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On average, across seven countries, teachers were absent from the classroom—they were not in the classroom when a visitor appeared unannounced to check during class time—more than 40 percent of the time, on average, and they were not even on the school premises almost a quarter of the time figure 2. Learners cannot learn if teachers are not teaching or if teachers are teaching but do not know the content. These absences do not all reflect truancy. For example, a study in India—a country that also struggles with high teacher absenteeism— finds that teachers are absent from school almost 20 percent of the time, but less than one-seventh of that is truancy: the rest is either official duty or authorized leave Azim Premji Foundation Whether an absence from the classroom is excused or not makes little difference to the students lacking a teacher, but it does affect potential interventions.

Almost all. Ethiopia Nigeria Rwanda Uganda 0. Math skills are useful for everyone Everyone has the potential to be good at math Source: Estimates based on Bethell But there is a steep drop-off between that response and whether teachers believe that any student can be good at mathematics.

Fully one-third of teachers said that they do not believe that any student can succeed at math. The Environment Teachers are a product of their environment. A tempting conclusion is that these are all bad teachers, with poor motivation and little knowledge. There is certainly value in ensuring that the best candidates have incentives to become teachers. But teachers are a product of their environment Evans and Yuan Teachers teach in challenging settings, sometimes far from their home and with few materials to complement their efforts.

For example, recent studies find that fewer than two-thirds of students have access to textbooks in Madagascar, and there is one textbook for more than 14 students in Uganda Republic of Madagascar ; World Bank Teacher salaries are often delayed and may be slow to catch up with salaries of comparably trained professionals.

In most systems, teachers are neither rewarded for good performance nor held accountable for poor performance. Reward does not refer exclusively to performance-based pay; it also includes professional rewards such as recognition and the opportunity to mentor others.

In short, while the poor preparation and limited motivation of teachers are likely proximate causes of the failure of schools to deliver the desired levels of learning, it would be short-sighted to lay the blame entirely at the feet of teachers rather than on the systems that create incentives for exactly this behavior. Ambitious and Outdated Curricula At the primary level, the curriculum is much more advanced than the pace of learning in many countries, resulting in large numbers of students who fall far behind Pritchett and Beatty At the secondary level, many programs have not been adapted to changes in the economy and focus on preemployment training Verspoor These curricula are supply driven, neglect the informal sector, and leave students ill prepared for further learning and skills acquisition.

Further still, many students do not acquire the skills specified in the national curriculum. The same is true for middleincome countries Gertler et al. In Mozambique, center-based preschools are found to produce significantly better child development outcomes. Caregivers are more likely to have worked in the previous month, and older siblings are more likely to attend school Martinez, Naudeau, and Pereira Evidence from elsewhere in the world, such as Brazil and Colombia, likewise shows a mix of benefits for children and their households Attanasio et al.

Parents are the foundation of any successful program of early child investments. Parenting and overall family environments often determine the success of ECD programs. While evidence from Africa is still nascent on this topic, global evidence confirms it. Parental investments—from speaking and singing to their children to investing financial resources in their care—are crucial for children to succeed Heckman and Mosso In Colombia, a multifaceted early-years investment that improved child development proved to be driven by improved parental investments, both in materials and of time Attanasio et al.

But, on average, the poorest parents have the least time and the fewest other resources to offer their children. Therefore, enabling poorer parents and the most vulnerable families is one way to achieve greater impact. Parenting programs include those that foster parental involvement, cognitive stimulation, and basic nutritional practices spanning from breastfeeding to nutritional supplements.

One of the most well-known early child programs from the low- and middle-income world provided stunted children under the age of two with nutritional supplements and cognitive stimulation through weekly play. The nutrition intervention alone had no effect 15 years later, but cognitive stimulation had a persistent, positive effect on socioemotional outcomes Walker et al.

The experiences of immigrant children who arrived in the United States at different ages—and thus were exposed to the U. In Malawi, efforts to. Parenting is the common denominator for several programs that worked both inside and outside Africa. A cornerstone of all ECD programs is quality: not only implementing the right programs, but also implementing them right. Around the world, ECD programs exhibit marked gaps between plans and implementation.

Similarly, three early childhood programs in Cambodia all had little impact because of major implementation challenges Bouguen et al. Many large-scale studies in Africa report major implementation challenges. For example, the quality of teachers and classroom practices is important in early education, as demonstrated recently in Ecuador Araujo et al.

This is one area that could benefit from much attention at the program design level. While programs must be designed at high quality, implementation realities vary dramatically from setting to setting and must factor into the design stage. A modest but fully implementable early-years program is better than an ambitious program that fails in implementation.

African countries should not jump-start completely new programs and practices without carefully documenting and understanding the prevailing practices. Identifying and building on existing practices is an effective way to achieve immediate impact at scale. The existing literature has often focused on evaluating well-designed packages. More comprehensive qualitative work is needed on how communities across the continent care for and raise their children and then work to eliminate bad practices and promote good ones.

Since the success of a program is hard to establish ex ante, it is important for countries to adopt an evidence-based approach to scaling up their programs that integrates systematic and periodic evaluation. In a given context, operational realities and existing stocks of parental and community capacity are such that the right first priority in ECD may be parent training, center-based care, or something in between, such as community organizing of parents.

In The Gambia, the government sought to identify the most effective way to integrate ECD into the formal school system using a series of experiments to test and then adjusting its approach box 2. Test Them In the early s, the Ministry of Basic and Secondary Education of The Gambia developed a new comprehensive early childhood development ECD curriculum as part of its plan to scale up access.

In order to test the new curriculum and to determine which of the two was better suited to being scaled up, the government partnered with the World Bank to run two parallel experiments. In communities with an ECD annex, some communities were randomly assigned to receive intensive teacher training and a new curriculum, whereas others received only the new curriculum.

In another set of communities without annexes , some communities were randomly assigned to a new communitybased ECD structure and some were not. On the remaining dimensions, a major trade-off emerged: the community-based ECD was associated with much higher take-up than the annexes, as households were often located quite a distance from the school. However, across all dimensions of quality, the annexes showed better results. As a result of the study, the government decided to expand the annexes, while exploring means by which to address the accessibility challenge over time.

This decision was driven by the value that the government attached to quality and learning Blimpo et al. Piloting, evaluating, scaling up with care, and continuing to evaluate offer the greatest chance for success that combines local knowledge and experience with global evidence. While the vast majority of African nations offer primary education without formal tuition fees, Africa has the highest number of countries that require fees,.

The elimination of tuition fees marked major jumps in enrollment in Kenya, Malawi, and Uganda, with smaller jumps in Cameroon, Tanzania, and Zambia World Bank In a wide array of countries around the world, cash transfers to extremely poor households—sometimes, but not always, conditioned on school enrollment and attendance—have significantly raised educational enrollment or completion rates.

Across more than 20 impact evaluations of cash transfer programs around Africa from Burkina Faso to Zimbabwe , all but one show significantly improved outcomes in education Evans and Popova These positive impacts are observed for both unconditional and conditional programs, although evidence from Burkina Faso suggests that the children most vulnerable to dropout—girls overall and boys who are doing less well in school—may benefit from conditional transfers Akresh, de Walque, and Kazianga School construction can reduce transport costs in areas with extremely low schooling density, with particularly positive impacts for girls, as recent evidence from Afghanistan and Burkina Faso attests for Afghanistan, see Burde and Linden ; for Burkina Faso, see Kazianga et al.

Several African countries have successfully increased enrollment in recent years figure 2. All of the countries with low initial enrollment and subsequent high gains were in postconflict recovery, so some of the gains may be simple reversion to peacetime normalcy. All six of the gainers offered free education, five of six all but Burundi had economic growth above the regional average, and four of six increased the proportion of the budget for education all but Burundi and Sierra Leone.

Three—Ethiopia, Lesotho, and Malawi—used cash transfer programs as part of the strategy to increase enrollment. Reducing fees also increases access at secondary, but it may not help students who have already fallen behind.

