Africa has made great progress in ensuring equal access to education and healthcare for its people, yet most African countries continue to rank at the bottom of the World Bank’s Human Capital Index, and the existing data also suggests that women are being overlooked in the drive to develop human capital. A lot is at stake for ensuring access to schooling and healthcare for all: Africa has the largest return on education of any continent, with each additional year of schooling raising earnings by 11% for boys and 14% for girls, and good health is essential for the overall wellbeing of people and their ability to participate in livelihood generating activities.
Transport connectivity and human capital indicators in Africa are highly correlated at the country level. For example, adult literacy and primary school completion rates tend to be higher and maternal mortality ratios lower in countries that perform better on the Rural Access Index. However, less is known about accessibility gaps and their impact on household decisions to seek medical help or send their children to school in the rapidly growing African cities. Working with colleagues in the Human Development sectors, our team in the Africa Transport unit undertook a study to start to build evidence on this topic. The study focuses on ten large cities across the region, analyzing how well their public transport systems ensure physical access to schools and clinics, who is being left behind, and how might the cities’ land use patterns explain the accessibility gaps. Yet, the study also identified other – non-transport – barriers that, when interacting with transport deficiencies and unequal spatial distribution of health and medical facilities, can inhibit access to schooling or care, especially for people with overlapping vulnerabilities like low-income women with disabilities.
Indeed, our analysis suggests that transport availability and distances that have to be traveled rank among the main constraints for accessing education and healthcare opportunities, as evidenced by the available household survey data. This finding also reinforces the results of the spatial modeling undertaken as part of the study, which shows that average travel times by public transport to the nearest advanced health facility, such as a hospital or a medical center providing comprehensive obstetric care, exceed half an hour in three of the ten cities studied and reach nearly an hour in one of them. And, despite relatively good average accessibility to primary and secondary schools, there is significant spatial inequality within most cities: tens or even hundreds of thousands of children, depending on the city, encounter extremely long travel times, or are “accessibility poor.”
Accessibility poverty is even more prevalent when it comes to healthcare: assuming one-way travel time of an hour as being acceptable, only in four of the ten cities is accessibility universal. The accessibility poverty pockets tend to cluster on the edges of cities, often overlapping with the neighborhoods where the poorest residents have settled. Therefore, it is no surprise that, across all the cities in scope of the study, the poor on average face higher travel times to reach the nearest school or health clinic. In fact, also the nearest public school and healthcare facility typically requires longer travel for the poor than for the non-poor, which means that access to the more affordable education and healthcare options is worse for those who depend on them the most.
Overall, lack of accessibility to affordable services features highly in the broader range of access constraints households identify as most concerning. In other words, while gaps in the physical connectivity represent an important challenge for children to attend school or for pregnant women to seek regular pre-natal check-ups, lifting this constraint is likely not sufficient in most cities. Even where physical accessibility to schools and clinics exists, some groups continue to have limited access to good quality education and health services, due to affordability constraints and – in some cases – also due to gender and social norms and time poverty that affect women and girls’ decision to travel in particular.
Transport and land use planning both need to be part of the solution to make education and healthcare opportunities accessible for all. Indeed, our analysis finds that accessibility to schools and clinics tends to be better in the cities where the land-use pattern is mixed rather than where it segregates residential from other uses. Accessibility is also better in cities that are more compact and dense: average travel times increase as population densities decline, with the residents of the denser cities like Conakry, Douala, and Nairobi seeing distinctly lower travel times.
On the other hand, population proximity to public transport routes, or transit-oriented development, which in other regions of the world has been a key ingredient for making cities more livable and productive, doesn’t appear to necessarily translate into better access, which may have to do with the poor technical performance of the existing public transport systems and the way informal public transport operators – which dominate many of the cities covered by the study – are allocating their routes: to serve more profitable and predictable demand such as commercial activity centers rather than health clinics to which trips are more irregular. Introducing innovative schemes to serve lower or less predictable demand destinations through on-demand services is therefore among the “low-hanging fruit” policy recommendations that emerge from this analysis, along with investment in quality pedestrian and cycling infrastructure that matters tremendously for accessing schools in particular, and improvements in the transport planning process to ensure that the voices of the more marginalized transport users are equally heard.
Governments across Africa recognize the importance of ensuring urban mobility for all by improving the existing public transport systems and have called for World Bank’s assistance to do so in a growing number of cities. The hope is that the knowledge generated as part of this study will allow many more teams to more effectively support the realization of the equal rights to education and healthcare through well-targeted urban mobility investments and policies, and serve as an input in the broader policy dialogue with country governments on the role of physical connectivity as a key barrier for human capital accumulation.