models using inverse probability weighting (IPW) to take account of time varying confounding by primary education and GDP. Counterfactual scenarios of no change in secondary education since 1980/1990 were estimated from model coefficients for each outcome. FindingsEach additional year of secondary education decreased AFR by 8.4% in mixed effects models and 14.6% in IPW models independent of primary education and GDP. Counterfactual analyses showed the proportion of the reduction in adolescent fertility rate over the study period independently attributable to secondary education was 28% in low income countries. Each additional year of secondary education reduced mortality by 16.9% for 15-19 year and 14.8% for 20-24 year old young women and 11.4% for 15-19 year and 8.8% for 20-24 year old young men. Counterfactual scenarios suggested 12% and 23% of the mortality reduction for 15-19 and 20-24 year old young men was attributable to secondary education in low income countries. Each additional year of secondary education was associated with a 24.5% and 43.1% reduction in HIV prevalence amongst young men and women. InterpretationThe health benefits associated with secondary education were greater than those of primary education and were greatest amongst young women and those from low income countries. Secondary education has the potential to be a social vaccine across many outcomes in low and middle income countries.

Grade Repetition and Primary School Dropout in Uganda

Research on education in low-income countries rarely focuses on grade repetition. When addressed, repetition is typically presented along with early school dropout as the “wasting” of educational resources. Simplifying grade repetition in this way often fails to recognize significant methodological concerns and also overlooks the unique insight that can be gained by focusing on repetition. In this article, Sarah Kabay uses mixed methods research to investigate repetition and its association with later school dropout in Ugandan primary schools. In a representative sample of pupils from 136 schools, Kabay finds that in spite of a policy of automatic promotion meant to limit repetition, 88 percent of pupils had repeated a grade and 11 percent had repeated three or more times. Kabay identifies age as a confounding variable for the association between repetition and dropout, and argues that attention should be drawn to the age of entry into schooling and language policy.

Financing higher education in sub-Saharan Africa: some reflections and implications for sustainable development

The purpose of this article is to discuss how best to finance higher education in low-income countries of sub-Saharan Africa, drawing on benefits and drawbacks of the prevalent models of higher education finance, and lessons to be learned from countries which have seen greater expansion of their higher education systems in recent decades. Two main aspects are distinguished: first, a recognition of the powerful evidence that the general level of education in a country, its human capital, matters in determining a path to economic development; second, understanding that it does not help to produce large number of unemployed graduates whose only option due to absence of jobs is to engage in rent-seeking activities which in the end undermine both the essence of the human capital investment made, and job creation to be associated with human capital skills. Three areas are discussed, fully publicly financed “free” university education model; feasibility and lessons about fees; feasibility and lessons about loans. In addition, the paper makes suggestions on the measures to widen participation and promote equity and quality.

Secondary education and HIV infection in Botswana.

In The Lancet Global Health Jan-Walter De Neve and colleagues present exciting results from an important study of the effect of a policy change that increased access to education among junior high school students in Botswana in 1996. The policy change led to an average increase of 0.8 years of schooling among teenagers who were just young enough to benefit from this policy. Using age-specific exposure to the policy as an instrumental variable De Neve and colleagues identified increases in education that were unlikely to be correlated with other factors that also affect HIV status and then showed that individuals who gained an additional year of schooling due to the policy were 8.1 percentage points (p=0.008) less likely to test positive for HIV about a decade later when most of those exposed to the policy were then in their mid-20s. Hence De Neve and colleagues provide strong and convincing evidence that increased education in Botswana was protective against HIV infection among young adults and is even cost effective by most standards. Their results were strongest among women (11.6 percentage points per extra year p=0.046) which is especially important given the worldwide inequities in access to secondary schooling for girls especially in Africa. Although this study provides important new insights into this important global health issue it has a few limitations. First the results are generalisable only to individuals who were surveyed and provided a blood sample which could be undermined if there were important rates of mortality or migration or if education was associated with completing the survey or consenting to an HIV test. Second the study was also not able to identify effect of education on risk of HIV infection for the entire lifetime. Irrespective of these considerations increasing access to education in low-income countries should be an important priority because of the proven economic returns to such investments. The health returns from education such as its potential role in HIV and child mortality should also make it a top priority for the global health community. (Excerpts)

Universal primary education in low-income countries: The contributing role of national governance

The Millennium Development Goal of universal primary education by 2015 cannot be achieved. We demonstrate that per-capita GDP and adult literacy, especially the latter, are significant in explaining national primary completion rates. National governance (measured by comparative perceptions of political stability, government accountability and effectiveness in delivering services) is also important. We also analyze the extent to which countries improved their respective 2001–2005 primary school completion rates in the second half of the decade. Here, quality of governance seems to be key. Adult literacy in 2001–2005 is significant, but explains little; per capita GDP in 2001–2005 is not significant.