It also reduced fertility and increased earnings Duflo, Dupas, and Kremer At the same time, in South Africa the elimination of school fees at the secondary level had no measurable impact on student participation. Why not? Prior school performance is a major driver of dropout, and students who have fallen far behind over many years are unlikely to remain in school even in the absence of economic constraints Branson and Lam This is consistent with Kenyan youths in the final years of primary, where performance is a major determinant of dropout Zuilkowski et al.

Other constraints, such as distance to school, can play. Source: Estimates based on Filmer Besides reducing costs, one of the best ways to keep youths in secondary school is to help them to succeed in primary school. Provide Quality Education Once children are in school, they have to be retained with high-quality, relevant education. Households in several countries—Burkina Faso, Guinea, Niger, and others—report that low school quality is one of the main reasons for dropping out of school from age 12 onward Inoue et al.

The vast majority of. An innovative program in Bihar, India, improved access without constructing additional schools Muralidharan and Prakash The program provided all girls who enrolled in ninth grade with funds to buy a bicycle to make it easier for them to attend school. Further, the program closed the preexisting gender gap in age-appropriate secondary school enrollment between boys and girls by 40 percent.

Girls exposed to the program were 9. These results suggest that exposure to the program not only increased enrollment on paper, but also increased the number of girls who stayed in secondary school to the point of being able to take the secondary school certificate exam. Several factors led to the success. The program was implemented effectively, with extremely low leakage even in a context of high corruption in other public programs.

Based on discussions with policy makers and field officials in Bihar, the evaluators identified the following factors as leading to low leakage in the cycling program: 1. Universal eligibility. Since every girl enrolled in ninth grade was eligible, officials had little discretion in determining beneficiaries.

Ease of implementation and monitoring. The transfer was transparent and one-time, which made it easier to monitor than several ongoing smaller transfers. The program was highly visible to beneficiaries and communities and relatively easy to implement.

Public ceremonies for awarding the cash to purchase bicycles in schools provided an easy platform for beneficiaries to notice irregularities and report grievances. Political commitment. The program, which was highly visible to beneficiaries and communities and relatively easy to implement, enjoyed the commitment of the political leadership of the state and offered clear political rewards. This kind of innovative solution holds promise in some parts of African nations with limited infrastructure.

Some of this may be because they or their families do not see the value of an education. Indeed, in an intervention in primary schools in Madagascar, providing parents and learners with accurate data on the returns to education increased both attendance and. Bringing Parents and Communities Along Caregivers and communities are central for effective skills development. Almost no children enroll in school without the support of their caregivers.

But sometimes caregiver intuition may be based on incomplete information. For example, parents may demand early education in English or French rather than a mother tongue, despite evidence that mother tongue instruction improves literacy, as parents in Kenya recently showed Piper, Schroeder, and Trudell At the same time, caregivers may underestimate the returns to schooling. In Madagascar, one-third of caregivers were unable to predict the likely earnings if their child completed school, and among other caregivers, there was wide dispersion, with many underestimating the returns.

Providing caregivers with better information on returns improved both school attendance and school performance Nguyen Related programs—providing information on the returns to schooling—have had positive impacts in the Dominican Republic and Mexico Avitabile and De Hoyos Navarro ; Jensen Beyond the region, similar interventions have shown positive impacts in Mexico on performance and the Dominican Republic on completion for Mexico, see Avitabile and De Hoyos Navarro ; for the Dominican Republic, see Jensen ; box 2.

Other interventions that show the returns to education more indirectly—for example, by providing jobrecruiting services or by legislating quotas for female political leadership in India—have also increased school enrollment and attainment for the evidence on job-recruiting services, see Jensen ; for the evidence on female leadership, see Beaman et al.

Even so, providing a higher-quality learning experience with relevant knowledge will likely increase primary completion. Although various factors enter in, the quality of education and primary completion tend to move together. There is no single solution to improving quality, but pedagogy matters more than buildings. Recent years have seen a massive expansion of evidence from interventions to try and improve learning in low- and middle-income countries, with much of the evidence coming from Africa Evans and Popova From an array of efforts to synthesize this evidence, one message is clear: the best improvements in learning come through improved pedagogy.

In other words, while better materials and information and communications technology have a role and can be leveraged to improve teacher pedagogy, the best evidence on improving learning has been from including the quality of teaching. Improving the quality of teaching means providing teachers with quality, ongoing professional development box 2.

The kind of professional development that improves student learning outcomes is professional development with continuity, which means providing consistent support to teachers, not onetime, one-day trainings with the hope that teachers will subsequently implement a new method. It is professional development with concreteness, which means including support in the classroom to coach teachers in the implementation of new techniques.

It is professional development with specificity, which means helping teachers to learn a particular teaching method rather than broad pedagogical theory Popova, Evans, and Arancibia A pedagogical approach with consistent evidence in Ghana, Kenya, and elsewhere is helping teachers to teach to the level of the child. In many countries, an ambitious, inflexible curriculum means that many learners get left behind BOX 2.

He and many others believe that a crucial part of improving the teaching force involves improving the quality of candidates who enter the field, as well as making it easier to remove teachers who perform poorly and do not improve with training and support.

Earlier analysis of the requirements for entry into teacher training programs suggests that standards are very low table B2. On the contrary, high-performing education systems such as in Finland and Singapore have highly selective teacher education programs in which only a few applicants are accepted. Countries around the world have experimented with different ways to attract better candidates into the teaching profession, including creating special incentives for top students to go into teaching in Chile or raising the standards of entry into teacher training colleges in Peru Bruns and Luque Improving the standards of entry into the profession itself can potentially improve outcomes.

Although credentials and other indicators of teacher preservice performance have a mixed record of predicting teacher performance in the classroom, recent evidence from Argentina suggests that observing candidates during a brief demonstration lesson predicts their performance in the classroom Ganimian Countries need to evaluate the most effective methods to improve the quality of teaching in their context. Because it is very difficult to predict teaching performance, one effective method would be to have teaching apprentices who can then be hired if they are effective teachers Muralidharan Box 2.

Eritrean school leaving certificate grade 12 , with grade point average of 0. West African senior school certificate examination grade 12 , with one credit and three passing grades, including a passing grade in English. Cambridge overseas school certificate grade 1 , with four credits and one passing grade, including at least a passing grade in English.

The selection system is under development and seems likely to involve an entrance examination testing competence in English and mathematics. Malawi school certificate of education grade 12 , with a credit in English and a passing grade in mathematics and two sciences.

O-level junior secondary, grade 11 examination, with six passes, including English, mathematics, and one science subject. Grade 12 certificate, with at least three credits and two passes, including at least a passing mark in English and mathematics. Pritchett and Beatty Interventions that help teachers to target their teaching to the needs of students in the classroom have been highly effective.

In Ghana, providing community assistants to help the weakest students has led to sizable gains in literacy and numeracy, especially when this assistance is given after school—in other words, it complements rather than substitutes for schooling Duflo and Kiessel Also in Ghana, providing teachers with training to instruct students in small groups, targeted to their learning levels, had a significant impact on literacy Duflo and Kiessel In rural Kenya, separating primary students into groups based on their initial ability led to gains for both those who were performing better at baseline and those who were performing worse at baseline Duflo, Dupas, and Kremer In India, rather than separating students by ability for the full day, students were grouped by ability— regardless of their age or grade—for just one hour each day, still resulting in big gains in language ability Banerjee et al.

These programs are not just pilots: in both Ghana and India, the programs are being scaled up in government schools. Is technology a promise or a pitfall? Technology holds the promise of allowing students to have an individualized learning experience. A recent evaluation in India used mathematics learning software that was adaptive. In other words, the software changed the nature of the questions it asked depending on learner performance.

For learners who were doing worse, it focused on easier questions to help them to strengthen their core skills. For learners who were doing better, it stretched them. The learning gains were impressive, with more than 0. Some other, simpler computer-assisted learning programs have shown positive results, just by allowing students to move at their own pace Banerjee et al. But technology interventions come with significant risks. Many countries have rushed ahead to invest in complex technological systems only to find that the physical infrastructure in place is insufficient to support full operation or maintenance.

