Social Development and

Human Development

Topic Guide
Authors and contributors
This Topic Guide was written by Evie Browne (GSDRC) and Kerry A. Millington (HEART). Its production was
supported by the UK Government.

GSDRC and HEART appreciate the contributions of Sheena Crawford (CR2 Associates Ltd); Rachel Tolhurst
(Liverpool School of Tropical Medicine); Kate Jehan (Liverpool School of Tropical Medicine); and Beth
Scott (DFID).

About GSDRC
GSDRC is a partnership of research institutes, think-tanks and consultancy organisations with expertise in
governance, social development, humanitarian and conflict issues. We provide applied knowledge
services on demand and online. Our specialist research team supports a range of international
development agencies, synthesising the latest evidence and expert thinking to inform policy and practice.
International Development Department, College of Social Sciences
University of Birmingham, B15 2TT, UK
www.gsdrc.org

About HEART
The Health & Education Advice & Resource Team (HEART) provides technical assistance and knowledge
services to the British Government’s Department for International Development (DFID) and its partners in
support of pro-poor programmes in education, health and nutrition. The HEART services are provided by
a consortium of leading organisations in international development, health and education: Oxford Policy
Management, CfBT, FHI360, HERA, the Institute of Development Studies, IPACT, the Liverpool School of
Tropical Medicine and the Nuffield Centre for International Health and Development at the University of
Leeds.
Oxford Policy Management, 6 St Aldates Courtyard, 38 St Aldates
Oxford, OX1 1BN, UK
www.heart-resources.org

Suggested citation
Browne, E. & Millington, K. A. (2015). Social development and human development: Topic guide.
Birmingham / Oxford: GSDRC, University of Birmingham / HEART.

© DFID Crown Copyright 2015 Supported by:

Licensed under the Open Government Licence:
www.nationalarchives.gov.uk/doc/open-government-
licence
The views expressed in this report are those of the
authors. They do not necessarily reflect the opinions of
GSDRC, HEART, their partner agencies or DFID, who
cannot be held responsible for errors or any
consequences arising from the use of information
contained in this report.
Contents
Overview 1

1 Concepts and debates 2

1.1 Key concepts 2
1.2 How does social development influence human development outcomes? 2
1.3 Key debates and challenges 3

2 Human development and human rights 5

2.1 Health 5
2.2 Sexual and reproductive health 6
2.3 Education 7
2.4 WASH 7

3 Human development and accountability 9

3.1 Health 10
3.2 Sexual and reproductive health 10
3.3 Education 11
3.4 WASH 11

4 Human development and gender inequality 13

4.1 Health / Sexual and reproductive health 13
4.2 Education 16
4.3 WASH 17

5 Human development and age 19

5.1 Health 20
5.2 Sexual and reproductive health 21
5.3 Education 22

6 Human development and social exclusion 23

6.1 Health / Sexual and Reproductive Health 23
6.2 Education 25
6.3 WASH 26

7 Analytical tools and monitoring and evaluation 28

7.1 Human rights 28
7.2 Accountability 28
7.3 Gender 29
7.4 Age 29
7.5 Social exclusion 30

Annex I: Evidence table 31

Overview
This Topic Guide aims to answer the question ‘What is the interaction between social development issues
and human development outcomes?’ An individual’s right to lead a long and healthy life, to be educated
and to enjoy a decent standard of living cannot be realised without addressing social development issues.
This is because these issues determine individuals’ access to resources – who gets what, where, and how.
This in turn affects whether human development is inclusive and equitable or perpetuates inequalities
and exclusion.

Two main rationales for considering social development emerge from the literature. Without
understanding and addressing social drivers of development, human rights will not be realised and
development gains will be undermined. Secondly, by taking social development issues on board,
development actors will achieve better results and better value for money.

This guide provides an overview of available evidence on how social development influences human
development outcomes. It focuses on five social development issues (human rights, accountability,
gender inequality, age and social exclusion) and their influence on four human development sectors: 1)
health; 2) sexual and reproductive health (SRH); 3) education; and 4) water, sanitation and hygiene
(WASH).

Human rights-based approaches form the basis of much of the literature. Rights underpin the purpose of
human development interventions, and provide the guiding structure for measuring outcomes. As such,
human rights encompass all aspects of social development. There are, however, four distinct social
development issues under the human rights umbrella that deserve particular attention:

 Accountability of governments, services, and interventions helps ensure transparency and

fulfilment of obligation in realising human development. Rights-based development is based on
development actors’ accountability in protecting and delivering those rights.
 Gender inequality remains a significant driver of poverty and gender inequity. Unequal power
relations between men and women affect people’s ability to fully access resources, services,
institutions and power that lead to human development. This applies at both individual and
structural levels.
 Children, adolescents and older people warrant special consideration in the realisation of
human development. Poor human development at an early age can have a strong impact on the
rest of life. Adolescents and older people have specific vulnerabilities and human development
needs, which may not be adequately catered for in broadly targeted programmes.
 Socially excluded groups experience discrimination and inability to access services and
institutions. Ethnic minorities, people living with disabilities (PWD), and those in isolated, rural
locations experience individual and structural disadvantages, which restrict their ability to realise
their rights and human development.
Almost all of the literature in this guide adopts an equity or inequality approach. Many papers
recommend an equity approach to service provision. An equity approach is firmly embedded in human
rights and, by recognising different individual and group needs, ensures greater access to services for a
greater number and range of people than a blanket approach which offers the same services to
everyone. On the whole, the literature recommends a multidimensional, relational, and inter-sectoral
approach to research and interventions.

1 Social development and human development: Topic guide

Concepts and debates

1 Concepts and debates

1.1 Key concepts
‘Social development’ refers to many of the non-economic processes and outcomes of development,
including but not limited to: reduced vulnerability; inclusion; wellbeing; accountability; people-centred
approaches; and freedom from violence.1 It is fundamentally concerned with human rights, formal and
informal power relations, inequality and possibilities for building greater equality among individuals and
groups within societies.

‘Human development’ is a process of enlarging people’s choices by building human capabilities to lead
lives that they value.2 This involves the capability to lead long and healthy lives, to be educated, to access
resources and social protection, and fair employment. As such, human development is also
fundamentally concerned with human rights, including those to life, health and wellbeing.

This Topic Guide explores how social development issues influence human development outcomes. It
shows that addressing social development issues is crucial to optimising success in all efforts to promote
human development.

1.2 How does social development influence human development

outcomes?
Addressing social development issues can improve and sustain human development and reduce
individual and community vulnerability. Poverty, gender inequality, social exclusion and geographic
location can all affect a person’s ability to realise their right to a decent standard of living. Moreover,
individuals and groups may face multiple barriers to realising their rights. These barriers can negatively
reinforce each other. For example, girls and women living with disabilities, or poor women living in rural
areas, are likely to face greater barriers than most women living in better-off, urban settings. Challenges
to human development can change throughout a person’s life and especially at particular periods. For
example, the early years of life, the transition from school to work and from work to retirement are
periods when human development challenges are high.

Realising rights to human development involves understanding and addressing the social drivers of
development. Without doing so, gains made will be undermined. By taking social development issues on
board, development actors will achieve better results and better value for money.

This guide breaks down social development issues and human development sectors for conceptual
clarity, but in reality the issues are intersecting and interdependent. Specifically, although human rights
are addressed in one section of this guide, they apply to all the social development sections.

1
World Bank, Social development overview:
http://www.worldbank.org/en/topic/socialdevelopment/overview#1
2
UNDP, Human development reports: http://hdr.undp.org/en/humandev

GSDRC / HEART 2
1.3 Key debates and challenges
Development actors have sought to incorporate a social development lens through approaches such as a
human rights-based approach, Political Economy Analysis, inclusive institutions, and good governance.
The literature recommends an inter-sectoral approach including engaging with other sectors of
government and society to address influences outside of human development sectors.

The international discourse has been strongly influenced by the Millennium Development Goals’ (MDGs)
focus on human development outcomes. The new Sustainable Development Goals (SDGs) involve moving
from a technical approach for increasing human development towards an equity/inclusion approach that
focuses on ‘leave no-one behind’ (Starfield, 2007). Discussions draw on analysis of underlying power
relations to understand intersecting inequalities and how these affect equitable outcomes. There is an
increased emphasis on social norms and understanding social institutions, and on politics ‒ including
informal politics such as clientelistic relationships ‒ and political analysis. Citizen engagement for
increasing accountability is a strategy that donors generally support (Gaventa & Barrett, 2010).

The value-added of a social development approach is recognised in academic literature and policy.
However, working to increase equity and shift power relations can be difficult to put into practice.
Cultural norms are difficult to change, and donors can be reluctant to engage with an overtly political
approach. Some of the barriers to including a social development lens include a lack of expertise in
specific areas, such as gender, age or disability, difficulty working across sectors, and technocratic
approaches to human development. Barriers also exist because people working in development and in
basic services hold the same social and cultural norms as do their clients, and are subject to the same, or
similar, social prejudices.

Starfield, B. (2007). Pathways of influence on equity in health. Social Science & Medicine, 64(7), 1355-
1362. http://dx.doi.org/10.1016/j.socscimed.2006.11.027
What are the pathways that generate inequities and through which they may be addressed? The
literature shows that:
 Inequities are greater for severity of illness than for occurrence of illness, and the extent of
inequities is greater at younger ages.
 Geographic aggregation of data influences conclusions on the nature and extent of inequities.
 Health services can contribute to reductions in inequity particularly through primary care
services. However, this contribution depends on the type of health services, attention to the type
and orientation of the health services system and not just simply the presence of health services.
Failure to recognise the existence of health problems associated with inequity may be more
important than failing to intervene when the problem is recognised.
 Efforts to improve average health are generally associated with increasing inequities, because
new and effective interventions often reach the more advantaged first.

Gaventa, J. & Barrett, G. (2010). So what difference does it make? Mapping the outcomes of citizen
engagement (Working Paper 347). Brighton: IDS. www.ids.ac.uk/files/dmfile/Wp347.pdf
This paper presents results from a meta-analysis of 100 research studies of citizen engagement in 20
countries. By mapping over 800 observable effects of citizen participation, the authors created a typology
of four democratic and developmental outcomes – construction of citizenship; strengthening of practices
of participation; strengthening of responsive and accountable states; and development of inclusive and
cohesive societies. Citizen participation produced positive effects across these outcome types in 75 per
cent of the outcomes studied, although in each category there were also examples of negative outcomes.
These outcomes also vary according to the type of citizen engagement and political context.

3 Social development and human development: Topic guide

Concepts and debates

See also the GSDRC Topic Guides on:

 Gender: gsdrc.org/topic-guides/gender/
 Human rights: gsdrc.org/topic-guides/human-rights/
 Inclusive institutions: gsdrc.org/topic-guides/inclusive-institutions/
 Service delivery: gsdrc.org/topic-guides/service-delivery/
 Social exclusion: gsdrc.org/topic-guides/social-exclusion/
 Voice, empowerment and accountability:
gsdrc.org/topic-guides/voice-empowerment-and-accountability/

GSDRC / HEART 4
2 Human development and human rights
Human rights encompass civil, political, economic, social and cultural rights. They include everyone
having a right to health, sexual and reproductive health and rights (SRHR), education and safe drinking
water and sanitation. These rights have been formally and universally recognised by all countries from
the 1948 Universal Declaration on Human Rights and reaffirmed through multiple treaties and
declarations since. International human rights law sets out the obligation of states to respect and fulfil
human rights for all. The international human rights framework can provide guidance on incorporating
human rights into policy and practice. Human rights for human development rely on mutual
accountability, whereby all actors, including citizens, communities, organisations and the government,
are responsible for respecting and fulfilling mutually agreed human rights obligations.

Recent policy discussions have focused strongly on an equity and inclusion approach that targets the
least served first (Pullan et al., 2014). In the health sector, this is health equity and health for all, meaning
that everybody has healthcare appropriate to their needs and situation, rather than equal healthcare,
where everybody receives the same care options (MacLachlan et al., 2012). In education, the Education
for All initiative aims to ensure equitable access to education, including for individuals from vulnerable
groups. In the water sector, there is a realisation that global progress on MDG7 has masked a failure to
reach people and areas in most need of access to drinking water and sanitation (Pullan et al., 2014). An
equity approach requires recognising the different needs of individuals and providing services that are
accessible and affordable (Narayanan et al., 2012). All individuals have a right to access quality
healthcare, education and safe drinking water and sanitation without discrimination or exclusion.

2.1 Health
Health policy draws on the right to the enjoyment of the highest attainable standard of physical and
mental health. Health and human rights are inextricably linked: human rights violations may have health
consequences, and the design or implementation of health policies and programmes may either protect
or violate human rights (MacLachlan et al., 2012). For example, the lack of access to effective care for
most people living with most diseases in poor countries can be viewed as a violation of human rights
(Gruskin et al., 2007). Marginalised groups are especially vulnerable (MacLachlan et al., 2012). Poor
health of a minority can undermine the health of an entire population. Human rights are imperative in
the delivery of care and implementation of public health programmes. For example, a human rights-
based approach has a strong potential for improvements in mental health policy and implementation
(Jenkins et al., 2011).

