Challenges for comprehensive education reform in South America

By: Gonzalo Alcalde

The integral reform of the education is necessary, but it will not be able to be obtained without special attention to the educative decentralization and the national political debates

The countries of South America continue to perform poorly in primary and secondary education, significantly below what would be expected at their income levels. This is a critical deficiency insofar as quality education is the most important element for sustainably reducing inequality and poverty, as well as for ensuring competitiveness. All of the region’s countries that participated in the most recent Program for International Student Assessment (PISA) study (Argentina, Brazil, Chile, Colombia, Peru, and Uruguay) consistently performed well below the OECD average in the reading, mathematics and science categories (see Table 1).(5)  In contrast, South Korea, one of the lowest-income OECD countries, topped the study’s rankings.

TABLE 1. Performance of South American Countries in 2009 PISA Study

Source: OECD, PISA 2009 Database (released in December 2010)

According to a 2010 OECD analysis of these recent results, “successful school systems provide all students, regardless of their socio-economic backgrounds, with similar opportunities to learn.” Students in the region are still far from this situation. While basic education access and enrollment have undoubtedly expanded (secondary education enrollment increased from 57 percent to 91 percent between 1999 and 2006), South American education systems still face significant challenges in quality, equity, and efficiency; the education received by the poor hinders social mobility.

Nevertheless, since the 1990s, reforms undertaken in South America have ostensibly sought to improve not only access, but also quality. The World Bank and IADB notably influenced the actual and recommended reforms undertaken in the region in this period, policies countries understood as the institutional reforms that must necessarily follow structural adjustment programs. These solutions emphasized a reduced role for the state, decentralization, school autonomy (sometimes involving privatization), new standards for evaluation, and measures to improve the quality of teachers. These reforms were not fully implemented and faced important challenges including, first and foremost, the scarcity of financial resources in an era of limited economic growth. They also faced significant political opposition from key actors such as national teacher unions.

In recent years, guidelines for reform have focused not only on changing the structure of education systems and improving financial and human resources, but also increasingly on the actual learning processes at the school level. This involves educational contents and the ways in which teachers and school officials perform their functions. Moreover, there is a new consensus related to restoring and expanding state responsibilities in order to achieve all these changes.(6) Past objectives of decentralization, school autonomy, teacher training, and broader coverage still require significant attention.

Thus, a more complex, integrated and comprehensive approach to reform is being called for, with strong leadership from the state in an era when resources are more plentiful and represent a window of opportunity. When planning reforms, it is essential that policy-makers take into account the anticipated demographic shift that will reduce school age population as a percentage of total population. Reforms in the last two decades, at the same time, suggest that at least two other important factors will determine the ability of countries to embark on such comprehensive changes.

Decentralization has moved forward in some countries, most notably Argentina, Brazil, Chile, Colombia and Peru, while in others there has been no significant change. A consistent criticism of these processes (and most evident in Argentina and Peru) is that new resources and capabilities have not accompanied this newfound autonomy. This issue limits possibilities for improving quality in coming years. At the same time, the central governments of these countries will likely find it more difficult to systematically reform structural, financial and procedural aspects of education because of the complex coordination efforts required vis-à-vis both subnational levels of government and autonomous schools.

Second, it must be assumed that comprehensive social sector reforms are an issue of national political debate. Since the late 1990s, the policy literature (for example, Grindle, 2004)(7) has predominantly viewed teacher unions, still powerful in many countries, and other stakeholder groups as “obstacles” for technocratic reformers to overcome. In practice, many social sector reforms in the region were attempted bypassing national political debate.  The new consensus on education challenges, however, suggests that the necessary changes are so comprehensive that they can only come about in a context of democratic dialogue and inclusiveness, engaging all relevant stakeholders. Thus, countries with stronger democratic practices and institutions should be at an advantage for implementing politically viable reforms.

These two areas pose challenges for international cooperation in education. In the case of decentralization, the incomplete nature of reforms and the pending agenda suggest it will be preferable in the foreseeable future to offer cooperation packages that promote coordination and collaboration between different levels of government, rather than to offer cooperation individually to actors within a heterogeneous set of subnational governments. On the other hand, to ensure the political viability of reforms, it is important to begin considering roles for often ignored stakeholders like teacher unions in the formulation and implementation of existing cooperation programs, including programs in such recent priority areas as inclusion of marginalized groups, learning processes and technology transfer.

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[5] Source: OECD, PISA 2009 Database. Online at http://dx.doi.org/10.1787/888932343342. Accessed: December, 2010.

[6] Rosalía Cortés and Claudia Giacometti, “Políticas de educación y su impacto sobre la superación de la pobreza infantil”. CEPAL, División de Desarrollo Social: Santiago de Chile, January 2010

[7] Grindle, M. (2004), Despite the Odds: The Contentious Politics of Education Reform. Princeton University Press.