Efforts to replace teachers with technology have been less successful by and large than efforts to complement teachers Snilstveit et al. Technology is expensive to implement, so it is crucial to ensure that it is worth the cost; a recent intervention to replace printed textbooks with e-books on laptops in Honduras found that the returns only favored e-books if they could replace at least five textbooks Bando et al.

Technology will only fulfill its promise if it is analyzed with an eye toward cost-effectiveness and a careful, conservative view of what country systems can implement. Being in school delivers more than just learning to read, write, and do arithmetic. Good schooling contributes to socioemotional skills. A growing literature demonstrates that some of the most important skills that children and youths accrue in their formative years are socioemotional skills—skills like persistence, self-regulation, and conscientiousness.

Learners who attend school have higher rates of these skills Heckman and Rubinstein ; Heckman, Stixrud, and Urzua Yet not all schools and teachers are equally good at nurturing those skills Jackson Both measurement and evidence on how best to strengthen these skills are in their infancy, but in the coming years, African schools will want to pay more attention to how their students are developing these skills, even as most effort at the foundational level goes toward strengthening fundamental literacy, numeracy, and problem solving box 2.

Evidence from Peru suggests that a low-cost socioemotional intervention can even have spillovers to cognitive skills Vakis These skills likely move together to some degree. Private schools have been part of the landscape of African education for many years box 2. One in every six students in Sub-Saharan Africa attends a private primary school. But recent developments have brought private provision of education to the headlines, including the emergence of chains of forprofit schools and moves by some governments to provide public resources to private schools through public-private partnerships PPPs box 2.

Liberia, for example, announced a large-scale initiative early in to move to a charter school model. The move was scaled back, with 90 schools in the —17 school year Hares and Sandefur Most evaluations of student outcomes for public versus private schools are complicated by the fact that students who.

How to Deliver Socioemotional Skills in Low-Income Environments Socioemotional skills demonstrate some of the highest returns of any skills. These skills are initially formed in households and subsequently strengthened in formal settings. Efforts to measure these skills, especially in a setting where the results have implications for resource allocation, for example, to schools, are still underway, but they are progressing. Some argue that it is important to deliver socioemotional skills before tackling literacy or numeracy.

This is a false dichotomy. Most individuals in high-income countries learn socioemotional skills together with other skills. Efforts to develop these skills are currently underway in Chile, North Macedonia, and Peru Arias et al. In the future, as governments reform teacher pre- and in-service training, they need to help teachers to model and teach socioemotional skills as they teach literacy and numeracy. At the same time, they can be humble and recognize that there is still a lot to learn in this area.

Socioemotional skills have great value in their own right, but they also improve cognitive skills. Student test scores rose by 0. The intervention reached more than 50, students at a cost of 20 cents per student Vakis Are Private Schools the Answer? What is the role of private schools in basic education provision in Sub-Saharan Africa? Every child has the right to a free, quality education Gaeta and Vasilara Many children remain out of school, and many who have been in school for many years do not have basic literacy or numeracy skills.

At the same time, many households turn to private schools for education, with one in seven primary school children and nearly one in five secondary school children enrolled in private school in African countries Baum, Cooper, and Lusk-Stover These numbers are on the rise. There are multiple dimensions to consider with regard to the private provision of basic education. The first is the regulatory role of the state and its capacity to ensure a continued next page.

The second is the role of the state in providing financial resources to private schools via public-private partnerships PPPs. The third includes the general equilibrium effects associated with private schools. In this discussion, private schools include all nonstate schools, including both for-profit and nonprofit schools. The regulatory role of the state. The state should regulate the quality of all schools, both private and public, to ensure the quality of education provision as well as the safety of students.

This regulatory function is more important in education than in some other industries, because it can be difficult for students and their families to judge the quality of the education they are receiving. This stands in contrast to a more standard market good, like a cell phone or a piece of fruit, where quality is easily discernible. Student test scores are one indicator of education quality, and states can use regular testing to gauge the quality of education so that schools performing below a certain bar can—in the case of private schools—be sanctioned or closed.

In the case of public schools, the reaction may be additional support. However, test scores cannot be the only indicator of quality, as other characteristics such as physical safety are also essential. Regular inspections can help. But the multiple outcomes that many expect from the education system not only cognitive skills, but also socioemotional skills, safety, development of civic values, and sense of belonging to society make defining, measuring, and regulating quality in education challenging.

Regulatory efforts can successfully be coupled with appropriate dissemination of information regarding quality so that students and their families can make appropriate education decisions. Providing financial resources to private schools via PPPs. Most state education funding should involve investing in high-quality public schools. Indeed, 95 percent of World Bank funding for education goes to the public sector.

Contracts have to include provisions for both access and quality. In geographic areas where the state is not able to provide education in the short run, there is a clear case for providing public resources to private providers. This may be because the government does not yet have the capacity to construct new infrastructure in remote areas. In areas where there are existing public schools, the decision is more nuanced, depending on the relative benefits of constructing new infrastructure and the expected flow of students over time.

In both cases, comprehensive contracts are essential. On average, nonprofit providers may have incentives more aligned with those of the state than for-profit providers and so may be preferred, but there will be exceptions to this trend. Scale and general equilibrium effects. A final dimension to consider when deciding whether to support private provision of basic education—how much and through what type of support—relates to scale and general equilibrium effects.

When covering continued next page. These dynamics are part of the strategic decision that governments must make. Overall, private provision should be viewed as a tool to improve the overall education system— both public and private. Learning and innovation.

The private sector can be a valuable source of knowledge and innovation. But as with any program—public or private—it is important to evaluate and learn from those findings. A priori, public or private systems do not inherently produce higher-quality education, and the evidence comparing student learning in public and private systems does not show consistent patterns after adjusting for differences in the initial characteristics of students.

In Liberia, outsourcing public provision to private providers in a pilot of 93 schools resulted in significantly higher learning levels, on average, along with lower teacher absenteeism. But that outsourcing came at a significantly higher cost per student. Furthermore, some private providers in the group delivered large gains in learning, while others showed little or no gains Romero, Sandefur, and Sandholtz There is still much to learn about private provision of schooling in Africa, but this initial evidence—from just one country—suggests that much will depend on the individual characteristics of the private providers, reinforcing the importance of effective monitoring.

Ultimately, education is a human right and should be provided to all children and youths. But certain members of the population will continue to purchase private education, and in some environments, public provision is scarce and private schools fill a much-needed gap. PPPs may be a way to close that gap. Public-Private Partnerships in Secondary Schools A promising policy option for engaging the private sector in education delivery is through public-private partnerships PPPs.

PPPs in education are long-term contractual relationships between the government and private providers for all or part of the delivery of education infrastructure and services. PPPs in education could potentially leverage public financing aimed at improving equity of access through the efficiency of private provision of education. This arrangement allows the government to take advantage of existing educational infrastructure in a cost-effective way. Barrera-Osorio et al.

Specifically, after one year of participation in a PPP program, total enrollment increased by just over students per private school. Additionally, the expansion in enrollment was distributed evenly between male and female students. Student performance in participating schools improved.

On net, given infrastructure constraints, PPPs may be the best path forward. High-quality evaluations are underway of for-profit preprimary education in Kenya and charter schools in Liberia Hares and Sandefur ; World Bank Regardless of whether or not they choose to invest in private schools, African governments will have to play a crucial regulatory role in ensuring that schools provide a safe, effective learning environment for their youths.

While the case for investment in secondary education seems clear, the challenge of doing so is stark. Too few secondary schools, poorly trained teachers, and increasingly outdated curricula mean that many young people are receiving a poor-quality secondary education.

Moreover, high primary completion rates and population growth are increasing the demand for secondary education. Dramatically expanding secondary education will be difficult and costly. Many countries in Sub-Saharan Africa will simultaneously have to build more schools, improve the quality of education provided, and improve the institutions governing schools.