MacLachlan, M., Amin, M., Mannan, H., El Tayeb, S., Bedri, N., Swartz, L., ... McVeigh, J. (2012).
Inclusion and human rights in health policies: Comparative and benchmarking analysis of 51 policies
from Malawi, Sudan, South Africa and Namibia. PLoS One, 7(5), e35864.
http://dx.doi.org/10.1371/journal.pone.0035864
How does health policy reflect human rights? If social inclusion and human rights do not underpin policy
formation, it is unlikely they will be realised in service delivery. This examination of policies from Malawi,
Namibia, South Africa, and Sudan shows that advances in the rights discourse around vulnerable groups
is not reflected in country-level policy. It establishes that the four countries had generally high levels of
core concepts of human rights included in their policies, but lower to poor inclusion of specific policies for
vulnerable groups.

Gruskin, S., Mills, E. J. & Tarantola, D. (2007). History, principles, and practice of health and human
rights. The Lancet 370(9585): 449-455. http://dx.doi.org/10.1016/S0140-6736(07)61200-8
This review provides a brief history of health and human rights and uses HIV/AIDS as an example of the
effectiveness of the human rights approach in improving health-related policy and practice. Integration of

5 Social development and human development: Topic guide

Human rights

human rights in health systems is essential for improvement of public health at the individual and
population level. The authors identify three topics that urgently need further work: 1) developing
adequate monitoring instruments that measure both health and human rights concerns; 2) building
evidence of the effects of applying the health and human rights frameworks to health practice; and 3)
creating a research agenda on associations between health and human rights.

Jenkins, R., Baingana, F., Ahmad, R., McDaid, D. & Atun, R. (2011). Social, economic, human rights and
political challenges to global mental health. Mental Health in Family Medicine, 8(2), 87-96.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178190/
This paper discusses the social, economic, human rights and political challenges to mental health,
highlighting implementation issues at country level and in relation to the global development agenda. It
draws on the small amount of published literature. It highlights the gaps in the global architecture for
mental health and the need to strengthen the links between mental health and social development to
ensure that factors that influence mental wellbeing, including access to adequate care, are effectively
addressed. Human rights are an important lever for mental health policy and implementation. However,
they have been used less effectively in low- and middle-income countries than in high-income countries,
partly because of a relative lack of resources and, in some countries, less democratic systems. More
international financing is needed to address growing mental illness.

2.2 Sexual and reproductive health

Sexual and reproductive health rights have been developed from the International Conference on
Population and Development and the Beijing Platform for Action. They include rights to decide freely and
responsibly on all aspects of sexuality, and the number and spacing of children; to be free from
discrimination; and to attain the highest standards of sexual and reproductive health.3

Development discourse has been slow to recognise these rights, and policymakers are often reluctant to
legislate on what is seen as a highly politicised and delicate area. The MDGs included SRHR in terms of
reducing maternal mortality and ensuring universal access to reproductive health services (MDG5; Yamin
& Boulanger, 2013). Whilst the MDGs increased attention to these issues, they reduced the wider
discussion around SRHR and women’s control of their bodies to a simplistic maternal health approach
(Yamin & Boulanger, 2013). This excludes and simplifies the feminist and inequality agenda, shifting the
discussion away from rights towards a technocratic and instrumentalist approach (Yamin & Boulanger,
2013). A rights-based approach allows a view of women and men as active subjects with control over
their bodies, not passive objects of development programmes (Yamin, 2013).

Yamin, A. E. & Boulanger, V. M. (2013). Embedding sexual and reproductive health and rights in a
transformational development framework: lessons learned from the MDG targets and
indicators. Reproductive Health Matters, 21(42), 74-85.
http://dx.doi.org/10.1016/S0968-8080(13)42727-1
This article argues that the MDGs have embedded normative values into the development discourse,
which has been particularly detrimental for sexual and reproductive health rights. Whilst setting simple
MDGs raised awareness and defined quantified targets, policy attention was diverted from structural
human rights concerns. The MDG agenda has depoliticised women’s rights, and has undercut some of the
gains made by the feminist movement. Women’s health is viewed as a basic need rather than a right,
which removes women’s agency and choice. The article argues that there must be a strong narrative on
social transformation to advance social, political, and gender justice.

3
http://www.srhrguide.org/what-is-srhr/definitions

GSDRC / HEART 6
Yamin, A. E. (2013). From ideals to tools: applying human rights to maternal health. PLoS
Medicine, 10(11): e1001546 http://dx.doi.org/10.1371/journal.pmed.1001546
This article outlines achievements in applying human rights frameworks to maternal mortality and SRHR.
It argues that human rights-based approaches can help shape policy decisions. It charts some of the
historical development of this approach through the 1990s onwards, including pressures from the
women’s movement, the MDGs, and significant Human Rights Council decisions.

2.3 Education
Everyone has a right to enjoy access to quality education, without discrimination or exclusion. The right to
education is affirmed in numerous human rights treaties and recognised by governments in international
goals including the Education for All (EFA) goals. Education must be available; accessible (including to the
most marginalised); of acceptable quality, relevant, non-discriminatory and culturally appropriate; and
adaptable to suit local context. Education is not only a right: it is key to human development through
improving health, reducing poverty and fostering peace, democracy and economic growth.

However, formal education is still denied to millions around the world due to lack of resources, capacity
and political will. Providing non-formal education can provide people with the life skills they need, and
can be a route back into the formal education system (Selim et al., 2013). Whilst international focus has
been on providing access to education, quality and retention in education has not received the same
attention. Consequently, even if children are attending school, the quality of education can be extremely
poor and insufficient to equip children with the skills and knowledge they need to lift themselves out of
poverty (UNICEF & UNESCO, 2007). A quality education cannot be achieved without recognising and
committing to the human rights of children while they are in school. This includes respecting their
identity, agency and integrity and addressing their rights to freedom from discrimination, to an adequate
standard of living and to meaningful participation. Children cannot achieve their optimum development
when they are subjected to humiliating punishment or physical abuse (UNICEF & UNESCO, 2007).

Selim, M., Abdel-Tawab, N., Elsayed, K., El Badawy, A. & El Kalaawy, H. (2013). The Ishraq program for
out-of-school girls: From pilot to scale-up - Final report. Cairo: Population Council.
http://www.popcouncil.org/uploads/pdfs/2013PGY_IshraqFinalReport.pdf
The Ishraq (Sunrise) multi-dimensional programme for 12 to 15 year-old out-of-school girls started in
2001. It prepares girls in rural Upper Egypt for re-entry into formal schooling using group-based
programming. This report describes the reach and effects of the programme on participants and
communities. One outcome was that 81 per cent of participants who took the national literacy exam
passed, and more than half of those girls joined formal schooling.

UNICEF & UNESCO. (2007). A human rights-based approach to education. UNICEF and UNESCO.
http://unesdoc.unesco.org/images/0015/001548/154861e.pdf
This document describes what is meant by a human rights-based approach to education, and its key
issues and challenges. It provides a framework to guide policy and programme development and
implementation to attain Education for All.

2.4 WASH
Access to safe drinking water (a water source that is protected from contamination) and sanitation
facilities are fundamental human rights and are essential for good health. The right to safe drinking water
and sanitation was fully recognised by the United Nations General Assembly and the United Nations
Human Rights Council in 2010. Governments, considered as the primary duty bearers of rights, are
obliged to include the rights to water and sanitation in their national legal systems and to ensure these
rights are enforced. The meaning and legal obligations of these rights have been explained in a recent
handbook (UN Special Rapporteur, 2014).

7 Social development and human development: Topic guide

Human rights

Where countries have recognised the right to sanitation, accelerated progress in coverage has been
noted (DFID, 2011). So a human rights approach is likely to be more equitable and inclusive than the
approach in those countries that have no specific rights focus (Narayanan et al., 2012). Although there is
progress in reaching MDG7, high geographical inequality in drinking-water supply and sanitation (WSS)
across sub-Saharan Africa highlights the need to reduce inequalities to reach the lowest coverage areas
and population groups (Pullan et al., 2014).

Pullan, R. L., Freeman, M. C., Gething, P. W. & Brooker, S. J. (2014). Geographical inequalities in use of
improved drinking water supply and sanitation across sub-Saharan Africa: Mapping and spatial analysis
of cross-sectional survey data. PLoS Medicine, 11(4). http://dx.doi.org/10.1371/journal.pmed.1001626
This paper uses data on household reported use of open defecation and improved WSS from 138 national
surveys undertaken from 1991–2012 in 41 countries. The data are used to develop maps of WSS
coverage in sub-Saharan Africa and show geographical inequalities beyond simplistic rural-urban analysis,
which provides the entry point for an equity and inclusion approach. Identifying and targeting
inequalities in access and use are essential to achieving the goal of universal water and sanitation.

UN Special Rapporteur. (2014). Realizing the human rights to water and sanitation: A Handbook.
OHCHR. http://www.ohchr.org/EN/Issues/WaterAndSanitation/SRWater/Pages/Handbook.aspx
This handbook is the product of six years of work by the first UN Special Rapporteur on human rights to
water and sanitation. It is presented in nine booklets for governments, donors and national regulatory
bodies. It explains the legal obligations that arise from these rights, provides guidance on
implementation, and shares examples of good practice.

DFID. (2011). Assessing the impact of a right to sanitation on improving levels of access and quality of
services: Executive summary. London: DFID in association with Coffey International Development.
http://r4d.dfid.gov.uk/PDF/Outputs/Water/60835_RTS-synthesis-for-SACOSAN-April.pdf
Does formal recognition of a right to sanitation (RTS) increase levels of availability and access to quality,
affordable and adaptable sanitation services? This study finds that progress towards these goals seems to
be faster in countries that have recognised an RTS. It is highly probable that sanitation services in
countries seeking to fulfil an RTS will be more equitable and inclusive than elsewhere. However,
attributing successes to a rights approach will require better monitoring and evaluation that includes
rights-sensitive indicators. A further finding is that what makes formal recognition meaningful is a
participatory approach to working to fulfil rights: citizen-state engagement is crucial.

Narayanan, R., van Norden, H., Gosling, L. & Patkar, A. (2012). Equity and Inclusion in Sanitation and
Hygiene in South Asia: A Regional Synthesis. IDS Bulletin, 43(2), 101-111.
http://dx.doi.org/10.1111/j.1759-5436.2012.00314.x
This paper strongly advocates an equity approach to WASH which specifically targets the excluded. In
part, this is to prevent elite capture and an increase in the inequality gap. In South Asia, the gains in
sanitation have mainly been among the richest quintiles. An equity approach requires addressing the
attitudinal, environmental and institutional barriers to adequate WASH.

See also:

 Combaz, E. (2013). Poor people’s rights and successful legal actions (GSDRC Helpdesk Research
Report). gsdrc.org/publications/poor-peoples-rights-and-successful-legal-actions/
 Crichton, J., Haider, H., Chowns, E. & Browne, E. (2015). Human rights: Topic guide. (Revised ed.)
GSDRC gsdrc.org/topic-guides/human-rights/rights-and-health-water-and-sanitation/
 The Right to Education Project: www.right-to-education.org
 The Rights To Water And Sanitation: www.righttowater.info

GSDRC / HEART 8
3 Human development and accountability
Accountability is about ensuring that governments and service providers are answerable to their citizens
and deliver on their commitments (political, financial or service delivery). To allow this, citizens must
have a voice, and governments and service providers must have the ability and motivation to respond.
This requires effective redress mechanisms when duties and commitments are not met.4 Accountability
relationships can occur at and between various levels – local, national and international, and be both
vertical and horizontal. Transparency and accountability of services, organisations and institutions help
improve their quality, responsiveness and answerability (O’Meally, 2013).

Accountability between citizens and public service providers can be understood as involving two
pathways: short and long. Short route accountability links citizens directly with service providers, while
long route accountability delegates citizens’ authority to political representatives, who govern
bureaucracies and service providers (Fox, 2014). ‘Tactical accountability’ approaches aim to improve
society’s voice and access to information, while ‘strategic accountability’ approaches use multi-pronged
practices which also encourage enabling environments and government responsiveness reforms (Fox,
2014). Strategic approaches show more evidence of impact, while tactical approaches have only very
limited evidence of effectiveness (Fox, 2014).

Context plays an important role in shaping accountability. Relevant contextual factors include
inequalities in society, the ability of elites and states to respond to demands, and the nature of the
political settlement and informal politics (O’Meally, 2013). It is important for accountability actors to
consider formal and informal politics and power relationships, and to focus on increasing responsiveness
and effectiveness, not just on increasing demand (O’Meally, 2013). Strategic accountability packages
need to be built on strong contextual analysis and, where possible, be locally led and owned (Fox 2014).

