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.
نقدم لكم مقالة أخرى في سلسلة المقالات التي نقوم بنشرها عن الريادة المجتمعية والمؤسسات الاجتماعية التى تساهم فى تقديم حلول مبتكرة وشاملة لقضايا وتحديات تنموية هامة في مصر. لقد تحدثت زميلتنا جيل ريتشمند مع الدكتورة ليلى اسكندر رئيسة مجلس إدارة شركة CID للاستشارات ، والتي حازت على جائزة "رواد العمل الاجتماعي للعام" في عام 2006 ، التي تقدمها مؤسسة شواب من خلال المنتدى الاقتصادي العالمي. كما أنها أيضا عضو في مجلس الأجندة العالمية (GAC) للابتكار الاجتماعي ، وتتمتع بخبرة أكثر من 20 عاما فى مجال حماية البيئة وإدارة النفايات الصلبة وإعادة التدوير، بالإضافة إلى التعليم، وتمكين النوع الاجتماعى، وبناء قدرات المنظمات غير الحكومية، وتوليد الدخل في القطاع غير الرسمي، والدفاع عن حقوق الأطفال العاملين. في هذه المقابلة، تحدثنا الدكتورة ليلى عن مفهومها عن "التعلم والكسب" والعمل فى تنمية المجتمع بشكل عام بما فى ذلك دعم قطاع الحرف اليدوية والذى يعتبر من القطاعات الهامة التى سيدعمها برنامج سوق التنمية المزمع إطلاقه بمصر فى أوائل نوفمبر 2012.
Here is another entry in a series of articles we are posting to describe the current outlook for social enterprises working on critical issues in Egypt.
The series is based on interviews with leading figures in the social entrepreneurship sector in Egypt and the MNA region.
For the Arabic translation of this blog, click here.
I spoke with Dr. Laila Iskandar the chairperson of CID Consulting, who was awarded the "Social Entrepreneur of the Year" in 2006 at the World Economic Forum by the Schwab Foundation. She is also member of the foundation’s Global Agenda Council (GAC) on Social Innovation. She has over 20 years of experience in: environmental protection, solid waste management and recycling, education, gender-based empowerment, capacity-building of non-governmental organizations (NGOs), income-generation in the informal sector, and advocating for working children. In this interview, she tells us about her ethos of ‘learning and earning.’
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.
Let's think together: Every week the World Bank team in Tanzania wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a couple of questions. This post is also published in the Tanzanian newspaper The Citizen every Sunday.
Tanzania has experienced an exceptionally high population growth – from 11 million in 1963 to over 45 million in 2012. Among the factors that have contributed to this increase –one of the fastest in the world– is the falling mortality rate. Life expectancy in Tanzania has increased over the past two decades from 50 to 58 years.
In addition, Tanzanian women have continued to have many children (5.4 per woman in 2010), which is higher than Kenya and Rwanda (4.6) as well as other sub-Saharan countries with the exception of Uganda.
Since 1991, this rate has only declined by 13 percent in Tanzania against 26 and 31 percent in Rwanda and Kenya, respectively. Several other factors have also contributed to the high population growth rate that Tanzania is experiencing:
Let's think together: Every week the World Bank team in Tanzania wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a couple of questions. This post is also published in the Tanzanian newspaper The Citizen every Sunday.
There is no doubt about the importance of water to human existence. People need clean water to survive and stay healthy. Lack of clean water contributes to the high mortality rates in children around the world. Water is also critical to a country’s development as it is needed not only for agricultural productivity but also for industrial production. Yet access to water remains a major challenge in many countries. Tanzania has been blessed, both on the surface and below ground, with three times more renewable water resources than Kenya and 37 per cent more than Uganda.
Despite the vast amounts of fresh water available, many Tanzanians are still faced with water shortages due to insufficient capacity to access and store it both in rural and urban areas. Few households have access to clean drinking water from a piped source. Only a small fraction of rural households can access water to irrigate their farms. The following statistics illustrate the magnitude of the problem:
Looking at communities across our planet, there is a brutal lack of resilience in our modern lives. Cities have expanded without careful planning into flood- and storm-prone areas, destroying natural storm barriers and often leaving the poor to find shelter in the most vulnerable spots. Droughts, made more frequent by climate change, have taken a toll on crops, creating food shortages.
In the past 30 years, disasters have killed over 2.3 million people, about the population of Houston or all of Namibia.
As a fan of numerology, let me focus on a special number that captures a global trend: call it the lucky number seven. Since the end of last year, we are seven billion people in the world. We produce a total GDP of US$70 trillion (which means that globally per-capita income is US$10,000 on average) and the average life expectancy worldwide is--you guessed it--70 years.
Let’s extend the seven thread: if the world economy grew at seven percent per year, it would double within a decade (because ten years of seven percent growth don’t amount to 70, but 99 percent, due to the compounding effect). Now with population growth at one percent (thankfully not seven), average per capita incomes would increase from US$10,000 to about 18,000. That is quite a jump, and a level of prosperity that few of our parents and grand-parents would never have imagined.
Sadly though, averages will continue to mask wide disparities, both between countries and within societies.
A new report released today by UNICEF, the World Health Organization and the World Bank shares the news that the number of children around the world who grow up stunted has decreased by 35% since 1990, from an estimated 253 million to 165 million in 2011. Although the news of the reduction is positive, the number remains one of tragic proportion. One hundred and sixty-five million children around the world will still grow up stunted and will not reach their full potential in life. Maternal and early childhood nutrition and education are the best investments we can make to help children thrive, learn, and grow up to lead healthy, productive lives.
Let's think together:Every week the World Bank team in Tanzania wants to stimulate an evidence-based debate by sharing data from recent official surveys and ask you a few questions. These posts are also published in the Tanzanian newspaper The Citizen every Sunday.
Tanzanian families have been doing things differently of late. More of them have been sending their daughters to primary school and more women have become heads of families with increasing financial responsibilities. Increasingly too, more women are involved in the political arena today. These trends can also be found in most countries in the world but they are especially visible in Tanzania as reflected by the following statistics.