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Health

Ending the Communicable and Non-communicable Disease Divide in Africa

Patricio V. Marquez's picture

Co-authored with Jill Farrington

The 2011 UN Summit on Non-communicable Diseases (NCDs) elevated the importance of NCDs as a pressing global health challenge.  While this recognition was long overdue, are we at risk of establishing a new vertical program, in direct competition for scarce funding with existing communicable diseases control programs and health system strengthening initiatives?

 

If we pay close attention to available evidence, that should not be the case.  The health situation in sub-Saharan Africa nicely illustrates this point, as we have learned from an extensive review of the literature.

 

While the focus in this region has been on communicable diseases and maternal, perinatal and nutritional causes of morbidity and mortality, less attention has been paid to the extent to which these conditions contribute to the growing NCD burden and to potential common intervention strategies. Indeed the biggest increase in NCD deaths globally in the next decade is expected in Africa, where they are likely to become the leading cause of death by 2030. 

Slums dwellers need opportunities not hand-outs

Wolfgang Fengler's picture

The International School of Kenya just hosted its last football tournament of the year. Teams from Nairobi’s poor neighborhoods dominated the event. Rain was pouring and many of the players were playing barefoot, but they still thrived, outperforming many teams from schools where the rich take their children.

In the 10-11 age group, the top three places went to teams from destitute neighborhoods, including Kibera, which some people have (wrongly) dubbed as the world’s largest slum. Kibera Sports Academy stood at the top of the podium, while second and third places went to Inspiration Kenya and Peace Academy respectively. 

Many people, including Kenyans, consider slums the epitome of misery. The common wisdom is they breed disease, crime and many other forms and manifestations of poverty. Why then are slums growing bigger, with people migrating to them in ever increasing numbers?

Do small countries do it better?

Apurva Sanghi's picture

In development circles, people talk about “countries that are too big to fail and too small to succeed”.  The jury may be out on the former but a new book by Shahid Yusuf and Kaoru Nabeshima, “Some Small Countries Do It Better” dispels the notion that countries can be too small to succeed.

Three small countries studied in the book - SIFIRE (SIngapore, FInland, IREland) – not only grew at high rates but were able to sustain them.

The book – which concludes with a section on implications for African countries – contends that growth recipes for SIFIRE were not tightly bound to the East Asian model of extremely high rates of savings and investment (although arguably, Singapore was in many ways the epitome of that model, thanks to its mandatory savings scheme which led to gross national savings in the neighborhood of 50 percent for decades).

The larger point is that these three countries augmented physical investment with healthy doses human capital and knowledge; by “opening their windows and letting it [knowledge in various forms, for example, that embodied in FDI] stream in”. And even though the book does not explicitly discuss it, they did so without massive infusions of foreign aid. Or perhaps it was the lack of aid that forced them to be nimble, agile, and forward-looking?

What precisely did SIFIRE get right? 

Thou shall not die: Reducing maternal deaths in sub-Sahara Africa

Patricio V. Marquez's picture

Mother and child in South Sudan There is growing optimism in the development community that the dawn of the “African Century” may be upon us.  The reasons for this optimism are real.  Over the last decade, six of the world's 10 fastest-growing economies were in Africa, and substantial political and social progress has been achieved.  

But I would say that the potential for this development may be undermined if the everyday tragedy of preventable maternal deaths continues unabated across the continent. 

 

The recently-released report “Trends in Maternal Mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates” paints a dramatic picture. Overall, close to 60% of global maternal deaths occur in sub-Saharan Africa, and at 500 maternal deaths per 100,000 live births, the region has the highest maternal mortality ratio (MMR) in the world, well above Southern Asia (220), Oceania (200), South-eastern Asia (150), and Latin America and the Caribbean (80).

Africa's success story: Infant mortality down

Gabriel Demombynes's picture

There is a tremendous success story in Sub-Saharan Africa that has only barely been recognized. Infant and under-5 mortality has plummeted in many countries in the region in recent years.

The under-5 mortality (U5MR) measure captures the number of children per 1000 live births who die before their 5th birthday. One of the Millennium Development Goals is a two-thirds decline in U5MR between 1990 and 2015, which would require an annual decline of 4.4 percent per year.