Fox, J. (2014). Social accountability: What does the evidence really say? (Draft paper for GPSA).
Washington, DC: World Bank. http://gpsaknowledge.org/wp-content/uploads/2014/09/Social-
Accountability-What-Does-Evidence-Really-Say-GPSA-Working-Paper-11.pdf
This paper re-evaluates the body of evidence on impacts of social accountability initiatives. It suggests
that there is more positive evidence for multi-pronged, strategic initiatives that encourage enabling
environments and state capacity to respond. These have more impact than tactical interventions, which
only promote citizen voice and access to information.

O’Meally, S. C. (2013). Mapping context for social accountability: A resource paper. Washington, DC:
World Bank. https://openknowledge.worldbank.org/handle/10986/16490
This paper finds that context shapes the form and effectiveness of social accountability in unpredictable
and complex ways. The main messages are:
 Think ‘politically’ in designing and implementing social accountability, as formal and informal
politics and power dynamics have strong effects.
 Build synergies between social and political forms of accountability, and work across the supply
and demand divide.
 Build on what is already there, embed social accountability in ‘organic’ pressures for pro-
accountability change, and ‘work with the grain’.
 Take a multipronged approach to accountability reform, and address issues of poverty,
inequality, and exclusion more systematically in social accountability programming. Address the
global dimensions of accountability failures.
 Adopt longer time horizons and an adaptable learning-by-doing approach.

4
http://www.transparency-initiative.org/about/definitions

9 Social development and human development: Topic guide

Accountability

3.1 Health
A systematic review suggests that there is no rigorous evidence on what works to improve accountability
in healthcare (Berlan & Shiffman, 2012). Healthcare providers in low- and middle-income countries
demonstrate limited accountability to consumers. This may have adverse effects on the quality of the
healthcare they provide and on health outcomes (Berlan & Shiffman, 2012).

Berlan, D. & Shiffman, J. (2012). Holding health providers in developing countries accountable to
consumers: a synthesis of relevant scholarship. Health Policy and Planning, 27(4), 271-280.
http://dx.doi.org/10.1093/heapol/czr036
What works in developing health care provider accountability? This is a systematic review of research on
health provision in low-, middle- and high-income countries. The evidence base on what works is
extremely weak. However, the research suggests four mechanisms that may improve provider
responsiveness: 1) creating official community participation mechanisms in the context of health service
decentralisation; 2) enhancing the quality of health information that consumers receive; 3) establishing
community groups that empower consumers to take action; and 4) including NGOs in efforts to expand
access to care.

3.2 Sexual and reproductive health

The literature suggests that accountability for SRHR is considered to be important in holding
policymakers to internationally agreed goals, transforming services and meeting family planning needs
(Boydell & Keesbury, 2014). There is almost no evidence on programme impact or effectiveness of
accountability interventions for SRHR (Boydell & Keesbury, 2014).

Accountability addressing SRHR problems and solutions at the global level is very different to the complex
reality that people experience in frontline health services. Approaches to accountability need to begin
with the dynamics of power in the health services on the ground (Freedman & Schaaf, 2013).

Freedman, L. P. & Schaaf, M. (2013). Act global, but think local: accountability at the
frontlines. Reproductive health matters, 21(42), 103-112.
http://dx.doi.org/10.1016/S0968-8080(13)42744-1
How do women and men experience SRHR accountability with local level health service providers? This
paper makes the case for a changed approach to accountability that begins with the dynamics of power
at the frontlines, where people encounter health providers and institutions. Conventional approaches to
accountability do not usually engage with power dynamics and the institutional incentives of
policymakers and service providers. The authors suggest that approaches drawn from implementation
science and systems science are better suited to understanding the political dynamics of health systems.
An understanding of power and politics improves accountability towards health service users.

Boydell, V. & Keesbury, J. (2014). Social Accountability: What are the Lessons for Improving Family
Planning and Reproductive Health Programs? A Review of the Literature (Evidence Project Working
Paper). Washington, DC: Population Council.
http://evidenceproject.popcouncil.org/resource/working-paper-social-accountability-what-are-the-
lessons-for-improving-family-planning-and-reproductive-health-programs/
This systematic review first presents the state of the evidence on accountability in the broader health
sector. It then focuses on the family planning and reproductive health fields. In these fields, activities are
often broader than social accountability (which tends to focus on the community or service delivery
level), focusing instead on tracking the fulfilment of global and national policy and financial
commitments. Some programmes are also applying the principles of social accountability to the delivery
of rights-based, voluntary, high-quality FP/RH services.

GSDRC / HEART 10
3.3 Education
There is little information on accountability in education, but lessons from the health and WASH sectors
might be applicable to education. Although the evidence is weak, it is known that participation helps
make services responsive to users and ensures that they are used effectively. Schools function best when
they respond to local needs and priorities, and local governance and accountability structures directly
contribute to quality of schooling (Pradhan et al., 2011). Accountability to communities has an impact on
keeping more children in school, and in improving their learning and ultimately their job prospects
(Pradhan et al., 2011).

Pradhan, M., Suryadarma, D., Beatty, A., Wong, M., Alishjabana, A. & Gaduh, A. (2011). Improving
educational quality through enhancing community participation: results from a randomized field
experiment in Indonesia. Washington, DC: World Bank. http://dx.doi.org/10.1596/1813-9450-5795
To address deficiencies in service provision, is it effective to make schools accountable for performance?
This study evaluates the effect of four randomised interventions aimed at strengthening school
committees, and subsequently improving learning outcomes, in public primary schools in Indonesia. It
concludes that measures that foster outside ties between the school committee and other parties,
particularly the village council, are more effective than reinforcing existing school committee structures
or providing grants and training interventions. This suggests that local governance contributes to
improved learning.

3.4 WASH
Improved water accountability improves sanitation and hygiene, leading to improved health. There is a
considerable body of literature on water services and governance, although less on water accountability
specifically. The literature emphasises the role of community, both individuals and organisations, in
managing water services accountably. Sanitation in particular requires locally appropriate technologies
and solutions. Progress on sanitation is restricted by a lack of commitment from governments, which may
change over time as sanitation became a human right in 2010.

Nicol, A., Mehta, L. & Allouche, J. (2012). Introduction: ‘Some for all rather than more for some’?
Contested pathways and politics since the 1990 New Delhi Statement. IDS Bulletin, 43(2), 1-9.
http://dx.doi.org/10.1111/j.1759-5436.2012.00300.x
This introduction provides a historical look at the development of the water and sanitation international
discourse since 1990. It challenges the wider global water and sanitation community to rethink
approaches and emphases, shifting from targets and technocratic terms to politics, sustainability and
local knowledge. Water management has a complex political, social, economic and ecological landscape,
which affects access, sustainability and control. There is an ongoing debate about whether water is an
economic good or a right. The paper also challenges the perception of communities’ ability and
willingness to lead management of WASH delivery.

See also:

 Broadbent, E. (2010). Public financial management and frontline service delivery (GSDRC
Helpdesk Research Report 653). http://www.gsdrc.org/docs/open/HD653.pdf
 Carter, B. (2014). Transparency and accountability (GSDRC Helpdesk Research Report 1067).
http://www.gsdrc.org/docs/open/HDQ1067.pdf
 GSDRC Topic Guide on Service delivery: http://www.gsdrc.org/topic-guides/service-delivery/
 GSDRC Topic Guide on Voice, empowerment and accountability:
http://www.gsdrc.org/topic-guides/voice-empowerment-and-accountability/

11 Social development and human development: Topic guide

Accountability

 HEART. (2010). Education and community empowerment (HEART Helpdesk report).

http://www.heart-resources.org/2010/11/education-and-community-empowerment/
 HEART. (2012). Voice and accountability in the education sector (HEART Helpdesk report).
http://www.heart-resources.org/2012/09/voice-and-accountability-in-the-education-sector/
 HEART. (2013). Accountability in education (HEART Helpdesk report).
http://www.heart-resources.org/2013/01/accountability-in-education/
 HEART. (2013). Community engagement in health service delivery (HEART Helpdesk report).
http://www.heart-resources.org/2011/11/community-engagement-in-health-service-delivery/
 HEART. (2013). Voice and accountability in the health sector (HEART Helpdesk report).
http://www.heart-resources.org/2013/06/voice-and-accountability-in-the-health-sector/
 Rao, S. (2013). Addressing high rates of public service absenteeism (GSDRC Helpdesk Research
Report 988). http://www.gsdrc.org/docs/open/HDQ988.pdf

GSDRC / HEART 12
4 Human development and gender
inequality
Persistent and entrenched gender inequalities mean that women often experience lower human
development outcomes than men. There are strong pressures on both men and women to behave in
certain ways, and clear structural inequalities based on sex. A gender perspective on human
development helps address the underlying social factors perpetuating gender inequality. These factors
result in women’s disproportionate ill health, lower educational levels and poor access to services. A
gender perspective is rooted in a rights-based approach, and this chapter of the report is closely linked to
the human rights chapter. As there is so much focus on women’s sexual and reproductive roles, here the
health and SRH sections are merged.

Women’s vulnerability to poor human development is affected by the intersection of their class, gender,
and other aspects of their social status (Iyer et al., 2008). Interventions are therefore most effective if
they address the multiple dimensions of inequality that women face. This can be achieved with, for
example, improved access to post-primary education, economic and political opportunity and the
guarantee of women’s safety.

Health, education and WASH services sometimes provide better services to men than to women. Women
face individual-level barriers to access, such as girls being required to stay at home to care for relatives,
and structural barriers, such as being less able than men to finance under-the-counter payments or
bribes (Govender & Penn-Kekana, 2008). Women’s rights to participate in public life and to make
decisions for themselves are not always supported by laws or informal institutions. Violence against
women and girls remains a systemic problem globally, with multiple human development effects such as
mental and physical health problems and school dropout. Women’s care roles and domestic duties also
remain important mediating factors affecting their human development, limiting their access to paid
work and schooling, and taking up a disproportionate amount of women’s ‘free’ time.

4.1 Health / Sexual and reproductive health

The health of both men and women can be placed at risk due to prevailing notions of manhood and
masculinity. These notions stem from patriarchal structures and social norms (Barker et al., 2007).
Programme evaluations suggest that men and boys who adhere to more rigid views of masculinity are
more likely to have used violence against a partner, to have had a sexually transmitted infection, to have
been arrested and to have used substances (Barker et al., 2007). In general, men are poorer users of
healthcare systems than women, and may find it harder to express vulnerability (Govender & Penn-
Kekana, 2008). Men and women sometimes receive differential care for similar illnesses, owing to
differences in health-seeking and provider behaviour (Govender & Penn-Kekana, 2008; Berlan &
Shiffman, 2012). Women also carry the main burden of caring for sick relatives and household members
(Esplen, 2009). This may undermine their rights and limit their opportunities, for example when girls drop
out of school to care for family members (Esplen, 2009).

Many countries do not support women’s rights in their legal and policy frameworks. This affects SRHR in
particular. Restrictive laws and policies on access to contraception and abortion have significant human
development costs, particularly when women seek unsafe abortion. Globally, forty per cent of women
live in countries with restrictive abortion laws (Rasch, 2011). Unsafe abortion results in a large number of
health consequences, including death. Poorer women are more likely to seek an unsafe method than
richer women (Rasch, 2011).

13 Social development and human development: Topic guide

Gender inequality

Female Genital Mutilation/Cutting (FGM/C) is a serious violation of women’s human rights. It is a form of
violence against women and girls held in place by powerful social norms.5 Up to nine out of ten women in
parts of North and West Africa have undergone FGM/C (Berg & Denison, 2013). FGM/C causes a wide
range of health complaints such as chronic pain, infections, fistula and difficulty in passing urine and
faeces, severe psychological and emotional trauma, and can cause death (Berg & Denison, 2013). A
recent systematic review confirms that, as there is no medical or religious requirement for FGM/C, its
continuation and prevention are upheld by cultural practices and beliefs. Successful interventions have
included legislation, awareness raising campaigns, and working through religious leaders and community
health practitioners (Berg & Denison, 2013). More generally, violence against women is rooted in
entrenched gender inequalities and must be tackled through community-based interventions that raise
public awareness and challenge social norms, rather than by focusing on individuals (Garcia-Moreno et
al., 2006).

Women’s empowerment is well-evidenced to increase use of maternal health services. A systematic

review (Prost et al., 2013) suggests that women’s groups that focus on participatory learning and action
are effective in reducing maternal mortality, neonatal mortality and stillbirths.

Iyer, A., Sen, G. & Östlin, P. (2008). The intersections of gender and class in health status and health
care. Global Public Health, 3(S1), 13-24.http://dx.doi.org/10.1080/17441690801892174
Different axes of social power relations, such as gender and class, intersect. This paper provides a
comprehensive literature review, suggesting that the impacts of single dimensions of inequality change
significantly when they intersect with other inequalities. Studies confirm that measures of socio-
economic status cannot fully account for gender inequalities in health. This strongly suggests that
economic class should not be analysed by itself, and that apparent class differences can be
misinterpreted without gender analysis.

