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Roads to Schools and Healthcare Facilities: Identifying Accessibility Gaps in Burkina Faso

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Roads to Schools and Healthcare Facilities: Identifying Accessibility Gaps in Burkina Faso TRANSPORT GLOBAL PRACTICE Public Disclosure Authorized ROADS TO SCHOOLS AND HEALTHCARE FACILITIES: IDENTIFYING ACCESSIBILITY GAPS IN BURKINA FASO Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized 1 CONTENTS CONTENTS ........................................................................................................................................................................................ 2 ACKNOWLEDGMENTS ................................................................................................................................................................... 3 ABBREVIATIONS AND ACRONYMS ............................................................................................................................................. 4 EXECUTIVE SUMMARY.................................................................................................................................................................. 5 1. STUDY BACKGROUND AND OBJECTIVES ....................................................................................................................... 10 2. CONTEXT ............................................................................................................................................................................. 11 2.1. Population, poverty, and human development .................................................................................................. 11 2.2. Overview of relevant policy goals and strategies .............................................................................................. 14 3. THE STATE OF TRANSPORT CONNECTIVITY IN BURKINA FASO ............................................................................... 16 3.1. Road conditions and Rural Access Index ............................................................................................................ 16 3.2. Public transport in Ouagadougou ......................................................................................................................... 17 4. THE SPATIAL DISTRIBUTION OF HEALTH & EDUCATION FACILITIES .................................................................... 19 4.1. Rural Burkina Faso .................................................................................................................................................. 19 4.2. Ouagadougou ............................................................................................................................................................ 22 5. ACCESSIBILTY IN RURAL BURKINA FASO ...................................................................................................................... 24 5.1. Accessibility considering road conditions in place at the end of 2019 ......................................................... 24 5.2. Accessibility constraints posed by flood risk ..................................................................................................... 28 5.3. Accessibility challenges associated with the security situation and internal displacement ..................... 31 5.4. Access constraints as reported by households in select regions .................................................................... 37 5.5. Prioritizing road improvements to improve accessibility ............................................................................... 44 6. ACCESSIBIILITY IN OUAGADOUGOU ............................................................................................................................... 51 6.1. Overall accessibility to schools & healthcare facilities ..................................................................................... 51 6.2. Inequality in accessibility depending on household poverty status .............................................................. 55 6.3. Access constraints as reported by Ouagadougou residents ............................................................................ 57 6.4. Expected accessibility improvements due to the planned new routes ......................................................... 61 7. LINKAGES BETWEEN ACCESSIBILITY TO SCHOOLS AND HEALTHCARE FACILITIES AND HEALTH AND EDUCATION OUTCOMES ............................................................................................................................................................. 64 7.1. Evidence from the global literature ..................................................................................................................... 64 7.2. Findings specific to Burkina Faso ......................................................................................................................... 65 8. CONCLUSIONS AND POLICY IMPLICATIONS .................................................................................................................. 70 REFERENCES ................................................................................................................................................................................ 73 ANNEX 1: REGIONAL LEVEL ANALYSIS (LOWEST-ACCESSIBILITY REGIONS) ....................................................................... 75 ANNEX 2: DETAILED RESULTS AT THE NATIONAL LEVEL ...................................................................................................... 85 ANNEX 3: REGRESSION RESULTS: TRANSPORT CONNECTIVITY AND SCHOOLING RATES .................................................. 87 ANNEX 4: REGRESSION RESULTS: TRANSPORT CONNECTIVITY AND HEALTH OUTCOMES ................................................ 90 2 ACKNOWLEDGMENTS The study was led by Aiga Stokenberga (Transport Economist, IAWT4), Cheick Omar Tidiane Diallo (Sr. Transport Specialist, IAWT4), and Boubakar Lompo (Sr. Education Specialist, HAWE3). Overall guidance was provided by Soukeyna Kane (Country Director, AFCW3), Aurelio Menendez (Practice Manager, IAWT4), Cheick Fantamady Kante (Operations Manager, AWCF2), and Maimouna Mbow Fam (Country Manager, AWMBF). The following World Bank staff and consultants provided helpful advice, data, or technical input: Christophe Rockmore, Eulalie Saisset, Tamara Kerzhner, Vincent Vesin, Mustapha Benmaamar, Lucien Barro, Ibrahim Kabore, David Newhouse, Nga Thi Viet Nguyen, Ryan Engstrom, Joshua David Merfeld, Clarence Tsimpo Nkenge, Keith Garrett, Cecille Lorillou, Vivien Deparday, Komlan Kounetsron, Adrien J. Bagbila, and a team of enumerators. We also acknowledge the extensive administrative assistance provided by Lisa Warouw and Tatiana Daza. Valuable feedback was provided by peer reviewers at decisive stages of the study: Andrew Losos (Sr. Sustainable Development Specialist, IAFT4), Fatima Arroyo Arroyo (Sr. Urban Transport Specialist, IAFT4), Pierre Xavier Bonneau (Program Leader, IAWT4), Muneeza Alam (Economist, ITRGK), and Nicolas Collin Dit De Montesson (Sr. Economist, HLCHN). The team would like to thank several external partners. Household survey data in rural Burkina Faso was collected by Innovative Hub for Research in Africa; surveys in Ouagadougou were fielded by Transitec. The team from New Light Technologies provided technical input to assess the flood risk exposure and criticality of the rural road network and school and healthcare infrastructure. 3 ABBREVIATIONS AND ACRONYMS ACLED Armed Conflict Location & Event Data Project ARV antiretroviral BEPC Brevet d’Etudes du Premier Cycle BRT Bus rapid transit CEP Certificat d’Enseignement Primaire CM Centre Médical (Health Center) CMA Centre Médical avec Antenne chirurgical (Health Center with a Surgical antenna) CONASUR Conseil National de Secours d'Urgence et de Réhabilitation (National Emergency Relief and Rehabilitation Council) CPF Country Partnership Framework CPIA Country Policy and Institutional Assessment CSPS Centre de Santé et de Promotion Sociale (Center for Health and Social Promotion) DALY Disability adjusted life year EHCVM Enquête Harmonisee sur les Conditions de Vies des Ménages (Harmonized Survey on Household Living Conditions) EMC Enquête Multisectorielle Continue (Continuous Multisectoral Survey) FCV Fragility, conflict, and violence GDP Gross Domestic Product GFDRR Global Facility for Disaster Reduction and Recovery GP Global Practice HDI Human Development Index IDP Internally Displaced Person INSD Institut national de la statistique et de la démographie (National Institute for Statistics and Demography) LMIC Low-to-middle-income country MDGs Millennium Development Goals PPS Post-primary or secondary school RAI Rural Accessibility Index RMAT Rayon moyen d'action théorique (average theoretical action radius) SAE Small-area estimation SOTRACO Société de Transport en Commun de Ouagadougou SSA Sub-Saharan Africa TVET Technical and Vocational Education and Training UNDP United Nations Development Program UNHCR United Nations High Commissioner for Refugees 4 EXECUTIVE SUMMARY THE WHY: TRANSPORT ACCESSIBILITY AND HUMAN CAPITAL Burkina Faso is an early adopter country in the World Bank’s Human Capital Project, and its priorities in this area are reflected in the various sector-specific strategies. Human capital as an overall Government priority is also reflected in the World Bank Country Partnership Framework (CPF) 2018-2023. Transport connectivity matters for people to be able to seek essential medical care and to be able to send their children to school. A growing global literature, including from countries in Sub-Saharan Africa, confirms that transport accessibility and affordability have an impact on human capital accumulation, via
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