Photo: Direct Relief, Flicker Creative Commons
The Kenyan government launched its national long-term development plan, Vision 2030, in 2008 with the aim of transforming Kenya into a newly-industrialised, middle-income country providing a high quality of life to all citizens by 2030, in a clean and secure environment.
Constructed around three key pillars – economic, social and political – the blueprint has been designed to address all aspects of the country’s infrastructure and economy, with a key component of the social pillar consisting of ambitious healthcare reforms. Ultimately, the government’s goal is to ensure continuous improvement of health systems and to expand access to quality and affordable healthcare to tackle the high incidence of non-communicable diseases that affect the region.
For those trying to address challenges in global poverty, inclusive businesses offer solutions to some of the world’s most intractable social problems. Business models that create value for the low-income communities are becoming viable - these have been tested, fine-tuned and perfected by some of the finest brains. Once perfected, it makes sense to contextualize and spread these innovations or the knowledge to markets across the globe. To be able to do this, replication is an important tool.
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.
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.
This blog post is co-authored with: Sheila Dutta
The 2012 World Development Report (WDR) “Gender Equality and Development” found that, while many disadvantages faced by women and girls have shrunk thanks to development, major gaps remain.
A significant gap is the excess female mortality in many low- and middle income countries, especially in childhood and during reproductive years. Cervical cancer —a preventable condition that usually results from a viral infection by the human papillomavirus (HPV) that is generally sexually transmitted— is one of the leading causes of premature death and ill health among women in sub-Saharan Africa. As the figure shows, the Eastern, Western and Southern African regions have the highest incidence rates of cervical cancer in the world. Rates exceed 50 per 100,000 populations and age-standardized mortality exceeds 40 per 100,000 populations.
Patricio Marquez’s post correctly identifies lack of access to quality medicines as one of the constraints to poor people’s health in Africa. But the solutions he recommends—more public money for “essential drugs benefits”, building resilient institutions, and providing physicians with better scientific information and guidelines about drug prescriptions—are unlikely by themselves to improve poor people’s health outcomes.
More public money. Patricio notes that out-of-pocket expenditures are about 40 percent of total health expenditures and most of this is spent on outpatient drugs. He assumes the reason is that countries have not adopted a program of essential drugs benefits, and the reason for the latter is lack of public resources. But consider the following facts.
Medicines are key inputs for quality medical care and the prevention of disease, and when administered appropriately, as evidence from Sub-Saharan African countries shows, they can contribute significantly to reducing death rates due to conditions such as HIV/AIDS, tuberculosis, and malaria.
But it is also obvious that not everybody in these countries, particularly the poor, enjoys this benefit, since limited access to essential drugs remains a key challenge in most health systems. High out-of-pocket expenditures, typically more than 40% of total health expenditures in some countries (a large portion for outpatient drugs), also place a heavy burden on poor families with chronically ill members who require daily drug intake.
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).
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.
Unlike other diseases in Africa (malaria, tuberculosis, intestinal worms, etc.), which mainly affect the young and the old, HIV/AIDS takes its toll on prime-age adults during the most productive years of their lives. The death of an adult family member can have large consequences for the surviving family. Given prevailing social norms in many African societies, the burden may likely be heaviest for women.
Most studies focus on the consequences for orphaned children – their schooling and health. We know less about how older adults are impacted. In our study, we track individuals and their households in northwest Tanzania, an area of high HIV prevalence in the 1990s, over a 13-year period.
We find that, when a family member dies, women (even old women) end up working more on the farm; men do too, but not as much. Having an asset such as goats enables them to work less.