Govender, V. & Penn-Kekana, L. (2008). Gender biases and discrimination: a review of health care
interpersonal interactions. Global public health, 3(S1), 90-103.
http://dx.doi.org/10.1080/17441690801892208
This comprehensive literature review shows that gender inequality, either alone or in combination with
other inequalities, influences interactions between health care providers and patients. This negatively
affects both women and men. Much of the gender bias reflects societal norms, and so needs to be
tackled at the societal level. The health system is a site where gender norms can be challenged.

Barker, G., Ricardo, C. & Nascimento, M. (2007). Engaging Men and Boys in Changing Gender based
Inequity in Health: Evidence from Programme Interventions. Geneva: WHO / Promudo.
http://www.who.int/gender/documents/Engaging_men_boys.pdf
How do social constructions of masculinity affect health equity? What kinds of interventions can produce
behavioural change in men and boys? This review of 58 evaluations assesses the effectiveness of
programmes seeking to engage men and boys in achieving gender equality and equity in health. The most
effective programmes are those that include gender-transformative elements, which seek to change the
social construction of masculinity and promote more gender-equitable relationships, and those that are
integrated with wider community outreach or mobilisation initiatives.

Esplen, E., (2009). Gender and care: overview report. Brighton: Institute of Development Studies.
http://www.bridge.ids.ac.uk/reports/cep_care_or.pdf
How can we move towards a world in which individuals and society recognise and value the importance
of different forms of care, but without reinforcing care work as something that only women can or should
do? Three approaches are explored: challenging gender norms to encourage more equal sharing of
unpaid care responsibilities between women and men and a less gender- segmented labour market in the

5
The customary or informal rules that govern behaviour in groups and societies.

GSDRC / HEART 14
care professions; greater recognition of the huge amount of unpaid care work performed and the value
of this work; and the social policy measures needed to ensure that care-givers are not disadvantaged
because of their unpaid care responsibilities. The report also considers measures to better protect the
rights of paid carers – to decent working conditions, minimum wages, basic benefits and protections, and
the freedom to form associations and trade unions.

Rasch, V. (2011). Unsafe abortion and postabortion care–an overview. Acta Obstetricia et Gynecologica
Scandinavica, 90(7), 692-700. http://dx.doi.org/10.1111/j.1600-0412.2011.01165.x
This article describes how restrictive laws are associated with the occurrence of unsafe abortion. It is
based on a near-systematic review of articles from 2005 to 2010, and includes 67 publications. It
describes providers and methods used to obtain unsafe abortion and the associated health
consequences. Finally, it discusses post-abortion care as a means to address unsafe abortion. The most
effective means of reducing unsafe abortion is legal change in restrictive laws, although this does not
tackle anti-abortion attitudes in healthcare providers, or social norms.

Berg, R. C. & Denison, E. (2013). A tradition in transition: factors perpetuating and hindering the
continuance of female genital mutilation/cutting (FGM/C) summarized in a systematic review. Health
Care for Women International, 34(10), 837-859. http://dx.doi.org/10.1080/07399332.2012.721417
This systematic review examines 21 studies. Six key factors underpin the continuance of FGM/C: cultural
tradition, beliefs on sexual morals, marriageability, religion, health benefits, and perceptions of male
sexual enjoyment. Four key factors are perceived to hinder FGM/C: health consequences, it not being a
religious requirement, it being illegal, and the rejection of FGM/C in host society discourse. The results
show that FGM/C is used as a tool of social control and control of women’s sexuality.

Garcia-Moreno, C., Jansen, H. A., Ellsberg, M., Heise, L. & Watts, C. H. (2006). Prevalence of intimate
partner violence: findings from the WHO multi-country study on women's health and domestic
violence. The Lancet, 368(9543), 1260-1269. http://www.dx.doi.org/10.1016/S0140-6736(06)69523-8
This study estimates the prevalence of IPV by conducting standardised population-based household
surveys in ten countries between 2000 and 2003 on women aged 15 to 49. The findings confirm that
physical and sexual partner violence against women is widespread. The reported lifetime prevalence of
physical and sexual IPV, or both, varied from 15 to 71 per cent and from 4 to 54 per cent in the past year.
In all but one setting, women were at far greater risk of physical or sexual violence by a partner than of
violence from other people.

Prost, A., Colbourn, T., Seward, N., Azad, K., Coomarasamy, A., Copas, A., ... & Costello, A. (2013).
Women's groups practising participatory learning and action to improve maternal and newborn health
in low-resource settings: a systematic review and meta-analysis. The Lancet, 381(9879), 1736-1746.
http://dx.doi.org/10.1016/S0140-6736(13)60685-6
What are the effects of women's groups practising participatory learning and action, compared with
usual care, on birth outcomes? This paper conducts a systematic review and meta-analysis of randomised
controlled trials undertaken in Bangladesh, India, Malawi, and Nepal to assess the effects in low-resource
settings. The results show that exposure to women's groups was associated with a 23 per cent non-
significant reduction in maternal mortality, a 20 per cent reduction in neonatal mortality, and a 7 per cent
non-significant reduction in stillbirths. The authors conclude that women's groups practising participatory
learning and action are a cost-effective strategy to improve survival, when at least a third of pregnant
women are participating.

15 Social development and human development: Topic guide

Gender inequality

4.2 Education
Gender gaps persist in education in a number of ways: sex disparities in enrolment or completion; girls
experiencing violence at school; informal institutions reinforcing gender stereotypes; self-esteem; and
aspirations. Schools are spaces that replicate wider societal power dynamics and gender roles; along with
formal learning, they also transmit social expectations and attitudes (Reilly, 2014).

In general, girls’ access to school is responsive to external variables – the higher the distance or cost, the
fewer the girls that go to school (Glick, 2008). Removing school fees has had a significant impact,
increasing the numbers of girls in school. Boys tend to be sent to school even when there are high costs.
Other factors also have more impact on whether girls, as opposed to boys, can access schooling. These
factors include safety when walking to school, separate school toilets for boys and girls, and demand for
domestic work (Glick, 2008). The policy implications are that schools closer to home, and reduced costs,
will have disproportionately greater positive effects on girls’ education.

Violence keeps girls (and boys) out of school (Reilly, 2014). Gender-based violence at school or on the
way to school can include corporal punishment, sexual harassment, transactional sex, and child-to-child
violence. Sexual violence is, in the main, perpetrated by male teachers on female students, often in
exchange for good grades (Reilly, 2014). Poorer girls are more vulnerable than others to sexual abuse if
they cannot pay for school-related expenses, or are at risk of failing exams. When girls do not want to
take up this kind of relationship, they often drop out of school to avoid it.

The Young Lives study shows that gender biases work against both boys and girls, and are often context-
specific, varying with location and age of the child (Dercon & Singh, 2013). It is important for
policymakers to target the specific biases in each community (Dercon & Singh, 2013).

Glick, P. (2008). What policies will reduce gender schooling gaps in developing countries: Evidence and
interpretation. World Development, 36(9), 1623-1646.
http://dx.doi.org/10.1016/j.worlddev.2007.09.014
This paper uses an economic model of why parents might invest in children’s human capital, and how policy
can change this. The evidence is mostly drawn from econometric analyses and some randomised
experiments. Girls appear to benefit more than boys from gender-neutral policies such as increasing the
general quality of schooling. A common finding is that girls’ education is constrained more than boys’ by the
distance to school, and is more sensitive to the direct and indirect costs of schooling. Gender-targeted
interventions have also been very effective for girls, and may be more expedient where there are large
gender gaps. In particular, household subsidies and financial incentives to teachers for enrolling girls are
successful. Gender-targeted interventions are broadly more effective for girls than gender-neutral ones.

Reilly, A. (2014). Adolescent girls’ experiences of violence in school in Sierra Leone and the challenges
to sustainable change. Gender & Development, 22(1), 13-29.
http://dx.doi.org/10.1080/13552074.2014.902239
How is gender-based violence in schools reduced? Plan UK have addressed violence in Sierra Leone
through an integrated programme for adolescent girls focusing on four areas: the attainment of a quality
basic education, freedom from violence, economic empowerment, and the enjoyment of sexual and
reproductive health and rights. Physical and sexual violence is common for girls in schools, and parents
and school boards often turn a blind eye. Plan has found that a holistic approach has helped reduce
violence, through girls’ and boys’ rights clubs, teacher training, community discussion of the issue,
engaging men and boys, and new school regulations.

Dercon, S. & Singh, A. (2013). From nutrition to aspirations and self-efficacy: gender bias over time
among children in four countries. World Development, 45, 31-50.
http://dx.doi.org/10.1016/j.worlddev.2012.12.001

GSDRC / HEART 16
The Young Lives longitudinal study collects data from 12,000 children across Ethiopia, India (Andhra
Pradesh), Peru, and Vietnam. This paper uses the data to assess gender gaps in nutrition, education,
aspirations, subjective wellbeing, and psychosocial competencies. The paper finds that while gender gaps
in child wellbeing persist, there is no overall trend in favour of boys, and trends vary considerably with
location and age. It is suggested that gender inequalities in one dimension can perpetuate inequalities
across different dimensions.

4.3 WASH
Poor and rural women and girls bear the brunt of the consequences of unsafe water and inadequate
sanitation (Kevany & Huisingh, 2013). Poor WASH services have disproportionately negative effects on
women and girls because they use these services the most (UNICEF, 2012). Girls and women are often
responsible for fetching water for the household, and often have to walk long distances every day
(UNICEF, 2012). Any risks associated with travelling, or travelling after dark, therefore apply
disproportionately to women. Women often have to wait until after dark to defecate if there are no
suitable facilities, which leaves them open to health problems and increased risk of sexual assault (Fisher,
2006). Shortages of water or inability to collect enough sometimes results in repercussions, such as
domestic violence against women (Kevany & Huisingh, 2013).

There is a culture of embarrassment and taboos surrounding menstruation (Mahon & Fernandes, 2010).
In parts of South Asia, it is common for women to be considered ‘polluted’ while menstruating, and for
them to restrict their public and private interactions (Mahon & Fernandes, 2010). Around the world, girls
often miss several days of school while they are menstruating. This is usually due to the lack of privacy
and water in latrines for washing themselves and menstrual cloths, and because of anxiety and social
stigma (Mahon & Fernandes, 2010). Access to facilities is not enough to improve menstrual hygiene;
cultural norms must also be taken into account (Mahon & Fernandes, 2010).

It is well-established that a gender perspective significantly improves WASH programmes’ effectiveness

and sustainability, improves women’s lives, and improves health in the wider community (Fisher, 2006).

Kevany, K. & Huisingh, D. (2013). A review of progress in empowerment of women in rural water
management decision-making processes. Journal of Cleaner Production, 60, 53-64.
http://dx.doi.org/10.1016/j.jclepro.2013.03.041
What are the links between water infrastructure, water policies, processes and protections, and women’s
leadership and decision-making? This comprehensive literature review takes the approach that
privatisation, climate change, and cost negatively affect women’s access to water. It identifies seven key
issues that affect women: 1) water insecurity contributes to poor mental wellbeing; 2) spiritual and
physical wellbeing are undermined by eco-disequilibrium and disrespect; 3) gender violence is associated
with unsafe and inaccessible water; 4) climate change, inconsistencies in rainfall, harvests, community
income, and global pressures in commodity trading affect rural wellbeing and gender equality; 5)
legislation that prohibits women’s entitlement to resources and land creates problems; 6) gender
inequality is maintained by political philosophies, policies and practices; and 7) strategies to privatise and
commercialise water are rapidly expanding. The paper outlines the international policy principles
responding to these issues.

UNICEF. (2012). Water, Sanitation and Hygiene. 2012 Annual Report. UNICEF.
http://www.unicef.org/wash/files/2012_WASH_Annual_Report_14August2013_eversion_(1).pdf
This annual report outlines UNICEF’s work and progress on WASH globally. It contains chapters on
emergency coordination, the environment and climate change, gender and monitoring.

Fisher, J. (2006). For her it's the big issue: putting women at the centre of water supply, sanitation and
hygiene (Water, Sanitation and Hygiene: Evidence Report). Geneva: Water Supply and Sanitation

17 Social development and human development: Topic guide

Gender inequality

Collaborative Council. https://dspace.lboro.ac.uk/dspace-

jspui/bitstream/2134/9970/20/wsscc_for_her_its_the_big_issue_evidence_report_2006_en.pdf
How does women’s involvement in WASH create benefits? This paper uses case studies to show that
women’s involvement in WASH has: improved interventions’ efficiency and effectiveness; promoted
changes in hygiene practices; changed traditional gender roles; increased opportunities for women’s
employment; increased girls’ school attendance; reduced child mortality; and increased women’s safety.

Mahon, T. & Fernandes, M. (2010). Menstrual hygiene in South Asia: a neglected issue for WASH
(water, sanitation and hygiene) programmes. WaterAid.
http://www.wateraid.org/~/media/Publications/menstrual-hygiene-south-asia.pdf
Why is menstrual hygiene management not generally included in WASH initiatives? What are the social
and health impacts of this neglect on women and girls? Women are often excluded from decision-making
and management of WASH programmes, which compounds the reluctance to speak openly about
menstruation. This paper provides examples of successful approaches to tackling menstrual hygiene in
WASH in South Asia. It is supported with a case study of WaterAid in India.