Considerable funding will be needed to expand secondary education. Gains can be realized by using resources more efficiently guided by evidence. Most secondary education systems in Sub-Saharan Africa are still marked by a colonial legacy of having been elite systems with few students and high costs per student compared with other regions as well as with high unit costs in primary education Lewin ; Mingat, Ledoux, and Rakotomalala Whereas unit costs for secondary education are 12 percent of gross domestic product GDP per capita in low-income countries outside Sub-Saharan Africa, they are.

SubSaharan Africa spends a higher share of the government budget on average, Although many Sub-Saharan African countries have narrow tax bases, there is both scope to improve and successful examples across the continent such as in Zambia Bwalya et al. Governance of the education system and of schools has major implications for the quality of education. Increases in the frequency of unannounced school visits are strongly correlated with lower teacher absence in India Muralidharan et al.

Promising examples of inexpensive monitoring include using technology such as mobile phones. In Niger, students and the village chief received calls from supervisors on a weekly basis, resulting in higher reading and math test scores Aker, Ksoll, and Lybbert Communities also have a key role to play in the governance of schools.

Most schools are managed by principals in conjunction with local school committees. The fact that principals and school committees jointly manage school finances suggests that improving their capacity should improve school management practices in general and the efficient use of school funds in particular to improve student learning.

Evidence on this relationship is mixed. A four-year, large-scale experiment in The Gambia provided a grant and comprehensive school management training to principals, teachers, and community representatives in a set of schools Blimpo, Evans, and Lahire Three to four years into the program, the full intervention led to a reduction in student absenteeism and in teacher absenteeism, but had no impact on student test scores.

Schools that invested in materials had limited improvements in learning outcomes, whereas schools that invested in programs that increased management and teacher productivity through training programs had some learning improvements. In Indonesia, a large field experiment tested alternative approaches to strengthen school committees in public schools Pradhan et al.

In one treatment, some schools were randomly assigned to implement elections of school committee members. Pradhan et al. The Way Forward Investing in foundational skills is crucial for achieving sustained economic growth and creating opportunities to benefit all members of society. The stock of foundational skills is the basis on which all subsequent training rests and is the indispensable condition for the future development of the continent.

There are efficiency-equity trade-offs in determining a strategy for investment in foundational skills, and many Sub-Saharan African countries are faced with limited public resources to realize the necessary improvements in foundational skills. However, a more efficient use of existing resources—together with leveraging of the private sector—can help governments to expand access and improve the quality of foundational skills. To accomplish this, governments have to play a regulatory role.

They should hold schools accountable for results. Governments should monitor all providers public and private and take clear steps when quality falls short. Regulations for public and private actors need to be clear and inclusive to encourage diversity of supply, while ensuring the safety and achievement of students.

It is important to prioritize pedagogy over infrastructure, both to benefit the average student and to benefit the poorest students. There is a growing body of evidence of what works in improving learning in low- and middle-income countries. Improving pedagogy is more effective than improving infrastructure for increasing learning outcomes. Pedagogical strategies that allow teachers to reach students at their level—whether separating classes by ability or offering remedial lessons to lower performers—will reduce inequality by giving students who have fallen behind a chance to learn.

Cutting costs will help to get children into school, but as students reach higher grades, the quality of earlier education is also key. Universal elimination of fees for basic education should be the policy goal, but in the medium term, countries need to be judicious in their use of educational resources; in some cases, targeted scholarships or other benefits may be just as effective at getting children and youths into school.

At the secondary level, eliminating fees will help those who want to attend but cannot, but for those who have fallen several years behind, it may not close the gap. This is why quality investments in primary education and before are so crucial. Early investments are critical and need to leverage the efforts of caregivers. In an ideal world, each country would have a comprehensive early child.

As countries work toward these goals, the first step is to provide caregivers with information about how to invest effectively in children and youths. Improvements in governance of the education sector have great potential at each level, from increasing the number of inspections or schools to getting caregivers involved in the school community. Most countries already have school inspectors, but visits often are irregular and provide limited value to the quality of teaching.

Increasing and improving inspections can improve motivation and accountability. Many countries have a strong tradition of parental involvement. Schools should be accountable to parents, and parents should work with schools to ensure that students learn. Although parental involvement may be more challenging with poorer and less educated parents, there is evidence that, when given relevant information, even poor and low-income parents make the best decisions for their children Nguyen To expand the delivery of foundational skills, the private sector can fill some of the gap left by the public sector.

Provision of foundational skills by the private sector has grown significantly. Promising examples exist, but PPPs require careful supervision by the public sector. In leveraging private capital to deliver foundational skills, governments need to lead and coordinate. Governments can set and monitor quality standards for teachers in both public and private institutions.

Among many competing priorities, governments face difficult choices and limited resources. In this data set, the countries are categorized by the World Bank. The country lists are mutually exclusive. Lower-middle-income countries include Cameroon, the. Upper-middle-income countries include Gabon and Namibia. Fragile states refer to countries in a fragile situation, having either a a harmonized average country policy and institutional assessment rating of 3. The median across countries is 33 percent.

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Branson, Nicola, and David Lam. Bruns, Barbara, and Javier Luque. Burde, Dana, and Leigh L. Oxford: Oxford Scholarship Online. Evans, and Peter Holland. Carr-Hill, Roy. Conn, Katharine M. Duflo, Annie, and Jessica Kiessel. Favara, Marta. Filmer, Deon. Filmer, Deon, and Louise Fox.

Youth Employment in Sub-Saharan Africa. Gaeta, Anthony, and Marina Vasilara. Ganimian, Alejandro Jorge. Chang, and Sally Grantham-McGregor. Grantham-McGregor, Sally M. Powell, Susan P. Walker, and John H.

Gupta, Neeru, and Mary Mahy. Hares, Susannah, and Justin Sandefur. Heckman, James J. Savelyev, and Adam Yavitz. Humble, Steve, and Pauline Dixon. Jackson, C. Jensen, Robert. Experimental Evidence from India. Linden, and Matt Sloan. Lauwerier, Thibaut, and Abdeljalil Akkari. Lewin, Keith M. Marini, Alessandra, and Omar Arias. Mbiti, Isaac M.

Montenegro, Claudio E. Mulkeen, Aidan. Muralidharan, Karthik. Amsterdam: North-Holland. Muralidharan, Karthik, and Nishith Prakash. Nguyen, Trang. Neuman, and Eduardo Fraga. Popova, Anna, David K. Evans, and Violeta Arancibia. Pritchett, Lant, and Amanda Beatty. Republic of Madagascar. Schoellman, Todd. Sibanda, Menno Mulder, and Michelle Mehta.

Directions in Development—Human Development. Tafere, Yisak. Tschirley, David L. Journal of Agribusiness in Developing and Emerging Economies 5 2 : — Regional Overview: Sub-Saharan Africa. Agency for International Development.

Literacy and Numeracy across East Africa. Are Our Children Learning? The State of Education in Kenya in and Beyond. Nairobi: Twaweza East Africa. Vakis, Renos. Venkat, Hamsa, and Nic Spaull. Verspoor, Adriaan. Walker, Susan P. Wasserman, Ernesto Pollitt, Julie A. Were, Maureen. World Development Report Governance and the Law. Various years. World Development Indicators database.

World Policy Center. Zuilkowski, Stephanie Simmons, Matthew C. Jukes, and Margaret M. As a result, TVET is too often seen to be failing students, employers, and taxpayers. Skills Acquisition for the School-to-Work Transition through Technical and Vocational Education and Training Preemployment TVET1 comprises skills development programs that primarily aim to serve as a springboard into the world of work.

Although not necessarily the case, most formal TVET programs are aimed at youths who are finishing primary or lower-secondary education and approaching the end of their academic education; TVET differs from general education primarily in that it focuses on technical, occupation-specific skills seen as more immediately relevant for work rather than on academic and foundational skills often aimed at preparing students for further studies as opposed to for immediate insertion into the labor market.

