At the World Bank Group (WBG)-International Monetary Fund Annual Meetings earlier this month in Bali, Indonesia, WBG President Dr. Jim Kim posed a critical question: “What will it take to promote economic growth and help lift people out of poverty everywhere in the world…How will they reach their ambitions in an increasingly complex world?”
For many of us who work in the health sector in Cambodia, the Universal Health Coverage Day in 2016 celebrates the beginning of a new journey. The recent launch of the Health Equity and Quality Improvement Project marked the beginning of a new phase in our journey to make Cambodia healthier and happier.
On a spring morning in 2016, Mrs. Dinh Thi Son of the Thai ethnic minority group brought her two month old baby to the Trung Son Hydropower Project construction site for medical services. Why go to a construction site? Because it has a health center that’s fully equipped with medical devices, well stocked with medicines, an ambulance, and doctors and nurses who provide healthcare services 24/7 for workers and local people alike.
It seems that everyone is talking about inequality these days, and I, for one, am happy to see this issue at the forefront in the development discussion.
We can look at inequality in a number of ways, which are not unrelated. One of the most visible types of inequality on the radar is inequality of outcomes — things like differences in academic achievements, career progression, earnings, etc. — which, in and of themselves, are not necessarily bad. Rewarding an individual’s effort, innate talents and superior life choices can provide incentives for innovation and entrepreneurship, and can help drive growth.
However, not all inequalities are “good.” When inequality perpetuates itself because those born poor consistently do not have access to the same opportunities as those born rich, what emerges is a deep structural inequality that is bad for poverty reduction, bad for economic growth, and bad for social cohesion. How pervasive are these deep inequalities? Much more than we would like. Indeed, when we examine what is happening in many countries around the world today, we find large and persistent, even growing, gaps in earnings between rich and poor. And we find that those who start out in poverty or are part of a disadvantaged group tend to remain there, with little opportunity to work their way out.
How do we explain this, and what can we do to tackle it? We need to take a step back and look at where this inequality originates, and that is where the concept of equality of opportunity comes in to play. This concept broadly refers to access to a basic set of services that are necessary, at the minimum, for a child to attain his or her human potential, regardless of the circumstances — such as gender, geographic region, ethnicity, and family background — into which he or she is born. Too often, access to such basic services like electricity, clean water, sanitation, health care and education is much lower among children born into circumstances that place them at a disadvantage. Children from disadvantaged groups thus set off on an unequal path from day one, which curbs their opportunities and potential into adulthood.
I’ve been struck recently by how little we (or at least I) seem to know about variations in use of health services across the world, and what drives them. Do people in, say, India or Mali use doctors “a lot” or “a little”. Even harder: do they “overuse” or “underuse” doctors? At least we could say whether doctor utilization rates in these countries are low or high compared to the rate for the developing world as a whole. But typically we don’t actually make such comparisons – we don’t have the numbers at our fingertips. Or at least I don’t.
I’m also struck by how strongly people feel about the factors that shape people’s use of services and what the consequences are. There are some who argue that the health problems in the developing world stem from people not getting care, and that people don’t get care because of shortages of doctors and infrastructure. There are others who argue that doctors are in fact quite plentiful – in principle; the problem is that in practice doctors are often absent from their clinic and people don’t get care at the right moment. There are others who argue that doctors are plentiful even in practice and people do get care; the problem is that the quality of the care is shockingly bad. Who’s right?
I was glad to read the announcement made by World Bank President, Dr. Jim Kim, at the start of this year’s UN General Assembly meetings, about the Bank’s projected financing support through the end of 2015 to help developing countries reach the Millennium Development Goals (MDGs) for women and children’s health. As we move toward the culmination of the MDGs in 2015 and beyond, preventing maternal and child deaths should be seen by all government delegations and their partners in the international development community as a clear yardstick to measure their commitment for creating more just and inclusive societies.
Given confusion around the phrase “science of delivery,” it’s important to state that delivery science is not a “one-size-fits-all” prescription based on the premise that what works somewhere can work anywhere. And it does not profess that research and evidence ensure a certain outcome.
A few weeks ago, the World Bank and the Korea Development Institute convened a global conference on the science of delivery. Several development institutions assembled including the Gates Foundation, the Grameen Foundation, UNICEF, the Dartmouth Center for Health Care Delivery Science, and the mHealth Alliance. We discussed development opportunities and challenges when focusing on the extremely poor, including experiments in health care, how technology is reducing costs and increasing effectiveness, and the difficulty of moving from successful pilots to delivery at scale.
The consensus in Seoul was that a science of delivery underscores the importance of a data-driven and rigorous process to understand what works, under what conditions, why, and how. Too often in international development, we jump to conclusions without understanding counterfactuals and assume we can replicate success without understanding its constituent elements.
- World Bank Institute
- health care
- mHealth Alliance
- Dartmouth Center for Health Care Delivery Science
- Grameen Foundation
- The Gates Foundation
- Korea Development Institute
- world bank
- Science of Delivery
- Private Sector Development
- Labor and Social Protection
- Climate Change
- Korea, Republic of
New approaches to medical care can improve health outcomes (Credit: World Bank, Flickr)
In many poor countries, a large proportion of health services is provided by the private sector, including services to the poor. However, the private sector is highly fragmented and the quality of services varies widely. Private health markets consist of providers with very diverse levels of qualification, ranging from formally trained doctors with medical degrees to informal practitioners without any formal medical training. According to Jishnu Das, in rural Madhya Pradesh— one of the poorest states in India, households can access on average 7.5 private providers, 0.6 public providers and 3.04 public paramedical staff. Of those identified as doctors, 65% had no formal medical training and of every 100 visits to healthcare providers, eight were to the public sector and 70 to untrained private sector providers.
MADRID -- One thousand days. That's all we have left to meet the Millennium Development Goals, a series of commitments to improve the lives of families in the developing world. I was just in Madrid to attend the United Nations' Chief Executives Board -- the heads of the UN agencies -- and we talked about the importance of setting targets to spur urgent action. Watch the video blog below to learn more.
In Sierra Leone's rainy season, the Sewa River, feared by many locals for its powerful currents, floods over its banks separating entire villages from basic services. Konta health clinic in Kenema district operates near the shores of the Sewa, and during the six-month rainy season, five of Konta’s 17 dependent villages cannot access the clinic. If women in those villages give birth during the rains, they entrust care to traditional birth attendants; if children fall ill, they turn to traditional medicine, stockpiled drugs, and, often, prayer. As one woman explained during a recent community meeting in Konta, these are the only options, even if the all-too-frequent consequence is death. Hearing her account, it’s difficult not to feel a strong sense of injustice, even in an incredibly resource-constrained country like Sierra Leone. But is there a role for the law in remedying this situation?