Health

Bed Nets, Drugs and a Finger Prick of Blood – Tanzania's Fight Against Malaria.

Sleeping under protective net With an estimated 10 million malaria cases in 2010, the World Health Organization considers Tanzania to be one of the four countries with the highest malaria prevalence in Africa, along with Nigeria, DRC and Uganda. And yet there are signs that efforts to fight the disease are bearing fruit:

- Data from Rapid Diagnostic Tests shows that malaria prevalence in children aged 6 months to 5 years fell by half from 18 per cent in 2007/08 to 9 per cent in 2011/12.
- Reported malaria deaths declined from around 20,000 per year in 2004-06 to below 12,000 in 2011. While there is a possibility that the malaria deaths are underreported, the trend signals substantial improvement.

Co-authored with Luc Christiaensen and Aly Sanoh

For a decade and a half now, Africa has been growing robustly, and the region’s economic prospects remain good. In per capita terms, GDP has expanded at 2.4 percent per year, good for an average increase in GDP per capita of 50 percent since 1996.

But the averages also hide a substantial degree of variation. For example, GDP per capita in resource-rich countries grew 2.2 times faster during 1996-2011 than in resource-poor countries (Figure 1). Though not the only factor explaining improved performance—fast growth has also been recorded in a number of resource-poor countries such as Rwanda, Ethiopia and Mozambique (before its resource discoveries)—buoyant commodity prices and the expansion of mineral resource exploitation have undoubtedly played an important role in spurring growth in several of Africa’s countries. Even more, with only an expected 4 or 5 countries on the African continent without mineral exploitation by 2020, they will continue to do so in the future. Yet, despite the better growth performance, poverty declined substantially less in resource-rich countries.

What will the world look like in 2030? Clearly, it will be very different from today and some of these changes can already be anticipated. Most of us can remember the year 1996 which is as far back in the past as 2030 is forward in the future. Today’s emerging trends will shape the world over the next two decades.

Every five years, the US’s National Intelligence Council publishes its analysis of “Global Trends”. This time, the analysis looks forward to 2030 and highlights four “megatrends” all of which will probably feel quite intuitive to people living in Africa.

If user fees for health have been so vilified (including in comments on this blog), why are we bringing the subject up again? Because new evidence calls into question the prevailing view, namely that removing user fees leads to: (i) increased use of health services and hence to (ii) improved health outcomes. Confirming (i), the recent literature shows that (ii) does not always follow.

Principles

Raising the price of a good or service has two effects: it reduces demand and increases supply. In the case of user fees for health, it was thought that paying for a service also makes people use it more appropriately (you don’t go to the doctor for minor ailments) and value it more than if they obtained it for free.

A common belief in rich countries is that people in Africa are poor but happy. This image is time and again confirmed by popular reality shows on Western television, in which the rich-and-famous visit little-known tribes in the most remote villages of rural Africa, only to concede, in front of a dozen cameras, that despite all their hardship, the people they visited really seemed happier than the average burnt-out desk-warrior in their home countries.

Are the poor in Africa really happier? In recent years economists started focusing on happiness and its measurement, a field long considered too trivial to pay much attention to. Recent research on the topic gives conflicting, and sometimes surprising, results. In 2012, an Ipsos poll measuring the degree of happiness in 24 countries found that self-reported levels of happiness were higher in poor and middle-income countries than in rich ones, seemingly confirming popular beliefs. In contrast, the first World Happiness Report, also published in 2012, finds that the rich countries in Scandinavia are the happiest on earth, while four poor Sub-Saharan African countries are at the bottom of the list. The Gross National Happiness (GNH) index, pioneered by the Kingdom of Bhutan, comes up with a number of surprises of its own: the GNH is highest among the young and the unemployed (and also-perhaps less surprising-among the unmarried), which seems at odds with today’s television images of the streets of Madrid and Athens.

Let's think together: Every Sunday the World Bank in Tanzania in collaboration with The Citizen wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a few questions.