See also:

 Kangas, A. (2011). Female Genital Mutilation/Cutting and gender indicators (GSDRC Helpdesk
Report). http://www.gsdrc.org/docs/open/HDQ734.pdf
 Kangas, A., Haider, H., Fraser, E. & Browne, E. (2014). Gender: Topic Guide. (Revised ed.) GSDRC.
http://www.gsdrc.org/go/topic-guides/gender/sexual-and-reproductive-health-and-rights
 HEART. (2011). Safe transport for girls (HEART Helpdesk report).
http://www.heart-resources.org/2011/07/safe-transport-for-girls/
 HEART. (2013). Community-led total sanitation in Africa (HEART Helpdesk report).
http://www.heart-resources.org/2013/05/community-led-total-sanitation-in-africa/
 HEART. (2013). Women’s literacy and the links between maternal health, reproductive health and
daughter education (HEART Helpdesk report). http://www.heart-
resources.org/2010/07/womens-literacy-and-the-links-between-maternal-health-reproductive-
health-and-daughter-education/
 HEART. (2014). Family planning topic guide. http://www.heart-resources.org/topic/family-
planning/
 MacAslan Fraser, E. (2012). Risks, effects and prevalence of VAWG (GSDRC Helpdesk report).
http://www.gsdrc.org/docs/open/HDQ775.pdf
 Mcloughlin, C. (2011). Impact evaluations of programmes to prevent and respond to violence
against women and girls (GSDRC Helpdesk report). http://www.gsdrc.org/docs/open/HD789.pdf
 Miller, J. (2013). Female Genital Mutilation (HEART multimedia resources). http://www.heart-
resources.org/mmedia/heart-talks-jane-miller-on-female-genital-mutilation/
 Tomlinson, M. (2014). Maternal mental health in the context of community based home visiting:
‘Acting urgently, building slowly’ (HEART multimedia resources). http://www.heart-
resources.org/mmedia/maternal-mental-health-context-community-based-home-visitingacting-
urgently-building-slowly/
 UNFPA & UNICEF (2013). UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting:
Accelerating change 2008-2012. Final report (Volume I). New York: UNFPA & UNICEF
http://www.unicef.org/evaluation/files/FGM-report_11_14_2013_Vol-I.pdf

GSDRC / HEART 18
5 Human development and age
How does age affect human development outcomes? It is widely known that the first five years of a
child’s life are crucial to later development, with impacts echoing throughout life. A large amount of
literature across international development topics looks at this period of life. Adolescence also involves
specific needs and impacts, as young people transition from school to work, and from childhood to
adulthood. In addition, as countries experience longer life expectancy and ageing populations, research
and policy interest has turned towards the specific needs of older people.

Age often equates with power: children and young people may not be able to exercise influence or make
decisions for themselves, and older people may be more respected but dependent on others for care.
Human development for these groups may therefore be mediated through their working-age, able-
bodied family members.

There is a considerable demographic transition underway globally, with youth6 and older people the key
sectors. In general, there is a global shift towards older populations, particularly in higher-income
countries, while low-income countries, particularly in sub-Saharan Africa, have a youth bulge. Globally,
the population aged over 60 is growing, and the world’s population is ageing rapidly (HelpAge
International, 2014). Currently one in nine people is over 60, and this is expected to increase to one in
five by 2050 (HelpAge International, 2014). Sub-Saharan Africa has a growing adolescent population, but
globally, the number of adolescents is declining (UNICEF, 2011). Sub-Saharan Africa is expected to have
more adolescents than any other region in 2050. This youth bulge may result in a demographic dividend,
if young people can be fully employed and contributing to the national economy. These demographic
changes mean that social policy must also change to secure human development for all people.

There is most evidence on the specific needs of children and adolescents. Human development factors
for children are well-evidenced and discussed in much development literature. The literature on
adolescents almost exclusively refers to their sexualities (Kabiru et al., 2013). In the health sector this
mainly addresses SRH needs, and in WASH it mainly addresses the sanitation needs of adolescent girls
(covered in the Gender section of this guide, so there is no WASH section below). There is therefore a gap
in the literature around the other human development issues for adolescents. There is a reasonable
literature on older people’s additional health needs, but almost nothing on their specific SRH, education
or WASH needs. The demographic shift signals an urgent need to consider the specific vulnerabilities and
circumstances of older people in developing countries.

The references cited below overlap across the human development categories of health, sexual and
reproductive health and education.

HelpAge International. (2014). Why health systems must change: Addressing the needs of ageing
populations in low- and middle-income countries (HelpAge briefing). HelpAge International.
http://www.helpage.org/global-agewatch/reports/helpage-briefing-why-health-systems-must-change/
This is an analytical report on a two-year HelpAge programme piloting a range of interventions to address
the health needs of older people in Cambodia, Mozambique, Peru and Tanzania. It confirms the
perception that older people face unique health and living challenges that demand innovative solutions.
It suggests: good care; health literacy; availability of essential treatments; health curriculum reform; and
simultaneous bottom-up and top-down strategies.

UNICEF. (2011). The state of the world's children 2011: Adolescence an age of opportunity. UNICEF.
http://www.unicef.org/sowc2011/pdfs/SOWC-2011-Main-Report_EN_02092011.pdf

6
‘Youth’ refers to people between 15-24 years old; and ‘adolescents’ are people between 10-19.

19 Social development and human development: Topic guide

Age

This report outlines the challenges adolescents face in health, education, protection and participation,
and the risks, vulnerabilities and opportunities of this pivotal stage of life.

5.1 Health
Household decisions about healthcare for children are usually made by parents or guardians, and can be
strongly mediated by cultural and social factors. These include beliefs and illness perceptions, perceived
severity of the illness and of the efficacy of treatment options, rural location, gender, household income
and cost of treatment options (Colvin et al, 2013).

Maternal education, empowerment and status are important social determinants of child health and
survival, as mothers often have primary responsibility for children’s care. Adolescent mothers are the
most likely to be poor, and to pass on poverty to their children (UNICEF, 2011). Women can have
restricted access to and control over resources (Richards et al., 2013) and decision making in seeking care
(Colvin et al, 2013). Exposure of children to domestic violence can affect their health, growth and
nutrition (Yount et al., 2011). It is important to ensure efforts to improve children’s health empower
women rather than reinforcing gender inequities.

Adolescents are generally healthier than in previous generations, and accidents are the greatest cause of
death for this group (UNICEF, 2011). Young people are often treated in adult health centres, but may not
be responsive to their needs ‒ which include limited knowledge, distrust, fear of mistreatment, shyness,
lack of money, barriers related to marital status and stigma for seeking SRH care (Kabiru et al., 2013;
UNICEF, 2011). UNICEF recommends adolescent-friendly health facilities.

For older people, the burden of ill health becomes greater as they age, needing more care at home and
more medical attention. The demographic shift towards an ageing population means there are fewer
infectious diseases and more chronic and degenerative diseases (HelpAge International, 2014). Older
people may find it difficult to travel to health centres, and may have lower incomes due to not working.
They require health and social care simultaneously. HelpAge recommends a holistic continuum of care for
older people, focusing on community and home-based care. Coordinating associations may help them to
navigate the healthcare system. It is also essential for older people to have health literacy.

Colvin, C. J., Smith, H. J., Swartz, A., Ahs, J. W., de Heer, J., Opiyo, N., ... & George, A. (2013).
Understanding careseeking for child illness in sub-Saharan Africa: A systematic review and conceptual
framework based on qualitative research of household recognition and response to child diarrhoea,
pneumonia and malaria. Social Science & Medicine, 86, 66-78.
http://dx.doi.org/10.1016/j.socscimed.2013.02.031
This systematic review synthesises qualitative evidence on factors that underpin household recognition
and response to child diarrhoea, pneumonia and malaria in sub-Saharan Africa. Factors that influence
household care-seeking include: cultural beliefs and illness perceptions; perceived illness severity and
efficacy of treatment; rural location; gender; household income; and cost of treatment. Previous
experience with health services and habit also play a role.

Richards, E., Theobald, S., George, A., Kim, J. C., Rudert, C., Jehan, K. & Tolhurst, R. (2013). Going
beyond the surface: Gendered intra-household bargaining as a social determinant of child health and
nutrition in low and middle income countries. Social Science & Medicine, 95, 24-33.
http://dx.doi.org/10.1016/j.socscimed.2012.06.015
Can a woman’s intra-household bargaining power influence child health and nutrition? This
comprehensive literature review examines the evidence of the impact of gender relations in the
household on child health and nutrition. Women’s access to resources can improve health and nutritional
outcomes for their children, but women do not always have control over the distribution of those
resources, and can have lower levels of income than men. This decision-making process often relies on

GSDRC / HEART 20
negotiation among household members, in many cases between the mothers and fathers, but also
between older and younger members (such as mothers-in-law and mothers).

Yount, K. M., DiGirolamo, A. M. & Ramakrishnan, U. (2011). Impacts of domestic violence on child
growth and nutrition: a conceptual review of the pathways of influence. Social Science & Medicine,
72(9), 1534-1554. http://dx.doi.org/10.1016/j.socscimed.2011.02.042
Children’s exposure to domestic violence (CEDV) predicts poorer health and development. Evidence is
emerging that CEDV affects child growth and nutrition, but this is an under-studied area. Younger children
are disproportionately exposed to domestic violence because they spend more time with their mothers
than do older children. Prevention of domestic violence could improve child growth and nutrition.

5.2 Sexual and reproductive health

The literature on SRH and age mainly focuses on adolescents. Immature bodies mean adolescents are
more vulnerable to STIs, HIV, and negative pregnancy outcomes). Girls are susceptible to coercive
relationships with older men, and boys are societally expected to have many sexual experiences. Condom
use is still not high, remaining at around a third to half of adolescents at most recent sex, although it is
increasing (Bearinger et al., 2007). Adolescents often avoid seeking healthcare for SRHR, because of long
waits, distance, lack of money to cover costs, and the lack of a welcoming atmosphere (UNICEF, 2011).
There is almost no literature on the SRHR needs of older people.

The health consequences of Child, Early and Forced Marriage (CEFM) include isolation and depression,
risk of STIs and cervical cancer, risks during pregnancy, labour and delivery and high rates of maternal
and infant morbidity and mortality (Raj & Boehmer, 2013). Adolescent pregnancy, whether inside or
outside marriage, involves high health risks (UNICEF, 2011). Current research suggests HIV is not more
prevalent among nations that are more affected by child marriage, although this is under debate (Raj &
Boehmer, 2013). Although child marriage includes boys, girls are most affected. Policymakers need to
address the social and cultural aspects of child marriage in order to mitigate the health consequences.

Other approaches for adolescent SRHR include: friendly clinical services; sex education programmes that
provide developmentally appropriate, evidence-based curricula; and youth development strategies to
enhance life skills, connections to supportive adults, and educational and economic opportunities
(Bearinger et al., 2007). UNICEF (2011) suggest that adolescent-friendly health centres are the most
effective way to encourage uptake of services.

Bearinger, L. H., Sieving, R. E., Ferguson, J. & Sharma, V. (2007). Global perspectives on the sexual and
reproductive health of adolescents: patterns, prevention, and potential. The Lancet, 369(9568), 1220-
1231. http://dx.doi.org/10.1016/S0140-6736(07)60367-5
What are the trends in adolescent SRHR? This paper synthesises the global findings from reviews. There
are huge variations across regions and countries, but some patterns in behaviours, access to services and
interventions. Young people need access to quality clinical services that offer effective treatments and
vaccines, coupled with sex education that gives medically accurate information and teaches skills for
negotiating sexual choices.

Raj, A. & Boehmer, U. (2013). Girl child marriage and its association with national rates of HIV,
maternal health, and infant mortality across 97 countries. Violence Against Women, 19(4), 536-551.
http://dx.doi.org/10.1177/1077801213487747
Are nations with higher rates of girl child marriage at increased risk for poorer maternal and child health
indicators and HIV? The authors used regression analysis on national indicator data from 2009 United
Nations reports from 97 nations for which girl child marriage data were available. Countries with higher
rates of girl child marriage are significantly more likely to contend with higher rates of maternal and
infant mortality and non-use of maternal health services, but not HIV.

21 Social development and human development: Topic guide

Age

5.3 Education
The key educational issues for younger children are mainstreamed throughout this guide. There is
increasing attention paid to adolescent and post-primary education. Adolescence is a period when school
dropout is most likely: one in five adolescents are out of school globally (UNICEF, 2011). Secondary
schools are often more costly and further from home. There are increasing incentives to drop out in
order to work. Early entry into the labour market has associations with reduced earning potential,
exploitation, and susceptibility to gang recruitment, among others (Kabiru et al., 2013). Young married
girls are also very likely to drop out of formal schooling (Lee‐Rife et al., 2012). A recent systematic review
suggests that an effective way of reducing CEFM is providing financial incentives for girls to stay in school
(Lee‐Rife et al., 2012). Education delays marriage, pregnancy and childbearing, and school-based sex
education can be effective in changing the attitudes and practices that lead to risky sexual behaviour in
marriage (Lee‐Rife et al., 2012).

