Improving adult health increases children’s schooling - evidence from Zambia

Both health and education are essential for reducing poverty. Unfortunately, the two are often interlinked and in many countries both are severely lacking. In a recent study of HIV/AIDS treatment in Zambia presented at the UNU-WIDER Human Capital and Growth conference, Nicholas Wilson, Margaret Chidothe, and I found an important positive link between improved adult health and children’s schooling outcomes.

As treatment for HIV/AIDS expanded across Zambia during 2004-07, children in households lead by a HIV positive adult were more likely to start school at the correct age and more likely to be the correct age for their grade, (i.e., not repeat grades or fall behind) than children in households without access to HIV treatment.

This is tremendously good news for the southern cone of Africa—the 10-nation region stretching from Angola to South Africa—where more than 10% of adults of prime working age are HIV positive, and where 20% of children live with an HIV-positive adult. Our study clearly shows that with treatment, the multigenerational effects of HIV can be lessened.

HIV/AIDS - You’re either infected with it or affected by it

Sadly, the above is a true statement in the southern cone of Africa. With large numbers of HIV-positive adults and many children living in their households, the effects of HIV reach beyond those infected. Specifically for children, ill health of other household members impedes their educational access and attainment. Since HIV leads to AIDS, debilitation, and then death if untreated, many children’s schooling levels in Zambia before 2004 were lowered by adult HIV/AIDS infections.

Since 2004 the internationally funded public health response in Zambia to HIV/AIDS has been to provide free antiretroviral therapy (ART) to those already infected and to try and prevent additional infections. We know from epidemiological studies based on small clinic populations that adherence to this prescribed therapy regime can reverse or prevent the debilitating effects of AIDS and lengthen life expectancy.

Zambia's antiretroviral programme boosted children’s schooling outcomes

In 2004 a model providing access to ART that had previously worked in clinics was scaled up radically in Zambia.

We find that the program substantially improved children’s outcomes in primary school (grades 1-7 in Zambia):

  • children were more likely to enroll on time
  • children were more likely to be the correct age for their grade, combining both on time enrollment and a decrease in grade repetition.

These outcomes are important as children who are above age for their grade are more likely to drop out in upper-primary school. Furthermore older girls are especially susceptible to this. We have suggestive evidence that the decrease in grade repetition is likely caused by increased attendance, due to children’s improved health, a reduction in their care-giving duties, and improved focus while in school.

Children’s schooling outcomes can be improved with interventions at home

Our work has two policy implications. First, the subsidized distribution of antiretroviral therapy has been successful at both increasing adult health and improving schooling outcomes for the children living with HIV positive adults. This second part is not usually included when doing cost-benefit or cost-effectiveness analysis of large health programmess. As donors and governments weigh up health-funding priorities, benefits that extend beyond those specifically treated should be considered.

Second, when policies to increase children’s schooling outcomes are considered, the focus is typically on school-based interventions, yet we showed that household health can be another substantial barrier to children’s schooling and should be considered in a holistic approach to improving children’s schooling outcomes.

Adrienne Lucas is an Associate Professor of Economics and a Faculty Research Fellow at the National Bureau of Economic Research (NBER).