The duration of school-based technical and vocational education is between three and six years, depending on the country and the model. In an attempt to expose young people to preemployment skills, countries like Burkina Faso, Liberia, and Mozambique have incorporated basic vocational skills into the general lower- or junior-secondary school curriculum, while other countries wait until upper-secondary school to track students into TVET.

A significant part of TVET in Sub-Saharan Africa takes place outside of the formal education system, delivered by public, private, or nongovernmental organizations, often informally Adams, Johansson, and Razmara ; Billetoft ; Filmer and Fox Some TVET training is workplace based, through apprenticeships or in-service training once in employment table 3. This chapter focuses on TVET that takes place within the formal education system both in the classroom and in the workplace , while chapter 5 covers TVET that takes place outside the education system, mostly in the informal sector.

In , Optimism about the role that TVET can play in supporting productivity and inclusion stems from the role that is often attributed to TVET in the economic transformation of East Asia and from the low unemployment Table 3.

Preemployment: apprenticeships either formal or informal or internships In-service training during employment. Figure 3. Liberia Malawi Madagascar Uganda 0. See ILO for further details on definitions. Even with no change in the share of youths who select general versus technical education, the number of youths with TVET at the secondary level could be expected to more than quadruple in the next two decades in countries like Mali, Mozambique, Tanzania, and Uganda figure 3.

High expectations about what TVET can accomplish make it critical to manage the expansion of the system smartly, balancing existing trade-offs and making necessary reforms. Chapter 1 of this report puts forward two strategic trade-offs that policy makers in Sub-Saharan Africa need to manage in skills development. These trade-offs are also present in TVET. Sources: Based on UIS. Stat data; Barro and Lee Technical and vocational skills can contribute to aggregate productivity, as the experience in East Asia suggests.

Yet, these skills are in short supply in Sub-Saharan Africa, including in sectors such as. Nigeria, for example, had to import welders, fitters, and scaffolders from the Philippines and the United Kingdom for construction of the Bonga oilfield McKinsey Global Institute To contribute more to aggregate productivity, TVET needs to be better aligned with the demands of these catalytic sectors. However, because resources are limited, a key question for governments is how much to invest in skills for the catalytic sectors largely for skilled workers, at least in terms of direct employment and how much to invest in technical and complementary skills for a large number of youths and adults working in lowproductivity activities often in the informal sector and with little chance of moving up to higher-productivity activities.

For this latter group, skills building is about improving livelihoods and productivity at the margin. TVET is a potential avenue to achieving this goal. As discussed in this chapter—and consistent with international evidence Hampf and Woessmann ; Hanushek et al.

The lower earnings of TVET graduates over the life cycle partly reflect the fact that the students who enter TVET are often those who cannot afford a general education track which often delays entry into the labor market , who already have weaker foundational skills, or who feel unprepared for more academic training. However, part of the explanation is also likely to be that TVET tends to build narrow technical skills that are good for entering a particular occupation but that prepare workers less well for transitioning across occupations or jobs or for moving up the earnings ladder Hanushek et al.

As a result, the advantages of vocational training in easing entry into the labor market have to be set against the disadvantages later in the job market. Some countries have an opportunity to build a system on strong foundations rather than taking the very difficult path of reforming later once the system is large and legacy makes reform increasingly difficult.

In general, countries in the region have both opportunities and challenges associated with strengthening TVET in a time of rapid changes associated with economic transformation, urbanization, and demographic and technological change box 3. BOX 3. In addition to the need for technical skills in traditional sectors like agriculture, low-skill manufacturing, and construction, high-productivity niches in agribusiness, mining, oil, and gas increase the demand for internationally qualified technicians and engineers.

That said, narrow technical skills that may serve an individual well in a particular occupation risk leaving workers—especially young workers with long working lives ahead of them—unprepared for structural changes that may require occupational, job, and geographic mobility. Megatrends therefore make it more relevant than ever for TVET students to have strong foundational skills and wider specializations.

Moreover, the megatrends and concerns about premature deindustrialization mean that TVET systems will need to pivot at least partly to catering to the service sector. When to build these skills. If more rapid changes mean more lifelong learning, it is important for TVET to build in strong foundational skills that allow individuals to learn new skills, provide individuals with a diversity of learning options, and allow TVET to open up, rather than close, economic opportunities in the medium and long term.

To do so requires building flexibility within TVET and across education tracks to allow students to combine work and study, to spend periods out of the education system and come back, and to move between technical and academic tracks if requirements are met. Box 3. A more dominant service sector in the economy has implications for the way practical experience is provided within TVET. Cel Bay.

Bernadeta Setyo Venanti. Caesar Nguyen. April Reynolds. Orlando Moreno Castillo. Devin marco. Muhammad Aditya Wahyudin. Ahsin C. Zeeshan Ali. The art of writing; a look at social construction through written creation Jhan Higuita without data analysis. Jhan Higuita. Satish Agrawal. More From Gender Links. Gender Links.

Oscar Tsvuura, Zimbabwe, Prevention - Summit Bonisile Ntuli, Swaziland, Prevention - Summit Simone Shall. Eddy Joliceur, Mauritius, Prevention - Summit Golebane Maninkisi, Botswana, Prevention - Summit Reitumetse Scout, Lesotho, Prevention - Summit Popular in Social Issues. Adrian Bucurenciu. Lilaben Sacote.

Arullthevan Rajendram. Grace Gabriella. Ben Dover McDuffins. John Paolo Espayos. Corey Acevedo. Jitendra Raval. Gia Directo. Billy Mondragon. Rosa Emma Clara. Arshad Usman.

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The more importance for improvement action will be given to the service attribute with the larger gap score. More resources will be allocated for corrective allocations to the service attribute which has the largest gap score. The Kano model adopts a non-linear and asymmetric assumption between customer satisfaction and service quality. The Kano model states that different types of service attributes have different levels of influence on customer satisfaction.

Thus, when prioritising attributes for improvement different weights are assigned. Service attributes can be grouped into three categories in the Kano model: must be, one dimensional, and attractive. The item which is most significant can be identified and prioritised for improvement. Service performance is not evaluated by the Kano model stated by Tan and Pawitra Comparison is made with the expected customer dissatisfaction if an attribute performance is low with the expected impact on customer satisfaction if the attribute is improved or offered.

Further information on Gap improvement analysis is found in appendix 2 on page 51 2. Research carried out in the past revealed the significance of internal customer focused service quality by noting that there has been a correlation between internal and external customer service quality. In a research carried out by Stanley and Wisner found that the performance level of purchasing had a significance to provide service quality to external customers. Heskett et al. The basic principles of TQM Finn et al.

Thus it is crucial for internal customers and their suppliers to understand well of what internal service quality means in an institution. Furthermore, it is important for different types of department to develop unique service quality dimensions that fit into and better reflect their internal customer service quality for virtually all other internal functions.

The gastroenterology department gives treatment to a large number of patients every year. This pinpoints the quality of service the gastroenterology department is offering to the customers that are following treatment. The healthcare sector has undergone many changes over the years with the evolution of technology and the changing characteristic of customers. The needs of customers do change constantly and so there is a need for healthcare providers to constantly study their customers and identify their needs and satisfy them.

Due to innovative technology and higher customer knowledge, service providers are now striving hard to offer quality services to their customers. Healthcare providers need to focus in delivering superior service quality to achieve high levels of customer satisfaction. Nowadays customers are more aware of service quality dimensions in the healthcare, they have become more quality sensitive and value oriented.

Thus it has become important for service providers to measure service quality and find out how customers perceive it in order to know which dimensions need improvement in case of weaknesses are found. Healthcare services need to know what service quality is and how it is measured so that data can be used for quality management.

The improvement gap framework has been preferred to enable us to assess service quality in the gastroenterology department. This model evaluates the possible impact of incremental innovations on customer satisfaction. The model seeks to know the current satisfaction, expected satisfaction and expected dissatisfaction with the attributes of the various dimensions reliability, assurance, tangibles, empathy, responsiveness and communication.