Kabiru, C. W., Izugbara, C. O. & Beguy, D. (2013). The health and wellbeing of young people in sub-
Saharan Africa: an under-researched area? BMC International Health and Human Rights, 13(1), 11.
http://www.biomedcentral.com/1472-698X/13/11
There are few SSA-based long-term studies on youth development that can clarify linkages between
health and the social, political, and economic contexts that define the lives of African youth. Youth
health and wellbeing literature mainly focuses on sexual and reproductive health. This paper
briefly reviews how the literature treats the following issues in relation to young people: education,
urbanisation, globalisation, HIV/AIDS and conflict.

Lee‐Rife, S., Malhotra, A., Warner, A. & Glinski, A. M. (2012). What works to prevent child marriage: A
review of the evidence. Studies in Family Planning, 43(4), 287-303.
http://dx.doi.org/10.1111/j.1728-4465.2012.00327.x
This article systematically reviews 23 child marriage prevention programmes carried out in low-income
countries. Most programmes included child marriage as a secondary aim. The primary focus was gender
inequality, poverty or other issues. The evidence suggests that programmes offering incentives and girls’
empowerment can be effective in preventing child marriage and can foster change relatively quickly. It
remains unclear whether impacts are sustained after the programme ends. Also unclear are the details of
how change happens.

See also:

 Haider, H. (2011). Early marriage and sexual and reproductive health (GSDRC Helpdesk report).
http://www.gsdrc.org/docs/open/HD784.pdf
 M’Cormack, F. (2012). Political commitments to improve adolescent sexual and reproductive
health (GSDRC Helpdesk report). http://www.gsdrc.org/docs/open/HDQ779.pdf
 HEART. (2011). The Impact of girls’ education on early marriage (HEART Helpdesk report).
http://www.heart-resources.org/2011/09/the-impact-of-girls-education-on-early-marriage/
 HEART. (2013). Child health and parents’ education (HEART Helpdesk report).
http://www.heart-resources.org/2011/11/child-health-and-parents-education/
 Mcloughlin, C. (2010). Child marriage (GSDRC Helpdesk report).
http://www.gsdrc.org/docs/open/HD663.pdf
 Rohwerder, B. (2014). Integrated programmes supporting adolescent girls (GSDRC Helpdesk
Research Report 1125). http://www.gsdrc.org/docs/open/HDQ1125.pdf

GSDRC / HEART 22
6 Human development and social exclusion
Exclusionary processes create inequitable distribution of resources and unequal access to capabilities and
rights necessary for human development (Popay et al., 2008). Social exclusion mediates access to
services, which has a strong impact on human development outcomes. Sometimes marginalised groups
are directly discriminated against and stigmatised, but they are also structurally excluded by factors
including geographical distance from services, language barriers, physical difficulties, or unsupportive
laws and policies. Human rights-based approaches are particularly important for tackling social exclusion.

Lack of clarity on what ‘social exclusion’ means makes measuring its relationship with human
development difficult (Popay et al., 2008). There is no agreement on social exclusion as a broad concept
rather than a state affecting certain groups, and it is not clear whether exclusion is a risk factor or an
outcome or both for human development processes (Popay et al., 2008). Most studies focus on a single
dimension of exclusion, so there is a large body of evidence on those specific dimensions.

There is most evidence on discrimination and exclusion in the health and WASH sectors. There is a strong
focus on people living with disabilities, although still insufficient evidence on this group. There is almost
no information on social exclusion and sexual and reproductive health except for PWD, so in this chapter
the SRH and health sections have been merged. Children with differing and increased learning
requirements still face inequalities in education. Most focus is on girls, and children living with
disabilities. The literature on WASH and social exclusion mainly focuses on access to water and
accountable water services, and there is a growing literature on slum dwellers. Ethnic minorities,
indigenous peoples and low-caste people remain less visible in these sectors. Women and girls are more
excluded than men and boys.

The disability literature highlights an important lesson for social exclusion: access to the necessary
information and services are mediated by attitudes and ignorance about disability issues, rather than by
the disability itself (Groce, et al., 2009).

Popay, J., Escorel, S., Hernández, M., Johnston, H., Mathieson, J. & Rispel, L. (2008). Understanding and
Tackling Social Exclusion. Final Report of the Social Exclusion Knowledge Network of the Commission on
Social Determinants of Health. Geneva: WHO.
http://www.who.int/social_determinants/knowledge_networks/final_reports/sekn_final%20report_042
008.pdf
In the SEKN conceptual model exclusion is viewed as a dynamic, multi-dimensional process driven by
unequal power relationships. It has four main dimensions – economic, political, social and cultural – and
operates at different levels, including individual, household, group, community, country, regional and
global. The report provides case studies on social exclusion, an overview of its meaning and
measurement, and a review of policies and actions undertaken by states, civil society and the private
sector.

6.1 Health / Sexual and Reproductive Health

Exclusionary processes restrict social, cultural, economic and political participation, which has negative
impacts on health and wellbeing (Popay et al., 2008). The poorest and most marginalised people are
usually the least able to claim their health rights (Lang et al., 2013). Marginalised groups often experience
discrimination at the point of service (Govender & Penn-Kekana, 2008; Berlan & Shiffman, 2012). This is
often shaped by the gap between patient and provider in gender, class, caste, or ethnicity (Govender &
Penn-Kekana, 2008). Minority ethnic or marginalised groups are less likely to seek health treatment
(Thornicroft, 2008), as are urban slum-dwellers (de Snyder et al., 2011).

23 Social development and human development: Topic guide

Social exclusion

People living with disabilities are more likely to seek healthcare, but are less likely to receive adequate
care (Lang et al., 2013). They are less likely to have regular employment, and are therefore less able to
pay for healthcare (Lang et al., 2013). PWD are more likely to experience physical, emotional, and sexual
abuse and other forms of gender-based violence, more likely to become infected with HIV and other STIs,
and sometimes experience forced decisions about their SRH (Groce et al., 2009). WHO recommends that
SRHR programmes and activism include disability needs, rather than creating separate programmes
(Groce et al., 2009). People living with disabilities have historically experienced medical professionals
exerting undue influence on their decision-making, such as their choice to attend school, and right to
marry (Lang et al., 2013).

The type of health issue may itself cause worse human development outcomes. Mental health disorders
carry a greater degree of stigma and discrimination than physical health conditions, and people with
mental health conditions are very likely to be socially excluded (Thornicroft, 2008). Aside from financial
barriers and lack of knowledge, the social factors creating this situation are: 1) reluctance to seek help
because of the anticipation of stigma; and 2) reluctance of diagnosed people to advocate for better
mental health care for fear of shame and rejection on disclosure (Thornicroft, 2008). HIV is highly
stigmatised and isolating (Popay et al., 2008). Populations at high-risk of HIV, such as people who inject
drugs, men who have sex with men, and sex workers, are often highly stigmatised and experience
structural barriers to accessing care and prevention services (Gruskin et al., 2013). Harmful laws and
policies create barriers that inhibit an effective HIV response, which is especially damaging for
populations already marginalised (Gruskin et al., 2013).

Lang, R., Groce, N., Cole, E. (2013). Conceptualising the linkages between the social determinants of
health and disability (Leonard Cheshire Disability and Inclusive Development Centre, Working Paper
Series, no. 19). London: LCDIDC. http://www.ucl.ac.uk/lc-
ccr/centrepublications/workingpapers/WP19_Linkages_between_the_SDH_and_Disability.pdf
This paper outlines the links between two policy directives: the Social Determinants of Health framework
and disability issues. The analysis highlights strong similarities and synergies, particularly in promoting a
human rights agenda and addressing the inequalities and inequities in access to healthcare and
rehabilitation services. Such inequalities must be placed in the context of much broader social, political
and economic contexts within and between countries.

Thornicroft, G. (2008). Stigma and discrimination limit access to mental health care. Epidemiologia e
Psichiatria Sociale, 17(01), 14-19. http://dx.doi.org/10.1017/S1121189X00002621
Why do people avoid seeking care for mental health disorders? Evidence from descriptive studies and
epidemiological surveys suggest that factors increasing the likelihood of treatment avoidance, or long
delays include: 1) lack of knowledge about the features and treatability of mental illnesses; 2) ignorance
about how to access assessment and treatment; 3) prejudice against people who have mental illness; and
4) expectations of discrimination. These results appear to be consistent across a wide range of settings
and conditions.

de Snyder, V. N. S., Friel, S., Fotso, J. C., Khadr, Z., Meresman, S., Monge, P. & Patil-Deshmukh, A.
(2011). Social conditions and urban health inequities: realities, challenges and opportunities to
transform the urban landscape through research and action. Journal of Urban Health, 88(6), 1183-1193.
http://dx.doi.org/10.1007/s11524-011-9609-y
This secondary review of literature describes how social exclusion contributes to urban health inequities.
Poorer health outcomes are widely observed among socially excluded urban residents, particularly slum-
dwellers. Factors influencing health outcomes include: education, employment, health care services,
social capital and social networks. Lower levels of any of these factors affect health outcomes, and
socially excluded groups are much more likely to have lower levels.

GSDRC / HEART 24
Groce, N.E., Izutsu, T., Reier, S., Rinehart, W. & Temple, B. (2009). Promoting sexual and reproductive
health for persons with disabilities: WHO/UNFPA guidance note. WHO: Geneva.
http://www.who.int/reproductivehealth/publications/general/9789241598682/en/
SRH for people living with disabilities deserves attention because these needs have been widely and
deeply neglected. PWD have equal rights to be sexually active as those without disabilities, but often do
not receive general or specific information and support about their SRHR. This guidance note lays out a
five point framework for inclusion: 1) establish partnerships with organisations of PWD; 2) raise
awareness and increase accessibility within own organisations; 3) ensure that all sexual and reproductive
health programmes reach and serve PWD; 4) address disability in national SRHR policy, laws, and
budgets; and 5) promote research on SRHR of PWD at local, national, and international levels.

Gruskin, S., Ferguson, L., Alfven, T., Rugg, D. & Peersman, G. (2013). Identifying structural barriers to an
effective HIV response: using the National Composite Policy Index data to evaluate the human rights,
legal and policy environment. Journal of the International AIDS Society, 16(1).
http://dx.doi.org/10.7448/IAS.16.1.18000
This paper examines law and policy data from 171 countries to assess attention to human rights in
national legal and policy environments. It looks specifically at the health and rights of key HIV populations
such as people who inject drugs, men who have sex with men and sex workers. Most countries (78 out of
106) report the existence of laws and policies that make it harder for key populations to access HIV
services. Yet there are also laws and policies that positively affect access to HIV-related services. A
supportive legal environment can play a strong role in building a responsive framework for HIV services.

6.2 Education
Social factors shape access to school, and broadening access to education means targeting specific
groups of children who are excluded. Intersecting inequalities mean that age, gender, location, class,
ethnicity and income all affect how well children are able to learn (Save the Children International, 2013).
Inequalities persist in access to schooling; although many more girls are now in school, children living
with disabilities, children from ethnic or religious minorities or those in remote locations still do not have
sufficient access to school (Hossain, 2010). Only 10 per cent of children living with disabilities are in
school (Miles & Singal, 2010). Exclusion from school has multiple impacts on perpetuating poverty
(Hossain, 2010).

Children in school face problems of inequitable quality of learning when schools do not meet children’s
differing and specific needs (Save the Children International, 2013). The already disadvantaged groups
suffer most from inadequate teaching, facilities and materials (Save the Children International, 2013).

There is a debate in policy between the Education for All (EFA) and the inclusive education agendas
(Miles & Singal, 2010). EFA is a rights-based commitment to ensure every child and adult receives basic
education of good quality. It aims to be an inclusive agenda that reaches all learners, but has historically
overlooked disability. There is a growing agreement among international agencies that children living
with disabilities should be integrated into mainstream programmes and schools. The inclusive education
agenda presses for developing inclusive schools that respond to the needs of all learners, no matter their
ability level. Inclusivity has no consensus in the literature, and does not provide conceptual clarity, but
inclusive education is commonly understood as being mainly about children living with disabilities. In
practice, this often means separate special schools.

Save the Children International. (2013). Ending the hidden exclusion: Learning and equity in education
post-2015. Save the Children International. http://www.worldwewant2015.org/node/343570
This paper discusses the ‘learning crisis’ for in-school children. Although many more children are now
attending school, a large number of them are not learning the basics and are struggling to achieve

25 Social development and human development: Topic guide

Social exclusion

learning goals. Children with pre-existing disadvantages suffer most. This paper puts forward a
framework for the post-2015 goals that focuses on inequity and quality in schools.