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Health trends in South America: Changes are accelerating as countries get richer

By: Fernando Prada

The epidemiologist profile of the countries of South America is undergoing trough important changes that will put pressure on the existing health systems. Planning for what it comes is the correct strategy.

Every four years, the Pan-American Health Organization (PAHO) publishes “Health in the Americas”, a comprehensive report on regional health trends. The most recent edition,(1)  published in 2007 with data up to 2004, concluded that: “the slowing of population growth, the lengthening of life spans, and the stemming of deaths from communicable diseases and perinatal conditions are among the foremost advances in health in the [Latin American] region.” The future prospects were cause of alarm: “the epidemiological profile in the Americas has undergone significant changes in recent decades (…) and over the next 10 years, deaths from chronic diseases will increase by 17 percent and deaths from diabetes will increase by over 80 percent. [This] is attributable to aging of the population as well as to unhealthy behavior and choices that individuals (…) make related to poor nutrition, overweight and obesity, tobacco and alcohol.” In this article we argue that these trends are accelerating for South American countries, and the impact of changes of the region’s epidemiological profile require urgent policy measures in the next five years.

The average mortality rate fell significantly in most South American countries from 1995 to 2008 (figure 1). The mortality rate in 1995 was 6.9 deaths per 1,000 people and 6.1 in 2008. The decreasing trend is even more pronounced in the case of infant mortality, passing from 43.3 per 1,000 live births in 1995 to 25.7 in 2010. Nevertheless, these improvements are not uniform between all countries. Peru, Chile and Argentina have experienced the most drastic reductions; while the mortality rate in Venezuela, by contrast, rose due to more homicides. In the case of infant mortality, Ecuador and halved the mortality rate of children under the age of 5 during a 15-year period. Despite this progress, their rates in 2010 are still far from those of Chile and Uruguay (Peru=30.6; Ecuador=23.7; Chile=8.3 and Uruguay=14.6).

FIGURE 1. General mortality rate (1995-2008) and under-5 mortality rate (1995-2010)

Source: Pan-American Health Organization http://ais.paho.org/phip/viz/mfr_indicatorserietable.asp 

Changes in epidemiology profiles have two causes: first, a reduction in mortality from communicable diseases such as intestinal infectious diseases, tuberculosis and mother-child transmitted diseases; and second, an increase in chronic diseases like diabetes mellitus, malignant neoplasm and cardiovascular conditions (see figure 2 in next page). These two trends and overall improvements in life expectancy and falling mortality rates mirror previous experiences in developed countries. South American countries need to prepare to make the transition from an epidemiology profile of communicable diseases towards one of chronic diseases, aging population and more complex and expensive treatments.

Source: Pan-American Health Organization http://ais.paho.org/phip/viz/mfr_indicatorserietable.asp

Cheap and widely available treatments and improvements in basic sanitation and health systems have helped reduce the incidence of and deaths from communicable diseases.(2) Moreover, as households in South America are covering a growing share of health expenses, the increase in per capita income has also had a positive effect.(3) Nevertheless, coping with this new epidemiology profile requires long-term reforms like promoting healthier lifestyles, preventing care to detect chronic diseases at the outset and cost-effective treatments to reduce strain on public and household budgets. Countries like China and India are making this transition too, and their response has been to promote the design and adaptation of medical technologies to provide low-cost care.(4)

During the next five years, the incidence of complex diseases will increase. Yet, as health care systems reform to cope with this new epidemiology profile, their mortality related to these diseases will fall, as they already have in Argentina and Chile in the case of diabetes mellitus (figure 2). In addition, costs to the health care system and households will increase since most chronic diseases require long treatments and expensive drugs. Insurance and other coverage schemes currently cover only a small proportion of the population, so public health systems will have to make up for these gaps in order to avoid a high cost in human lives.

International cooperation actors have played an essential role in fostering health policies that focus on reducing communicable diseases (e.g. MDGs), and financing cost-effective solutions to cope with them, especially in the most vulnerable communities. Most countries in South America have now the capacity and knowledge to mobilize resources to tackle this challenge. Thus, cooperation actors future role should pivot to raising awareness about the new epidemiological profile and finding cost-effective solutions to coping with these new challenges.

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[1] PAHO (2007), “Health in the Americas 2007”, Scientific and technical publication No. 622, Washington D.C.: PAHO.

[2] Nevertheless, data of incidence of most common communicable diseases (number of cases) is scarce because of underreporting.

[3] There is no available data about household expenses in health treatments. A good proxy is the share of public/private expenses: while the public sector spent 2.6 percent of the GDP in 2008, the private sector contributed with 2.0 in South America (PAHO). 

[4] “Frugal healing: Inexpensive Asian innovation will transform the market for medical devices”, The Economist Jan. 20, 2011.

FIGURE 2. Mortality rates: intestinal infectious diseases and diabetes mellitus (1997-2008)

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Demographic transition in South America: from demographic window to population aging

By Mario Bazán

South America will go from 399 million to 520 million inhabitants between 2010 and 2050. Whereas the minors of 15 years happen to be 27 percent of the population to 17 percent, the majors of 65 years will happen to represent 7 percent 20 percent of the population of the region between these years.

