Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents.

Investment in the capabilities of the world's 1·2 billion adolescents is vital to the UN's Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8-6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3-6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions-investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6-12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy.

Better Secondary Schooling Outcomes for Adolescents in Low- and Middle-Income Countries: Projections of Cost-Effective Approaches.

PURPOSE: The purpose of this article was to identify effective interventions to reduce secondary school dropout rates, increase the quality of learning in secondary schools in developing countries, and estimate the cost and educational impact of a sustained program to implement a selection of these interventions. METHODS: Dropout risk is analyzed by multivariable regression using micro-datasets for 44 developing countries for which Demographic and Health Surveys are available. The analysis of interventions accesses recent meta-analyses of educational interventions in developing countries. We incorporate these results into a model of progression in secondary school-by grade, age, and gender, augmented by learning measures and by a facility to allow interventions to reduce dropout rates and improve learning-to estimate the impact and cost of a package of interventions out to 2030. RESULTS: Poverty, female gender, and rural location are key risk factors for secondary school dropout. In terms of interventions, school proximity for rural students is critical. Better teaching both reduces dropout and improves learning, whereas instruction in the mother tongue improves also improves learning. Systematic implementation of nine interventions in the 44 countries,1 costing US$10.5 per capita per annum, would increase secondary completion rates by about 25% and more than double the index of learning achieved by 2030, with the effects being more pronounced in low-income countries. CONCLUSIONS: Powerful interventions are available to change the trajectory of schooling in developing countries but the costs are substantial, and a coordinated funding effort will be required.