|welfare by increasing per capita investments in human capital in the form of education and health. In most of sub-Saharan Africa there has been an enormous expansion of public outlays for education. There is still a formidable challenge, however, to improve the quality of educational institutions at all levels.|
Much less has been done toward ensuring that rural areas have access to interlinked health and family planning activities. It is especially important in this instance to be concerned with a proper sequencing of the activities that receive priority. There are cogent reasons for assigning priority initially to activities such as immunization programs, oral rehydration therapy, and nutrition and hygiene education, all concentrated on infants and small children under five and their mothers. Those groups are especially vulnerable and the preventive and promotive technologies available are exceptionally cost-effective. Efforts to integrate different types of activities confront serious administrative problems, but the potential advantages appear to outweigh the drawbacks of linking health and family planning activities. There is a great deal of evidence which suggests that improving the prospects that infants and small children will survive to adulthood, together with parental awareness of those improved prospects, is probably the most important single determinant of the success of efforts to promote family planning. All of the other development priorities will be for naught unless the countries of sub-Saharan Africa begin to make substantial progress in slowing their population growth rates of 3 and even 4 percent.
In conclusion, if policy makers can reach a consensus on these six strategic priorities, then they can achieve structural transformation in an accelerated time period. They can also avoid, as Lele (this volume) has noted, the uncertainties resulting from cyclical shifts in priorities from food security issues to macroeconomic issues of "getting prices right," and back again to food security issues. They can help achieve that balance between governmental resources and responsibilities that is so crucial to growth of output, expansion of employment opportunities, and rural development.