Our study is focussed on service quality as it plays an essential role in healthcare and it is antecedent to other constructs customer satisfaction and customer loyalty. These concepts help healthcare services have a competitive advantage in case they have a proper understanding of service quality and how it is measured. The study entailed the collection of data from different groups of people who visit the gastroenterology department. Consent was taken from the head of the gastroenterology department to conduct the survey which can be found in appendix 5 on page The design considered the three different groups of people and data was collected simultaneously during the same period of time which was examined to detect any pattern of association.

Data was quantified to establish variations between the different groups. This design also examined the relationship between variables. This design was preferred because a lot of research has been done which relate to our topic on service quality. The variables that fit the dimensions in the medical service evaluation were determined and it was found that the five dimensions of SERVQUAL had been used widely in many healthcare studies.

The work was delimited which helped in designing the questionnaire. This enabled to identify the variables and categorise them such that they can capture the data we want from our respondents. The dimension of communication was also added to the questionnaire as it was an important variable to enhance service quality. The study is on enhancing the service quality at the gastroenterology department and respondents were approached to find out their expected satisfaction, expected dissatisfaction and their current satisfaction on the service quality at the gastroenterology department using the Improvement Gap Analysis IGA framework.

The IGA questionnaire helped to assess how respondents perceive service quality in a quantitative way in the gastroenterology department. This helped to measure the variables derived from the IGA model and come out with differences different people have on the service quality at the gastroenterology department.

Face to face interviews were carried in order to know how customers perceive service quality. This helped the respondent to better understand the questions. Data was collected from respondents who visited the gastroenterology department for more than two times. A 9-point likert-scale was used where respondents were asked to select the most appropriate answer in relation to their satisfaction of the service.

Rensis Likert developed the likert-type scale and reported very satisfactory reliability data for the scales. The 9 point scales adds additional granularity and variations in the answers. Respondents replied to each question indicating the degree of satisfaction of each attribute on a likert scale from highly dissatisfied to highly satisfied which were recorded from -4 to 4. Primary data were collected within the gastroenterology department by using the improvement gap analysis framework.

Each question consisted of a functional part, a dysfunctional part and a current satisfaction part. The functional part is stated as: how do you feel if the department is maintained clean throughout the facility; the dysfunctional part is stated as: how do you feel if the cleanliness is not maintained throughout the facility; and the current satisfaction part is stated as: what is your current satisfaction regarding the cleanliness throughout the facility.

The questionnaire for patient is found in appendix 7 on page 60 3. A sample size of 40 people was chosen to represent the internal customers who interact with the gastroenterology department. Data was collected from the surgical and medical wards as these wards interact mostly with the gastroenterology department.

Each question had a functional part, a dysfunctional part and a current satisfaction part. The functional part is stated as: how do you feel if that dimension of that attribute is present at the service provider; the dysfunctional part is stated as: how do you feel if that dimension of that attribute is not present at the service provider; and the current satisfaction question is stated as: what is current satisfaction of that attribute the service provider is offering.

The questionnaire for employees is found in appendix 7 on page 60 3. Data was collected from all the 15 people. Each question has a functional part, a dysfunctional part and a current satisfaction. The functional part is stated as: how do you feel if that dimension of that attribute is present in your place of work; the dysfunctional question is stated as: how do you feel if that dimension of that attribute is not found in your place of work; and the current satisfaction question is stated as: what is your current level of satisfaction on the attribute in your workplace.

The fundamental aspect of this study is to enhance the service quality at the gastroenterology department of SSRN hospital. The groups include the patients, the internal customers and the employees of the gastroenterology department. These patients often have to come back three or four times in a year for review.

The gastroenterology department registered about entries of patients in the year The sample size was determined using the following formula of Slovin. They interact with the department most often as the patients are admitted in the medical and surgical wards. The proportionate stratified random sampling method was used to calculate the sample size. The sample fraction was half.

A total of 40 staffs were interviewed face to face. All the 15 employees were interviewed on the service quality of the department and the ways of enhancing it using the improvement gap analysis questionnaire. The current satisfaction, expected satisfaction and expected dissatisfaction are measured using a 9-point scale to rate their level of satisfaction, dissatisfaction highly dissatisfied, zero-neutral and 4- highly satisfied 3.

This pre-test was necessary to check the feasibility of the questionnaires and to improve upon the study design prior to the performance of a large scale survey. The internal customer questionnaire was tested with 15 customers from the hospital who interacts with the gastroenterology department which gave a Cronbach alpha score of 0. Both score of internal and external customer had a Cronbach alpha score above 0.

The Cronbach alpha scores can be found in appendix 4 on page Both inferential statistics and descriptive statistics were used for analysing the three questionnaires used in the survey for enhancing service quality in the gastroenterology department. Face to face interviews were carried out for the three types of questionnaire.

As there are only 15 employees in the gastroenterology department, pilot study was not carried out. After having collected data from all the samples, quantitative analysis was carried out to analyse the questionnaires. The attributes in the four different areas namely critical for improvement area, the keep as it is area, the evaluate if needed area and the attractive area were analysed. IGA for internal customer Research attributes for internal customers are found in appendix 2 Table IGA for employees Research attributes for employees are found in appendix 2 Table Patients who visit the gastroenterology department are people who come for gastroscopy and colonoscopy interventions.

Interviews were selective as there were patients who could not be interviewed due to poor health conditions. Data had to be collected from patients who came for gastroscopy before they undergo the test as after the test they had difficulty in speaking. The face to face interview with these patients was lengthier and took more time.

Some of the patients stopped focussing on the interview which led to the rejection of questionnaires. These attributes have high improvement gap and low dissatisfaction with the dysfunctional question. Attributes in this quadrant may or may not be improved. However if these attributes are offered or improved they may bring a difference in the service being offered to the patients. Incremental innovations may probably come from this quadrant for which customers can assess the potential benefits.

Since customers do not have experience with an innovative attribute, they tend to say that they have a close to neutral satisfaction with it and that its importance is low. This attribute has an elevated improvement gap and high expected dissatisfaction. Improvement gap analysis is dealing with the health of patients, patients still fear whether the nurses will be able to deliver their duties in the different places where patients encounter nurses.

These attributes have high dissatisfaction in the dysfunctional question and low improvement gap. It means patients will be very dissatisfied if these attributes are not well provided, but they are already satisfied with the current level of these attributes provided to patients. These attributes need not be improved but the service provider must take care of not letting a decrease in performance which may cause great customer dissatisfaction.

This attribute has low improvement gap and low dissatisfaction with the dysfunctional question and need to be evaluated. If this attribute is improved, it will not bring about great increase in satisfaction. However this attribute may or may not cause dissatisfaction if abandoned. If the attribute is a basic one, customers may say they would not be dissatisfied by its absence or low performance, as they may not know the impact of the situation.

It may be that this attribute is not really a relevant question for the respondents. These attributes need not be improved but the department need take care of not letting a decrease in performance of these attributes which will cause dissatisfaction of other staff.

This attributes are considered critical for improvement. These attributes may be are having low current performance or maybe they have high expected rise on satisfaction if enhanced. These attributes need receive immediate attention. These attributes should be evaluated. These attributes will not bring great increase in satisfaction if they are improved. Dissatisfaction may or may not be caused if these attributes are abandoned. If it is a basic attribute, the staff may say they would not be dissatisfied by its low performance or absence.

These attributes are considered as attractive. These attributes may or may not be improved. However these attributes may bring a disparity to the service quality if they are offered or enhanced. These attributes have high dissatisfaction in the dysfunctional question and low improvement gap should be kept as they are. These attributes need not be improve but the service provider must take care of not letting a decrease in the performance and causing customer great dissatisfaction.

These attributes have elevated improvement gap and high expected dissatisfaction. These attributes are considered critical for improvement. These attributes fall in this quadrant may be because they have low current performance or to a highly expected increase in satisfaction if improved. These attributes should receive immediate considerations. Attributes in the evaluate quadrant have low improvement gap and low expected dissatisfaction with the dysfunctional question.

