In the face of budgetary limitations, constrained international aid, and competitive demands from different sectors, how can those of us working in the health sector make a strong case to finance ministers that public investments in health are as productive as public investments in, say, infrastructure or agriculture?
The poor cannot afford to pay money for health care so they use mainly free government-run health services. Isn't that what you were always told? So if donors want to help the poor they should give their money to governments that provide such services for the poor. I am sure you have read that in many books and articles.
Wait, let’s run that scene once more in real time. What actually happens out there in the real world? Often the government clinics described above have difficulty hiring staff, especially in poor rural areas. The majority of young health workers prefer to live in urban areas where they feel safer and can bring up their children with good schools, near family and friends. Long wait times and lack of medicines at government-run health facilities make the private health sector more attractive to consumers.
Depending on which country you live in, if you bought an airline ticket lately you may have saved a life without even knowing it. A number of countries have implemented a small airfare tax (also referred to as the “solidarity tax”) to raise funds to fight three of the world’s deadliest diseases: HIV/AIDS, Malaria, and Tuberculosis. In France, for example, air travelers pay an additional €1 in tax on domestic tickets and if in business class, €10. With aid falling, innovative finance mechanisms, such as microdonations, will be crucial in solving serious global problems. As quoted in a recent article in the Financial Times, Philippe Douste-Blazy, the man behind the airfare tax (also the former French Minister of Foreign Affairs), says that “certain sectors have benefited enormously from globalization: financial transactions, tourism and mobile phones. We need to tax an economic activity that’s only done by the rich, and tax it so lightly that nobody will notice.” He says the additional tax travelers pay is “absolutely painless!”
As the World Bank Group, we are dedicated to a world free of poverty. Poverty has many manifestations, of course, but few are sadder than child hunger and malnutrition. It is not just the heart-rending pangs of hunger or the susceptibility of a malnourished infant or child to ailments and diseases. The persistent effects are even more troubling. Poor nutrition impairs physical and mental development so that children benefit less from education and are less productive as adults. It leads to increased morbidity and mortality, causing output losses and increased spending on health and social support. Long ago William Blake wrote "some are born to endless night," poignantly capturing the tragedy of lives blighted by childhood deprivation.
If the extent of hungry children in the world – more than 350 million – is an inconvenient truth, their numbers in the South Asia region are acutely embarrassing.
Despite the volatility of Armenia’s economy in the twenty years since the country gained independence, effective government reforms led to double-digit growth rates from 2001 to 2007. That ended with the global financial crisis in 2008.
Since 1988, when the World Health Organization, Rotary International, CDC and UNICEF launched the Global Polio Eradication Initiative (GPEI) more than US$ 8.2 billion has been invested in polio immunization and surveillance. It’s an investment that has paid off: The number of polio cases worldwide decreased by more than 99%, from 350,000 in 1988 to less than 650 cases in 2011, while the number of polio endemic countries (those with ongoing domestic transmission of the virus) decreased from over 125 to just three: Afghanistan, Nigeria and Pakistan.
Malaria, a life threatening mosquito-borne infectious disease, poses a risk to approximately 3.3 billion people, approximately half of the world’s population. Most malaria cases occur in Sub-Saharan Africa, but they also occur in Asia, Latin America, and to a lesser extent the Middle East and parts of Europe. In 2010, malaria was found in 106 countries and territories, with an estimated 216 million cases and nearly 0.7 million deaths – mostly among children living in Africa. In addition to its health toll, malaria places a heavy economic burden on many countries with high disease rates, with estimates of as much as a 1.3 percent reduction in GDP in those countries.
As our sturdy Land Cruiser inched its way down a precipitous dirt track, trying to descend from a high ridge into the Rift Valley, I wondered what might happen if we had an accident here in the heart of Kenya’s remote Samburu County. Mobile signals had faded soon after we left the town of Maralal several hours before. We could have tried to walk back, but would have been very unlikely to make it before nightfall. Luckily, after a few mishaps and some serious jolting, we arrived at our destination in the valley—lonely Suyan manyata, whose distant circular outline we had seen from the ridge.
Talking to some of the women in the manyata, I realized that the ground that we had covered to get to them was nothing. We had done it in good health in a vehicle built for difficult terrain. As they told us what life was like in their village, my heart quailed at the thought of enduring a bumpy ride in a run-down van if one were pregnant or in labor with complications—if at all transport could be obtained. Just a few days ago, a child had died here of malaria, the women said. How did they usually get help, I asked. “We send our fastest runner 18 kilometers to the nearest dispensary,” said Ma Toraeli, a grandmother in the village. “From there someone comes to help us”. Health workers also visited the village from time to time, she said, to immunize babies and perform other routine checks.
Immunization seemed high on people’s minds in Samburu. Later that day, we visited Barsaloi, a larger village with its own government dispensary and another run by Catholic nuns. The two stood side by side, with a well-worn path between them. There I met another grandmother, Agnes, who had brought an infant girl, Salini, to be immunized, although her record showed that she was early and didn’t need this service yet. But while Stephen, the clinical officer at the government dispensary, was examining the baby and we were on the subject of immunization, the district head nurse showed us how vaccines were stored at the required temperature in the two-room government dispensary without power supply.
In my post “Should you trust a medical journal?” I think I might have been a bit unfair. Not on The Lancet, which I have since discovered, via comments on David Roodman’s blog, has something of a track record of publishing sensational but not exactly evidence-based social science articles, but rather on Ernst Spaan et al. for challenging the systematicness of their systematic review of health insurance impacts in developing countries. It’s not that I now think Spaan et al. did a wonderful job. It’s just that I think they probably shouldn’t have been singled out in the way they were.