Tanzania is ranked the second lowest in terms of access to improved sanitation worldwide out of 171 countries that reported statistics for 2010. The details read as follows:
- Only 1 in 10 Tanzanians has access to an improved sanitation facility, such as a flush toilet connected to a sewage system or septic tank or a covered pit latrine not shared with other households.
- The above access to improved sanitation for Tanzania is well below the average for sub-Saharan Africa (31 percent), and also much lower than in Kenya (32 per cent), Uganda (34 per cent) and Malawi (51 per cent).
- Urban residents are three times more likely to use an improved toilet facility than their rural counterparts (20 per cent vs. 7 per cent).
- A staggering 5.4 million Tanzanians do not have access to any toilet facility, and answer nature’s call in the open. This burden falls most heavily on the poorest quintile.

The mobile phone is a truly novel device. It comes in just as handy and as easily when we need to communicate about the serious things as to chat about the simpler things in life. Mobiles are not only being used as radios and flashlights but they are also delivering banking and financial services to those who urgently need them.

Increasingly, people around the world, especially in Africa, are paying their school fees, healthcare and utility bills using mobile phones today. Businesses use mobile money phones to pay their staff and suppliers. Poor people who have never entered a bank are using mobile services to send or receive remittances and to save their money.

“So how are you enjoying living in paradise?” Michael Geerts, the former German ambassador to Kenya asked me the other day. He was posted in Nairobi during the difficult years in the end of the 1990s, and continues to stay in touch with a country he loves dearly. Many colleagues, who once worked in Kenya have bought houses in Nairobi, and plan to retire in the “city under the sun”. But not everybody shares their passion and faith in the country’s future. There are many pessimists who feel that the country is moving in the wrong direction. Kenya, they say, will never rid itself from grand corruption, and crime such as drug trafficking will continue to flourish.

Are they seeing the same country? Maybe both perspectives are right, because Kenya is a country of extremes.

The data are un-ambiguous: Kenya’s economy is starting to catch up with the rest of the world. But many of you probably wonder if that is really true, especially when observing the streets of Nairobi or the daily life in rural areas. In other words, is economic catch-up translating into social progress? Will today’s children live a better life than their parents? Will everyone enjoy decent social and infrastructure services in the new Kenya? Let’s zoom in on the case of health.

How healthy is Kenya today? Simply said, it could do better. This is important from an economic standpoint, because a population’s health is a key foundation for development. Healthy populations are more productive; they also save and invest more. On average and all other things equal, one extra year of life-expectancy is associated with an increase in a country’s GDP by 4 percent.

From almost every point of view, Rwanda’s performance over the past decade has been an unambiguous success story.

Between 2001 and 2011, Rwanda’s economy grew by 8.2 percent per annum, earning the country a spot on the list of the ten fastest growing countries in the world. Poverty rates fell by 14 percentage points, effectively lifting more than one million Rwandans out of poverty. Social indicators followed the general trend: Net enrolment in primary school increased to almost 100 percent, completion rates tripled, and child mortality decreased more than threefold, hitting the mark oftwo-thirds reduction as targeted by the Millennium Development Goals.

Yet buried under all this good news lays another maybe even more important evolution. After a decade-and-a-half stall, total fertility rates in Rwanda dropped from 6.1 in 2005 to 4.6 in 2010. This means that during a period of five years, the average number of children a woman of childbearing age can expect to have, has declined by 1.5.

Health

Bed Nets, Drugs and a Finger Prick of Blood – Tanzania's Fight Against Malaria.

Making the most of Africa’s growth momentum

2030: Global shifts and Kenya's transformation

User fees and abuser fees

Poor but happy?

Toilets missing in action

A bank in your pocket: The mobile money revolution in Tanzania

To succeed, Kenya only needs to look within

Punished twice: Kenya’s dual health burden

Is Rwanda Set to Reap the Demographic Dividend?

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