Hossain, N. (2010). School exclusion as social exclusion: the practices and effects of a conditional cash
transfer programme for the poor in Bangladesh. The Journal of Development Studies, 46(7), 1264-1282.
http://dx.doi.org/10.1080/00220388.2010.487096
This article argues that being excluded from school leads to further social exclusion. Exclusion from
education increasingly entails exclusion from economic opportunities, and from knowledge of the tools,
language and actions required for citizen engagement with the state. The case study of a cash transfer
programme in Bangladesh shows that this programme tends to reinforce social inequalities by failing to
target the ultra-poor.

Miles, S. & Singal, N. (2010). The Education for All and inclusive education debate: conflict,
contradiction or opportunity?. International Journal of Inclusive Education, 14(1), 1-15.
http://dx.doi.org/10.1080/13603110802265125
This paper explores the history of the international Education for All (EFA) programme and its tendency
to overlook some marginalised groups of children, in particular those seen as having ‘special educational
needs’ or impairments and disabilities. Inclusive education is in part a response to this agenda, and is
seen as focusing mainly on children living with disabilities, which fills the gap left by EFA. The paper
argues for greater collaboration and synergy between these initiatives, and suggests ways in which
practitioners and policy makers can develop more sustainable, and context‐appropriate, policies and
practices.

6.3 WASH
The most commonly noted inequalities in the WASH sector are between rural and urban populations, and
particular socio-economic groups (Pullan et al., 2014). Narayan et al. (2011) note that WASH services
often do not reach those most in need and highlight three barriers to social inclusion in WASH:
institutional, environmental and attitudinal. Programmes in South Asia that have tackled all three barriers
together have been shown to be successful.

Community-Led Total Sanitation (CLTS) aims to support improved sanitation through community
awareness-raising and ownership. Although it aims at inclusion, PWD and other socially excluded people
tend to have their needs overlooked, or to be represented by others at community meetings (Wilbur &
Jones, 2014).

The design of facilities is crucial to make them accessible to PWD. Technical barriers include steps,
height, and distance of facilities, lack of transportation and unsuitable equipment; while social barriers
include stigma, low self-esteem if requiring help to use facilities, lack of understanding from service
providers, and lack of knowledge about where to access services (Groce et al., 2011; Lang et al., 2013).
Despite these known challenges, there is no body of knowledge on the WASH or health needs of people
living with disabilities (Groce et al., 2011). The CLTS programme provides some concrete
recommendations for improving inclusion (Wilbur & Jones, 2014).

Groce, N., Bailey, N., Lang, R., Trani, J. F. & Kett, M. (2011). Water and sanitation issues for persons
with disabilities in low-and middle-income countries: a literature review and discussion of implications
for global health and international development. Journal of Water and Health, 9(4), 617-627.
http://dx.doi.org/10.2166/wh.2011.198
How do people living with disabilities access WASH? This comprehensive literature review presents what
is currently known about access to water and sanitation for PWD in low- and middle-income countries
from the perspective of both international development and global health. It identifies gaps in research,
practice and policy that are of pressing concern if the water and sanitation needs of this large population

GSDRC / HEART 26
are to be addressed. It emphasises that there are low-cost, low-tech interventions that work, such as
universal design, but that there are few documented examples of good practice, and most are small-
scale.

Wilbur, J. & Jones, H. (2014). Disability: Making CLTS fully inclusive (Frontiers of CLTS: Innovations and
Insights Issue 3). Brighton: IDS.
http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/media/Frontie
rs_of_CLTS_Issue3_Disabilities.pdf
This paper focuses on people living with disabilities and their particular needs for access to WASH. The
paper acknowledges the many forms of disability. PWD tend not to be present at CLTS community
triggering events. They often lack voice in the community, have their needs overlooked, and may even be
hidden by their families. They face physical, organisational and institutional barriers. The paper outlines
how CLTS facilitators can include PWD. It highlights that many of the lessons from PWD can be applied to
other excluded groups.

See also:

 HEART. (2011). Language of instruction (HEART Helpdesk report).

http://www.heart-resources.org/2011/06/language-of-instruction/
 HEART. (2013). Inclusive and effective schools (HEART Helpdesk report).
http://www.heart-resources.org/2013/07/inclusive-and-effective-schools/
 HEART. (2013). Mother tongue education – Girls and poor/vulnerable children (HEART Helpdesk
report). http://www.heart-resources.org/2011/11/mother-tongue-education-girls-and-
poorvulnerable-children/
 HEART. (2013). Universal design of schools and classrooms (HEART Helpdesk report).
http://www.heart-resources.org/2013/07/universal-design-of-schools-and-classrooms/
 HEART. (2014). Inclusive learning topic guide.
http://www.heart-resources.org/topic/inclusive-learning/
 Heise, L. (2013). STRIVE and the drivers of HIV (HEART multimedia resources).
http://www.heart-resources.org/mmedia/heart-talks-lori-heise-on-strive-and-the-drivers-of-hiv/
 Paxton, W., (2013). Will Paxton on opportunities to address inequality in education (HEART
multimedia resources). http://www.heart-resources.org/mmedia/will-paxton-on-opportunities-
to-address-inequality-in-education/
 UNICEF. (2013). State of the world’s children 2013: Children with disabilities. United Nations
Children's Fund.
http://www.unicef.org/sowc2013/files/SWCR2013_ENG_Lo_res_24_Apr_2013.pdf
 Walton, O. (2011). Self-esteem, shame and poverty (GSDRC Helpdesk report).
http://www.gsdrc.org/docs/open/HD788.pdf
 Walton, O. (2012). Economic benefits of disability-inclusive development (GSDRC Helpdesk
report). http://www.gsdrc.org/docs/open/HDQ831.pdf
 WHO & World Bank (2011). World report on disability. World Health Organization.
http://www.who.int/disabilities/world_report/2011/en/

27 Social development and human development: Topic guide

Analytical tools / M&E

7 Analytical tools and monitoring and

evaluation
This section lists key programme design and evaluation tools on integrating social development principles
into human development programmes.

7.1 Human rights

de Albuqerque, C. (n.d.). On the right travel: Good practices in realising the rights to water and sanitation.
Geneva: UN. http://www.ohchr.org/Documents/Issues/Water/BookonGoodPractices_en.pdf

Freedman, L. P. (2001). Using human rights in maternal mortality programs: from analysis to strategy.
International Journal of Gynecology & Obstetrics, 75(1), 51-60.
http://dx.doi.org/10.1016/S0020-7292(01)00473-8

UNICEF (2014). Child rights education toolkit: Rooting child rights in early childhood education, primary
and secondary schools (First Edition). UNICEF.
http://www.unicef.org/crc/files/UNICEF_CRE_Toolkit_FINAL_web_version170414.pdf

WHO. (2014). Ensuring human rights in the provision of contraceptive information and services: Guidance
and recommendations. Geneva: WHO.
http://apps.who.int/iris/bitstream/10665/102539/1/9789241506748_eng.pdf?ua=1

7.2 Accountability
CARE. Mutual Accountability Tool. http://bbnc.care.org.au/mutual-accountability-tool

de Asís, M. G. (2009). Improving transparency, integrity, and accountability in water supply and
sanitation. Washington, DC: World Bank. https://openknowledge.worldbank.org/handle/10986/2628

EdQual. (2010). A framework for education quality (Policy Brief No. 10). Bristol: EdQual
http://www.heart-resources.org/doc_lib/framework-education-quality/

Fritsche, G. B., Soeters, R. & Meessen, B. (2014). Performance-based financing toolkit. Washington, DC:
World Bank. https://openknowledge.worldbank.org/handle/10986/17194

Global Water Partnership Toolbox. http://www.gwp.org/en/ToolBox/

Kar, K. & Chambers, R. (2008). Handbook on community-led total sanitation. London: Plan UK.
http://www.communityledtotalsanitation.org/resource/handbook-community-led-total-sanitation

Muller, M., Simpson, R. & Van Ginneken, M. (2008). Ways to improve water services by making utilities
more accountable to their users: a review (Water working note 15). Washington, DC: World Bank.
http://documents.worldbank.org/curated/en/2008/05/9567119/ways-improve-water-services-making-
utilities-more-accountable-users-review

World Bank Group Health Results Innovation Trust Fund. (2014). RBF: A smarter approach to delivering
more and better reproductive, maternal, newborn and child health services. Washington, DC: World Bank.
http://www.rbfhealth.org/sites/rbf/files/HRITF%202014%20Annual%20Report_0.pdf

GSDRC / HEART 28
7.3 Gender
House, S., Ferron, S., Sommer, M. & Cavill, S. (on behalf of WaterAid). (2014). Violence, gender and
WASH: A practitioner’s toolkit. http://violence-wash.lboro.ac.uk/

House, S., Mahon, T. & Cavill, S. (2012). Menstrual hygiene matters: a resource for improving menstrual
hygiene around the world. WaterAid.
http://www.wateraid.org/~/media/Files/Global/MHM%20files/Compiled_LR.pdf

Interagency Gender Working Group (IGWG) Gender and Health Toolkit.

https://www.k4health.org/toolkits/igwg-gender

UNICEF (n.d.). Promoting gender equality through UNICEF-supported programming in basic education:
Operational Guidance. UNICEF. http://www.unicef.org/gender/files/BasicEducation_Layout_Web.pdf

United Nations Girls’ Education Initiative (UNGEI) resources.

http://www.ungei.org/resources/index_3216.html

USAID (2007). Training guide: Continuum of approaches for achieving gender integration in programming:
A decision-making tool for education officers. Prepared by the EQUATE team for USAID.
http://www.ungei.org/resources/files/USAID_EQUATEGenderContinuum.pdf

WHO. (2011). Human rights and gender equality in health sector strategies: How to assess policy
coherence. Geneva: WHO. http://whqlibdoc.who.int/publications/2011/9789241564083_eng.pdf?ua=1

WHO. (2013). Responding to intimate partner violence and sexual violence against women (WHO clinical
and policy guidelines).
http://www.who.int/reproductivehealth/publications/violence/9789241548595/en/

WHO guidelines on maternal, reproductive and women's health.

http://www.who.int/publications/guidelines/reproductive_health/en/

Wilson, E., Reeve, J. & Pitt, A. (2014). Education. Period. Developing an acceptable and replicable
menstrual hygiene intervention. Development in Practice, 24(1), 63-80.
http://dx.doi.org/10.1080/09614524.2014.867305

7.4 Age
HelpAge International guidelines on working with older people:
http://www.helpage.org/resources/practical-guidelines/

Uhlenberg, P. (2009). International handbook of population aging. (Vol. 1). Dordrecht: Springer.
http://link.springer.com/book/10.1007/978-1-4020-8356-3/page/2

UNICEF. Child Friendly Schools. http://www.unicef.org/cfs/

UNICEF. Water, Sanitation and Hygiene (WASH) in schools (A companion to the Child Friendly Schools
Manual). http://www.unicef.org/publications/files/CFS_WASH_E_web.pdf

WHO guidelines on child health: http://www.who.int/publications/guidelines/child_health/en/

29 Social development and human development: Topic guide

Analytical tools / M&E

7.5 Social exclusion

Booth, T. & Ainscow, M. (2011). Index for inclusion: Developing learning and participation in schools
(Third Edition). Bristol: Centre for Studies on Inclusive Education.
http://www.csie.org.uk/resources/inclusion-index-explained.shtml

DFID. (2009). Gender and social exclusion analysis: How to note (A DFID Practice Paper). London, UK:
Department for International Development. http://www.gsdrc.org/docs/open/SE9.pdf

Hinds, R. (2013). Tools for participatory analysis of poverty, social exclusion and vulnerability (GSDRC
Helpdesk Research Report 959). Birmingham, UK: GSDRC, University of Birmingham.
http://www.gsdrc.org/docs/open/HDQ959.pdf

Lang, R., Kett, M., Groce, N. & Trani, J. F. (2011). Implementing the United Nations Convention on the
rights of persons with disabilities: principles, implications, practice and limitations. ALTER-European
Journal of Disability Research, 5(3), 206-220. http://dx.doi.org/10.1016/j.alter.2011.02.004

Rheingans, R., Anderson, J. D., Luyendijk, R. & Cumming, O. (2014). Measuring disparities in sanitation
access: does the measure matter? Tropical Medicine & International Health, 19(1), 2-13.
http://dx.doi.org/10.1111/tmi.12220

UNESCO (2008). Equity and inclusion in education: Tools to support education sector planning and
evaluation. Paris: UNESCO http://www.unesco.org/bpi/pdf/iatt_equity_inclusion_tools_042008_en.pdf

UNESCO Bangkok (2004-13). Embracing diversity: Toolkit for creating inclusive learning-friendly
environments. Bangkok: UNESCO.
http://www.unescobkk.org/education/inclusive-education/resources/ilfe-toolkit/

GSDRC / HEART 30
Annex I: Evidence table
What do we know about the effects of social development on human development outcomes? The table
below organises the research and evidence included in this guide into four human development sectors ‒
health; sexual and reproductive health (SRH); education; and water, sanitation and hygiene (WASH) ‒ and
five social development issues (human rights, accountability, gender inequality, age and social exclusion).