The population of South America is set to expand by 90 million people in the next 40 years. As the demographic structure of the region shifts, governments will have to account for this growth when planning and designing long-term public policy. The principal changes anticipated are: declining birth rates, the predominance of working-age people (between 15 and 65 years old), the relative aging of the population, and greater urbanization.

These long-term tendencies predict a radical shift in the status quo. Between 1970 and 2010, the regional population grew by nearly 200 million people—from 191 to 393 million. This growth has created a demographic structure in South America commonly known as the demographic window: for several years, working-age people will predominant as a proportion of total population, accompanied by falling demographic dependency ratios—the number of people under the age of 15 or over the age of 65 relative to the working-age population.

The demographic dependency ratio is already falling and will continue to fall until 2025, when it is expected to bottom out and start to creep upward (see figure 1). According to the United Nations Economic Commission for Latin America and the Caribbean (ECLAC), there were 8.3 dependents for every 10 working-age people in 1970, compared to 5.1 dependents in 2010. The commission expects 2025 to be the low point in dependency and high point in productive capacity, with only 4.7 dependents for every 10 working-age people. By 2050 the dependency ratio is expected to return to 2000 levels - about 5.7 - as the population ages. These demographic shifts imply that the 50-year span from 2000-2050 represents the region’s demographic window, its opportunity to harness peak productive capacity to accumulate financial resources, transform its institutions and accelerate economic growth.

FIGURE 1. Population by age and dependency rate in South America (1970-2050)

Source: ECLAC (ECLACSTAT)

One of the main differences between the last 40 years and the next 40 is the shift from a predominantly young to a predominantly elderly population. The last four decades saw rapid population growth and, consequently, a high ratio of youths under the age of 15. Between 1970 and 2010, the number of people in that age group grew from 79 million to about 107 million, representing 41 percent and 27 percent of total population, respectively. The youth age group is expected to decline in size and as a proportion of society beginning in 2010, however. The number of people under the age of 15 will fall to 97 million—20 percent of total population— by 2025, and will continue to fall to 86 million by 2050 —16 percent of total population. Inversely, in the past four decades the number of people over the age of 65 grew from 7 million in 1970 to 27 million in 2010, representing 4 percent and 7 percent of the total population, respectively. This age group will continue to grow to 50 million people by 2025 and 103 million by 2050, representing 10 percent and 20 percent of total population, respectively.

Population growth in the next four decades will continue to occur in urban areas, as it has for four decades. This does not necessarily imply a significant drop in the number of people living in rural areas, however, only a reduction of their size relative to the rest of the population. The urban population tripled between 1970 and 2010, from 112 million to 332 million, and it is expected to reach 398 million by 2025. By 2050 the urban population will grow to 457 million people, or 87 percent of the total population. By contrast, the size of the rural population relative to the rest of society has fallen dramatically from 41 percent to 18 percent between 1970 and 2010. Yet total rural population was fairly steady over the period, falling from 80 million to 68 million people. This trend is expected to continue: the rural population will fall to about 65 million people by 2025, where it will hold steady until 2050. Yet its relative size will fall from 14 percent to 12 percent of total population, respectively.

These anticipated demographic changes require shifts in social, economic, and urban planning policy. A few measures for policy-makers to consider:

• The reduction in the youth population will require shifts in health and education policy. The current focus on increasing health and education services to cover more children will decline in importance, allowing for a renewed focus on the need to improve the quality of these services.

• The aging of the population will require a shift in social policy to protect and provide for the elderly. The region will only be able to meet these future social welfare demands if it takes advantage of the current demographic window to save for the future. If the region misses the opportunity to generate surpluses now, living standards achieved during the demographic window will erode. 

• Population growth will put more pressure on rural areas. The continued growth of major cities, the consolidation of intermediate cities and the rise of new cities will all encroach on sparsely populated rural areas. Urban growth also provides opportunity, however, boosting demand for food products and recreation land and giving rural areas the chance to revalue their agricultural, environmental, and ecological products and services. The challenge for rural areas will be to maintain their ecosystems, agricultural biodiversity, soil quality, and water supply, while simultaneously increasing the living standards in these zones.

• Rapid urban growth means cities, especially the region’s vast megalopolises, face increased levels of violence and criminality, shortages of basic resources like energy, water, infrastructure and housing, and more waste and contamination. To overcome these challenges, the region must meticulously plan the expansion of its cities and map out intermediate cities to reduce the pressure on existing urban areas.

The transformations expected in South America require an immediate rethinking and reinterpretation of basic concepts like economic growth, development, sustainability, cultural exchange, social welfare, social responsibility, property, and frontiers, among others. These concepts can provide a basis for designing long-term, strategic options for the region. To be successful in the next half century, governments must develop or recuperate their capacities for long-term strategic planning and for identifying challenges and opportunities in the demographic shifts to come.

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