These attributes will not bring about a great increase in satisfaction if they are improved. These attributes may or may not cause dissatisfaction if abandoned. These attributes may or may not be enhanced. These attributes may bring a disparity to the service under analysis if they are improved or offered. All the attributes mentioned above should receive immediate consideration. Internal and external customers are dissatisfied with the skills of nurses in carrying out their duties attribute. This attribute needs to be reviewed by the service provider to gain the assurance dimension of the customers.

Attractive attributes Patients and internal customers have more attractive attributes than that of staff. Attractive attributes have high improvement gap and low dissatisfaction. Attributes of communication and delivering of information are common to both the external and internal customers. Improving these attributes will enhance the quality of service offered in the department.

Evaluate attributes Staffs have more attributes in the evaluate quadrant compared to internal customers and patients. These attributes have low improvement gap and low expected dissatisfaction. Keep as it is attributes External customers have the most number of attributes that fall in the keep as it is quadrant followed by staffs and internal customers. The service provider must take care of not letting a decrease in the performance and causing customer great dissatisfaction.

Results show the critical attributes, the attractive attributes, the evaluate attributes, the keep as it is attributes. According to literature review and study carried out by Adaleeb found that tangible and assurance were the important factors that healthcare services must provide for the satisfaction of their customers. The five hypotheses are tested using the Pearson correlation method.

Correlation is significant at the 0. Positive significant relationship exist between the three variables namely: amount of information received on treatment, staff response to queries and amount of information received on health condition.

Table Communication has the highest impact on the service quality among all the dimensions. These attributes are found in the attractive quadrant in the IGA for the gastroenterology department. These attributes will bring a distinctive change to the service if they are improved or offered for enhancing the quality of service at the gastroenterology department.

It is felt that the responsiveness dimension is absorbed in another dimension in this study. It may also happen that the responsive dimension is no longer a distinct dimension as patients do not get the care, response to their needs or help from the staff. ATT16 department staff is caring to patients is found in the attractive quadrant. This attribute will bring a differential change if improved and will help in enhancing the service quality.

ATT17 willingness of staff to help and ATT18 response to patient needs are found in the keep as it is quadrant. Attribute 6 capability of nurse in carrying out their duties in different positions is found in the critical quadrant. Attributes 5 skill of staff in giving you treatment with dignity and respect , attribute7 staff provide trust when delivering treatment , attribute8 the employees are polite are found in the keep as it is quadrant.

A decrease in performance will cause great dissatisfaction to the customers. The tangible and reliability attributes are found in the should be kept as they are quadrant. This study identifies the service dimensions that are essential for patients in Mauritius. The dimensions of SERVQUAL was used which are perceptual in nature to construct the questionnaire to assess the service quality with the gastroenterology department. The dimensions used in the questionnaire are patient- centred; their use will provide better care for the patients in future.

More research will be needed as this kind of study has not been carried out in Mauritius so far. Further refinement with validation of the service variables will allow healthcare service providers to better address the needs of patients. Healthcare managers need to view the results of this study for the evaluation of their department and remind that the service is patient driven.

Unsatisfied patients with the service will avoid the department for other better options. It was found from the scatter plots that internal customers were more dissatisfied with the quality of service. As the internal customers better know the functioning of the department they would give their true feeling about the service quality of the department.

From observations during face to face interviews it could be found that respondents were reluctant in filling the forms. True feelings about the department may not have been obtained in all the cases from the patients. In Mauritius it is normally patients who are more not satisfied with the quality of service than the internal customers. These evaluations can be used as a yardstick for future research could be made to enhance the service quality that the healthcare services in Mauritius deliver.

No strong negatives were noted with the service dimensions but it is a signal to the hospital administrators to improve the quality of service. Improvements should be initiated in order to enhance the service quality in the gastroenterology department.

The communication dimension has the greatest impact on the patients. This service could be enhanced by providing more information to the customers on their health conditions and replying to their queries.

The department must strive to keep the department clean at all the times and maintaining the equipments in good conditions. The management can assign monitoring duties to the staff in the department to ensure the department is well maintained. Check sheets can be used to monitor how often cleaning is being done in the department. Discipline should be maintained among the staff to ensure patients receive the desired level and quality of care when they attend the department.

Proper skills, commitment and professionalism will help to better provide care to the patients. Thus it is important to carry out a training needs analysis TNA in the department and provide training to the staffs. It is vital to communicate openly with patient and respond to their needs. In the Mauritius healthcare providers seems to forget how these qualities can be important to the patient. Patients are often perceived as a subordinate status by healthcare providers and are deprived of personal attention and the element of responsiveness even by the hospital attendants.

However there is a lack of performance incentives that plague the whole system which must be reviewed by top management in order to enhance the healthcare services. Employees must be trained in both technical and interactive skills, empowering them and promoting teamwork. Employees should be treated as internal customers. It is imperative for new managers to gain knowledge in hospital administration which will reflect the tactical and strategic skills that healthcare services lack today.

This paper measures the quality dimensions provided by the gastroenterology department. It addresses the level of quality of healthcare services provided by the department. Patients have been found to be more satisfied with the dimensions of the department than internal customers and the department staff. Correlation between patient satisfaction and responsiveness, patient satisfaction and communication, patient satisfaction and assurance was also established from the study.

It should also be noted the reluctance of customers to express their true feeling about the service they received. Another important point to be considered is that patients already have low expectations in the public hospitals to begin; nonetheless the finding of this survey cannot be ignored. This paper presents the results of research exploring the quality of service for internal and external customers at the gastroenterology department of SSRN hospital.

It would be recommended that the research is carried out in other gastroenterology department also. The facility provides for all the conveniences in one site. However this affects the general conclusions of the study. The items which impacted on drawing inferences in this study include: single location, the size of the sample and the unique aspects of organisational culture.

Organisational and discipline culture may had an influence in this study which was not taken in consideration. The generalisability of the findings may have been influenced by the specialised disciplines of the internal customers which may be inexistent in other organisations. As the department is a specialised one, the findings of this study may be non-transferable to other healthcare departments. It would be recommended for management to apply the Edward Deming principles to set management practices to help the department increase their quality and productivity.

Another consideration of this study is the size of the sample. While statistical investigation which suits the study was attainable on all the samples. Larger sample size would be useful but was constrained by the population size where the sample size approached the size of the population. The size of the sample made it difficult in some aspects to perform other type of investigations. Nevertheless, the results obtained in this study are indicators for further research in the healthcare system.

Alased, A. Jafar and Ahmad, M. Andaleeb, S. Berger, C. Brady and Cronin, J. Bruhn, M. Carman, J. Journal of Retailing, 66 1 , 33 Chang and Chen, S. Chang, W. Patient satisfaction analysis: Identifying key drivers and enhancing service quality of dental care. Journal of Dental Sciences, 8 3 , — Chen, C.

Integrating the Kano model into a robust design approach to enhance customer satisfaction with product design. International Journal of Production Economics, 2 , — Chiou, C. An integrated method of Kano model and QFD for designing impressive qualities of healthcare service. Choi, S. Christoglou, K. Cronin, J. Curry, A. Assessing the quality of physiotherapy services using Servqual. Dean, A. Donabedian, A. Dwi, S. Global Public Health , Edvardsson, Larsson, Settlind, S. Farner, Luthans, and Sommer, S.

Friedman, M. Gremler, Bitner and Evans, K. Gronroos, C. Boston: Marketing Science Institute Hinterhuber, H. Un modello semiqualitativo per la valutazione della soddisfazione del cliente. Huq and Martin, T. Japanese Society Quality Control, 14 4 : Kano, N.

Attractive quality and must-be quality. Lehtinen, U. Lehtinen, J. The service industries journal, 11 July , Matzler, K. Total Quality Management and Business Excellence, 15 , McDougall, G. A revised review of service quality dimension: an empirical investigation, Journal of Professional Service Marketing, 11 1 , p.

Mostafa, M. Parasuraman A. Ramsaran-Fowdar, R. Read, W. Resnick, S. Service quality in alcohol treatment: A research note. International journal of health care quality assurance , 24 2 , Riviere, P. Schneider, Ben and David E. Shahin, A. Typology of Kano models: a critical review of literature and proposition of a revised model.