Limitations of the evidence base

Overall, the size and quality of the evidence on social development and human development is rigorous
and reliable in the health and SRH sectors, but less so in education and WASH. There are several
systematic reviews in health and education, which provide robust conclusions.

The human rights evidence base for these issues has a disproportionate focus on SRH, reflecting the
politicisation of this issue. SRH is very closely linked to gender inequality. The evidence on social
development issues is generally heavily weighted towards gender inequality.

Evidence on age-related issues, including children, adolescents and older people, focuses almost
exclusively on health and SRH; there is little to no rigorous evidence on how age affects education or
WASH. Disability, included here under social exclusion, is poorly evidenced and hardly visible in some
sectors, such as sexual and reproductive health. Much of the literature on disability is policy-oriented,
advocacy-based, or secondary, and does not provide any evidence.

The evidence base is weighted towards easily measureable impacts and the prevalence of particular
issues. There is much less evidence on power relations, how to shift inequalities, or addressing cultural
norms.

Almost all of the literature included here focuses on sub-Saharan Africa and South Asia.

31 Social development and human development: Topic guide

Strength of the evidence base: how well studied are the links between social development issues and human development outcomes?

Human development outcome

Health Sexual and reproductive Education Water, sanitation and

health hygiene

Human rights (6) (8) (16) (20) (16) (27) (29) (34) (35) (8) (29) (21)
Social development factor

Accountability (4) (12) (33) (34) (35) (10) (12) (24) (10) (12)

Gender inequality (1) (3) (5) (7) (8) (9) (11) (14) (1) (2) (3) (25) (27) (28) (7) (8) (9) (13) (29) (31) (8) (9) (21)
(19) (25) (30) (34)

Age (2) (5) (17) (20) (27) (30) (32) (2) (22) (27) (32) (29) (32)

Social exclusion (5) (7) (16) (20) (23) (18) (31) (15) (26) (33)

Each number in the table refers to a study listed on the following pages. More numbers in each cell indicate more available evidence in the papers listed in this
guide; fewer numbers, or blank spaces, indicate a lack of evidence in these papers.

GSDRC / HEART 32
References included in table
Key: type of research
1 [S; OR] Barker, G., Ricardo, C. & Nascimento, M. (2007). 6 [S; OR] de Snyder, V. N. S., Friel, S., Fotso, J. C., Khadr, Z.,
Engaging men and boys in changing gender based inequity Meresman, S., Monge, P. & Patil-Deshmukh, A. (2011). [P&E] Primary and Empirical
in health: Evidence from programme interventions. Geneva: Social conditions and urban health inequities: realities, [EXP] Experimental
WHO/Promudo challenges and opportunities to transform the urban [OBS] Observational
http://www.who.int/gender/documents/Engaging_men_bo landscape through research and action. Journal of Urban
ys.pdf Health, 88(6), 1183-1193. [S] Secondary
http://dx.doi.org/10.1007/s11524-011-9609-y [SR] Systematic Review
2 [S; OR] Bearinger, L. H., Sieving, R. E., Ferguson, J. &
Sharma, V. (2007). Global perspectives on the sexual and 7 [P&E; E] Dercon, S. & Singh, A. (2013). From nutrition to [OR] Other Review
reproductive health of adolescents: patterns, prevention, aspirations and self-efficacy: gender bias over time among
and potential. The Lancet, 369(9568), 1220-1231. children in four countries. World Development, 45, 31-50.
http://dx.doi.org/10.1016/S0140-6736(07)60367-5 http://dx.doi.org/10.1016/j.worlddev.2012.12.001 12 [S; OR] Gaventa, J. and Barrett, G. (2010). So what
3 [S; SR] Berg, R. C. & Denison, E. (2013). A tradition in 8 [S; OR] Esplen, E., (2009). Gender and care: overview difference does it make? Mapping the outcomes of citizen
transition: factors perpetuating and hindering the report. BRIDGE, Institute of Development Studies. engagement (Working Paper 347). Brighton: IDS
continuance of female genital mutilation/cutting (FGM/C) http://www.bridge.ids.ac.uk/reports/cep_care_or.pdf http://www.ids.ac.uk/files/dmfile/Wp347.pdf
summarized in a systematic review. Health care for women 13 [S; OR] Glick, P. (2008). What policies will reduce gender
9 [S; OR] Fisher, J. (2006). For her it's the big issue: putting
international, 34(10), 837-859. schooling gaps in developing countries: Evidence and
women at the centre of water supply, sanitation and
http://dx.doi.org/10.1080/07399332.2012.721417 interpretation. World Development, 36(9), 1623-1646.
hygiene. Water Supply and Sanitation Collaborative Council.
4 [S; SR] Berlan, D. & Shiffman, J. (2012). Holding health https://dspace.lboro.ac.uk/dspace- http://dx.doi.org/10.1016/j.worlddev.2007.09.014
providers in developing countries accountable to jspui/bitstream/2134/9970/20/wsscc_for_her_its_the_big_i 14 [S; OR] Govender, V. & Penn-Kekana, L. (2008). Gender
consumers: a synthesis of relevant scholarship. Health ssue_evidence_report_2006_en.pdf biases and discrimination: a review of health care
Policy and Planning, 27(4), 271-280. interpersonal interactions. Global public health, 3(S1), 90-
10 [S; OR] Fox, J. (2014). Social accountability: What does
http://dx.doi.org/10.1093/heapol/czr036 103. http://dx.doi.org/10.1080/17441690801892208
the evidence really say? (Draft paper for GPSA).
5 [S; SR] Colvin, C. J., Smith, H. J., Swartz, A., Ahs, J. W., de Washington, DC: World Bank. 15 [S; OR] Groce, N., Bailey, N., Lang, R., Trani, J. F. & Kett,
Heer, J., Opiyo, N., ... & George, A. (2013). Understanding http://gpsaknowledge.org/wp- M. (2011). Water and sanitation issues for persons with
careseeking for child illness in sub-Saharan Africa: A content/uploads/2014/09/Social-Accountability-What- disabilities in low-and middle-income countries: a literature
systematic review and conceptual framework based on Does-Evidence-Really-Say-GPSA-Working-Paper-11.pdf review and discussion of implications for global health and
qualitative research of household recognition and response international development. Journal of Water and Health,
11 [P&E; OBS] Garcia-Moreno, C., Jansen, H. A., Ellsberg, M.,
to child diarrhoea, pneumonia and malaria. Social Science & 9(4), 617-627. http://dx.doi.org/10.2166/wh.2011.198
Heise, L. & Watts, C. H. (2006). Prevalence of intimate
Medicine, 86, 66-78.
partner violence: findings from the WHO multi-country 16 [S; OR] Gruskin, S., Ferguson, L., Alfven, T., Rugg, D. &
http://dx.doi.org/10.1016/j.socscimed.2013.02.031
study on women's health and domestic violence. The Peersman, G. (2013). Identifying structural barriers to an
Lancet, 368(9543), 1260-1269. effective HIV response: using the National Composite Policy
http://www.dx.doi.org/10.1016/S0140-6736(06)69523-8 Index data to evaluate the human rights, legal and policy
environment. Journal of the International AIDS Society,
16(1). http://dx.doi.org/10.7448/IAS.16.1.18000

33 Social development and human development: Topic guide

17 [P&E; EXP] HelpAge International. (2014). Why health 24 [P&E; EXP] Pradhan, M., Suryadarma, D., Beatty, A., 30 [S; OR] Richards, E., Theobald, S., George, A., Kim, J. C.,
systems must change: Addressing the needs of ageing Wong, M., Alishjabana, A. & Gaduh, A. (2011). Improving Rudert, C., Jehan, K. & Tolhurst, R. (2013). Going beyond the
populations in low- and middle-income countries (HelpAge educational quality through enhancing community surface: Gendered intra-household bargaining as a social
briefing). HelpAge International. participation: results from a randomized field experiment in determinant of child health and nutrition in low and middle
http://www.helpage.org/global-agewatch/reports/helpage- Indonesia. Washington, DC: World Bank. income countries. Social Science & Medicine, 95, 24-33.
briefing-why-health-systems-must-change/ http://dx.doi.org/10.1596/1813-9450-5795 http://dx.doi.org/10.1016/j.socscimed.2012.06.015
18 [S; OR] Hossain, N. (2010). School exclusion as social 25 [S; SR] Prost, A., Colbourn, T., Seward, N., Azad, K., 31 [S; OR] Selim, M., Abdel-Tawab, N., Elsayed, K., El
exclusion: the practices and effects of a conditional cash Coomarasamy, A., Copas, A., ... & Costello, A. (2013). Badawy, A. & El Kalaawy, H. (2013). The Ishraq program for
transfer programme for the poor in Bangladesh. The Journal Women's groups practising participatory learning and action out-of-school girls: From pilot to scale-up. Final report.
of Development Studies, 46(7), 1264-1282. to improve maternal and newborn health in low-resource Cairo: Population Council.
http://dx.doi.org/10.1080/00220388.2010.487096 settings: a systematic review and meta-analysis. The Lancet, http://www.popcouncil.org/uploads/pdfs/2013PGY_IshraqF
381(9879), 1736-1746. inalReport.pdf
19 [S; OR] Iyer, A., Sen, G. & Östlin, P. (2008). The
http://dx.doi.org/10.1016/S0140-6736(13)60685-6
intersections of gender and class in health status and health 32 [P&E; OBS] UNICEF. (2011). The State of the World's
care. Global Public Health, 3(S1), 13-24. 26 [P&E; OBS] Pullan, R. L., Freeman, M. C., Gething, P. W. & Children 2011: Adolescence an Age of Opportunity. UNICEF.
http://dx.doi.org/10.1080/17441690801892174 Brooker, S. J. (2014). Geographical inequalities in use of http://www.unicef.org/sowc2011/pdfs/SOWC-2011-Main-
improved drinking water supply and sanitation across Sub- Report_EN_02092011.pdf
20 [S; OR] Jenkins, R., Baingana, F., Ahmad, R., McDaid, D. &
Saharan Africa: Mapping and spatial analysis of cross-
Atun, R. (2011). Social, economic, human rights and political 33 [S; OR] Wilbur, J. & Jones, H. (2014). Disability: Making
sectional survey data. PLoS medicine, 11(4).
challenges to global mental health. Mental Health in Family CLTS fully inclusive (Frontiers of CLTS: Innovations and
http://dx.doi.org/10.1371/journal.pmed.1001626
Medicine, 8(2), 87. Insights Issue 3). Brighton: IDS.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178190/# 27 [P&E; OBS] Raj, A. & Boehmer, U. (2013). Girl child http://www.communityledtotalsanitation.org/sites/commu
__sec1title marriage and its association with national rates of HIV, nityledtotalsanitation.org/files/media/Frontiers_of_CLTS_Is
maternal health, and infant mortality across 97 countries. sue3_Disabilities.pdf
21 [S; OR] Kevany, K. & Huisingh, D. (2013). A review of
Violence Against Women, 19(4), 536-551.
progress in empowerment of women in rural water 34 [S; OR] Yamin, A. E. & Boulanger, V. M. (2013).
http://dx.doi.org/10.1177/1077801213487747
management decision-making processes. Journal of Cleaner Embedding sexual and reproductive health and rights in a
Production, 60, 53-64. 28 [S; OR] Rasch, V. (2011). Unsafe abortion and transformational development framework: lessons learned
http://dx.doi.org/10.1016/j.jclepro.2013.03.041 postabortion care–an overview. Acta Obstetricia et from the MDG targets and indicators. Reproductive Health
Gynecologica Scandinavica, 90(7), 692-700. Matters, 21(42), 74-85.
22 [S; SR] Lee‐Rife, S., Malhotra, A., Warner, A. & Glinski, A.
http://dx.doi.org/10.1111/j.1600-0412.2011.01165.x http://dx.doi.org/10.1016/S0968-8080(13)42727-1
M. (2012). What works to prevent child marriage: A review
of the evidence. Studies in family planning, 43(4), 287-303. 29 [S; OR] Reilly, A. (2014). Adolescent girls' experiences of 35 [S; OR] Yamin, A. E. (2013). From ideals to tools: applying
http://dx.doi.org/10.1111/j.1728-4465.2012.00327.x violence in school in Sierra Leone and the challenges to human rights to maternal health. PLoS Medicine, 10(11).
sustainable change. Gender & Development, 22(1), 13-29. http://dx.doi.org/10.1371/journal.pmed.1001546
23 [P&E; OBS] Popay, J., Escorel, S., Hernández, M.,
http://dx.doi.org/10.1080/13552074.2014.902239
Johnston, H., Mathieson, J. & Rispel, L. (2008).
Understanding and tackling social exclusion. Geneva: WHO
http://www.who.int/social_determinants/knowledge_netw
orks/final_reports/sekn_final%20report_042008.pdf

GSDRC / HEART 34