 

In the 20 countries for which recent data is available, 12 show rates of decline above this “MDG rate.” In particular, Senegal, Rwanda, Kenya, Uganda, and Ghana have experienced extremely large drops at a rate of more than 6 percent per year. This does not necessarily indicate that any particular country will meet the MDG. But it does tell us that the African Renaissance is bringing tangible benefits to the continent’s citizens. Because of this miracle, hundreds of thousands of parents will be spared the agony of the loss of a child.

Five reasons why Kenya and Africa should take off

Wolfgang Fengler's picture

A week hardly goes-by without one or more international investors announcingmajor investment interests in Nairobi, or other African capital cities.

Nokia, Nestle, and IBM are some of the companies which intend to position themselves more strongly in (East) Africa. True, their investments may still be low by international standards, but they are increasingly becoming noticeable. 

On a macroeconomic level, the new Africa momentum has also been evident. Africa has weathered both the global financial crisis, and the turbulence in the Euro zone. According to World Bank’s latest economic outlook, Sub-Saharan Africa is projected to grow above 5 percent in 2012 and 2013. This would be higher than the average of developing countries (excluding China), and substantially, above growth in high-income countries. This means that at some point in this decade, Africa could grow above the levels of Asia.  A few years ago, it would not have been possible for economic observers to consider such a scenario.  Once Africa becomes the fastest growing continent in the world; this will also be the true turning point for Africa’s global perception.

Big shifts and what they mean for Africa and Kenya

Wolfgang Fengler's picture

Can Africa claim the 21st century? When the World Bank’s Africa department published this book in April 2000, most observers were doubtful that African countries would ever be in a position to become emerging markets. That year, The Economist called Africa “The hopeless continent” and global attention was focused mainly on Africa’s problems: HIV/Aids in Southern Africa; the relentless war in Somalia; and, droughts in the Sahel—which gave the pessimists plenty of ammunition. 

But over the last several years, something remarkable has happened: Africa’s fragile and conflict-affected countries remain a major development challenge, but besides these, a Stable Africa has emerged. Most of this Stable Africa has experienced continued high growth for a decade, and major improvements in social indicators. Africa is becoming an investment destination, and there is hardly a week which goes by without a major investor dropping by my office, to discuss the region’s economic fundamentals.

How has Africa changed over the last decades?

Rewarding safe sex

Damien de Walque's picture

Prevention strategies have had limited impact on the trajectory of the HIV/AIDS epidemic. New, innovative approaches to behavioral change are needed to stem the epidemic.

In a joint effort with many colleagues, and in collaboration with the Ifakara Health Institute in Tanzania and, the University of California at Berkeley, we launched a study with the acronym RESPECT (“Rewarding STI Prevention and Control in Tanzania”).

We started with an observation:  Conditional cash transfers (CCTs) have been used successfully to promote activities that are beneficial to the participants such as school attendance  and health check-ups for children.  The Tanzanian experiment asks whether CCTs can be used to prevent people from engaging in activities that are harmful to themselves and others, such as unsafe sex. This is a controversial idea.

Africa is rising - is poverty falling?

Shanta Devarajan's picture

Several people, from The Economist to this blog, have been highlighting Africa's accelerated GDP growth of about 5 percent a year for the decade before the 2008-9 global economic crisis, and the two years since the crisis. But has this growth served to reduce poverty?

The latest globally consistent estimate of poverty rates has an answer: Yes. 

Using the measure of people living on $1.25 a day or less, the World Bank's poverty measurement team, led by my colleague Martin Ravallion, estimates that the percentage of poor Africans fell from 58 percent in 1999 to 47.5 percent in 2008.  This rate of decline of about one percentage point a year is a welcome change from the previous decade when growth was much slower and the poverty rate increased. 

Tanzania’s Steep Learning Curve

Stevan Lee's picture

Tanzania has shown massive achievements in education – well known progress in primary enrolment plus less well known, but in some ways even more spectacular, growth in post-primary education. 

Yet, Tanzania needs to improve learning outcomes if a virtuous cycle of growth and human capital investment is to be sustained. This is “The Steep Learning Curve” which Tanzania needs to get onto with modest fiscal resources but a rapidly growing number of new students, and therefore with a keen eye for value. This should be possible.

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