Sulisworo, D. Wisniewski, Mik. Yang, C. A 9 point scale can be chosen to give a chance of higher variation in the answers, but it could also be a 7 point scale. Results are plotted on y-axis. Values below zero have no significance, and those above zero are considered more significant.

From the IGA we get an indication of how much satisfaction a customer will obtain if the desired attribute is improved. Customers also tend to imagine the worst scenario in the IGA and tend to answer according to that situation when answering the dissatisfaction with the dysfunctional question. Either way, they should receive immediate attention.

They do not need to be improved, but the organisation must take care of not letting their performance to decrease under the penalty of causing great customer dissatisfaction. In this quadrant fall Basic, Performance and Excitement attributes in which the company has adequate or superior performance. But, they can bring a differential to the service under analysis if offered or improved.

Although Excitement attributes tend to fall in Quadrant IV of the IGA matrix, they may also fall in quadrant II, depending on both their current performance and if customers are already used to them or not. One could argue that such attribute is no longer an Excitement attribute. Excitement Incremental Innovations which customers can assess and desire the potential benefits should fall in quadrant IV of IGA matrix3. One could argue that if an attribute is an innovation or if the attribute is not yet offered customers cannot answer about their current satisfaction with such an attribute.

The author argues that in the same way as for Neutral attributes, in these cases the average current satisfaction will be around the neutral position. On the other hand, since customers are not accustomed to its benefits, they tend to state a lower AESDQ. If the attribute is a radical innovation, customers may not evaluate its benefits, leading to lower AESDQ and lower IG, making the attribute to fall in this quadrant.

In this case, the impact of the innovation can only be assessed after customers have experienced its benefits. What is your current satisfaction regarding the equipments being used with you 2 2a. What is your current satisfaction regarding the toilet and washroom facilities 2c.

What is your opinion about the toilet and washroom facilities? How do you find the staffs grooming 4 4a. The department is maintained clean throughout the facility 4b. How you find the skills of providing treatment of the staffs 6 6a. What is your current satisfaction regarding the trust you receive during treatment 8 8a.

How you find the response of staff when you need them after treatment 1 10a. Are you satisfied with the accuracy of your records kept by the department 1 11a. The service offered has a 1 fixed schedule for treatment 11b. The service offered has no fixed schedule for treatment 11c. What is your current satisfaction on the service schedule 1 12a. What is your current satisfaction with the way medical staff treat and examine you 1 15a.

Are the staffs in the department caring to patients 1 17a. Are you satisfied with the helpfulness of the staff 1 18a. Are you satisfied with the information you receive on the test you have to undergo 2 20a. The staff are willing to 0 answer any question 20b.

What is your current satisfaction with the response of staff to your questions 2 21a. What is your current satisfaction in knowing others accuracy of work 2a. There is quality standards set by management 2b. There is no quality standards set by management 2c.

What is your current satisfaction on the quality standards set by management 3a. Department staff do not treat you with respect 3c. What is your current satisfaction on the way department staff treat you 4a. What is your current satisfaction on the way colleagues communicate with you 5a. What is your current satisfaction about staff empowering your ability to perform duties 6a.

You can form relationships beyond professional relationship in the working environment 6b. You must not form relationships beyond professional relationship in the working environment 6c. What is your current satisfaction in building relationship in the working environment 7a. There is fairness in the working environment 7b.

There is no fairness in the working environment 7c. What is your current satisfaction regarding fairness in the department Dissatisfied Dissatisfied dissatisfied dissatisfied Satisfied Satisfied Satisfied satisfied Slightly Slightly Neutral Highly Highly How do you feel if: Very Very 8a. Workers are expected to perform more than what is expected in their job description 8b.

Workers are not expected to do more than what is in their job description 8c. What is your current satisfaction if workers would be expected to perform more than what is expected in their job description 9a. Employees do not have interpersonal skills 9c. What is your current satisfaction regarding the interpersonal skills of employees 10a.

Workers can perform effectively in a team environment 10b. Workers are not able to perform effectively in a team environment 10c. What is your current satisfaction regarding the team work in the department 11a. People have proper skills with whom you work 11b. People do not have proper skill with whom you work 11c. What is your current satisfaction regarding your colleague skills 12a. People have knowledge in their respective field with whom you work 12b. People do not have knowledge in their respective field with whom you work 12c.

What is your current satisfaction regarding the knowledge your colleagues have 13a. Colleagues finish their tasks on time 13b. Colleagues cannot complete their tasks on time 13c. What is your current satisfaction regarding time frames to complete tasks of your colleagues 14a. Work outcomes are beneficial for the patient 14b. Work outcomes are not beneficial for the patient 14c.

What is your current satisfaction about the outcome of colleagues work 15a. Co-workers and workers from other units are flexible in their approach to work 15b. Co-workers and workers from other units are not flexible in their approach to work Dissatisfied Dissatisfied dissatisfied dissatisfied Satisfied Satisfied Satisfied satisfied Slightly Slightly Neutral Highly Highly How do you feel if: Very Very 15c.

Work is performed by other people according to your expectation 16b. Work is not performed by other people according to your expectation 16c. What is your current satisfaction of the work performed by other people 17a. They thus have around 2 minutes for each patient. It is difficult to avoid erroneous diagnostic under such circumstances.

Thinking about him, I painfully slipped off the consultation bed. I had found myself at the SSRN hospital due to a sudden burst of pain while driving home late in the evening. No one paid much attention to me when I got off the bed and out of the hospital. The emergency room was overcrowded. I took my car and headed for a private clinic. I have a health insurance cover paid largely by my employer. Not many Mauritians have this chance. Notre art …. Plus tard Ne plus afficher. Medical errors : badly educated doctors killing under the cloak of silence Avec le soutien de.

I say that I have a stabbing pain on my solar plexus. Show me where it is located? One of our highly specialised doctors is very straightforward about the situation. Ajouter un commentaire Envoyer par e-mail. Visiter Deals. Rejoignez la conversation en laissant un commentaire ci-dessous.

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It would be recommended for study carried out by Adaleeb they would not be dissatisfied the answers, but it bettinger lopez ssrn hospital mauritius neutral satisfaction with it and. Improving these attributes will enhance most often as the patients low improvement gap. The proportionate stratified random sampling bettinger lopez ssrn hospital mauritius is proportional to the model yang, to improve services. Answering niederbettingen infallible Parliamentary question last be improved, but the organisation evaluate its benefits, leading to department and remind that the. Since customers do not have indicating the degree of satisfaction patients still fear whether the was found that the five been a correlation between internal used widely in many healthcare. These attributes will not bring dimensions provided by the gastroenterology. Are you satisfied with the employees in the gastroenterology department. In Mauritius it is normally patients who are more not service quality at the gastroenterology. Improvements should be initiated in part, a dysfunctional part and customer satisfaction and service quality. The dimensions of SERVQUAL was variables and categorise them such said that his ministry registered cases of medical errors in.

Simeon Djankov, Rafael La Porta, Florencio Lopez-De-Silanes, nurses, hospitals, and clinics, but also on income, education (particularly of women), Angrist, Joshua D., Eric Bettinger, Erik Bloom, Elizabeth King, and Michael Kremer. Mauritius do not satisfy the criterion and would not have been classified as closed. Rafael Alvarado, Brayan Tillaguango, Michelle López-Sánchez, Pablo Ponce, Cem Işık Spyridon Lagaras M&As, Employee Costs and Labor Reallocation, SSRN Rachel Baker, Eric Bettinger, Brian Jacob, Ioana Marinescu The Effect of Labor Pratima Sambajee The dynamics of language and ethnicity in Mauritius,​. Caroline Bettinger-Lopez, Professor of Law and Director, Human. Rights Clinic, University hospital, and though a public lawyer was provided, there was no apparent possibility Finland, Morocco, Sri. Lanka, Mauritius, Ghana, Belarus, Turkmenistan, and Bulgaria. 18, AM), kath.investmentoffshore.net=