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How and why do countries vary so much in their use of health services?

Adam Wagstaff's picture

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?

COP-19 and Forests – Why Big Progress on This Front, but Less on Others?

Jon Strand's picture

Last month’s global climate talks in Warsaw may be remembered mainly for progress on programs for Reduction of Emissions from Deforestation and Forest Degradation (REDD+), the UNFCCC mechanism for payments to reduce emissions from deforestation and forest degradation in low-income countries. Seven key decisions were agreed related to REDD+: on finance; reference levels; measuring, reporting and verification (MRV); safeguards; forest monitoring systems; institutional arrangements; and addressing drivers of deforestation. Additional funding of $280 million toward implementation of an extended REDD+ agenda was secured, coming mostly from Norway, but with contributions from the United Kingdom and the United States too.

Global forest losses in rainforest regions close to the Equator today represent close to 20% of net global greenhouse gas emissions, although the share has recently been falling slightly mainly due to less deforestation in Brazil. The target is now to reduce tropical countries’ forest losses to half by 2020, and eliminate such losses completely by 2030. It is encouraging that wider agreement seems to be forming on this issue.

Friday Round-up: Nelson Mandela, the power of Universal Health Coverage, the AIDS epidemic in 4 charts, gauging corruption, and grim climate trends

LTD Editors's picture

The week ended with the passing at age 95 of Nelson Mandela, father of South African democracy and a global icon for freedom. Read President Jacob Zuma's statement  as well as a statement from World Bank Group President Jim Yong Kim --

Universal health coverage was the topic of a December 6 speech by Jim Kim in Tokyo.

On the heels of World AIDS Day on December 1, Tariq Khokhar of the World Bank's Data Group provided a snapshot of the global state of AIDS in four charts.

Do our minds play tricks on us?

Karla Hoff's picture

The following post is the first in a series exploring 'mind and culture: pathways to economic development,' the theme of the World Bank's upcoming World Development Report 2015.

Try to guess the answer to the question:

How many seven -letter words of which the sixth letter is “N” (_ _ _ _ _ N _) would you expect to find in four pages of a novel in English (about 2,000 words)? 

Now guess the answer to another question:

How many seven-letter words of which the last three letters are “ING” (_ _ _ _ ING) would you expect to find in the same four pages? 

If you are responding as most people have, then your estimate is several times greater for ING words than for _N_ words.  This violates logic. With some reflection, it’s easy to see that every ____ING  word is also an _____N_ word.  The mistake is famous and so is its explanation.    _ING words are a standard category, _N_ words are not, and standard categories shape how we think.  We confuse what it is easy to think of with what is frequent. This bias, called the availability bias, is just one of a multitude of biases that appear to be universal.

Poverty reduction at the forefront of development

Punam Chuhan-Pole's picture

The Millennium Development Goals (MDGs) put the fight against poverty at the center of the international development agenda.  And progress has been noteworthy - so much so that it is now fueling more ambitious goals on poverty reduction. But this also brings new demands for better data to measure progress.

 UN Secretary General Ban Ki-moon recently called the MDGs “the most successful global anti-poverty push in history.” With their mutually reinforcing linkages, they committed the world to reducing extreme poverty to historically low levels, while also improving education, health, nutrition, and other development prospects for hundreds of millions of the world’s poorest people. There is no doubt that since their announcement in 2000, the MDGs have raised the profile of poverty reduction in national development strategies, aid discussions and allocation, and the international development discourse. Systematic cross-country monitoring of simple to understand targets proved to be an effective tool in raising this profile.

What exactly is the public-private mix in health care?

Adam Wagstaff's picture

I’ve been in quite a few meetings recently and read quite a lot of documents where people have made claims about the relative sizes of the public and private sectors in health care delivery. A recent report from the World Bank Group on the private sector in Africa claims that “the private health sector now provides half of all health services in the region.” A document I reviewed recently claimed that “much” of medical care is provided by the private sector – an assertion I hear quite often.

As far as I can make out, the data underlying such claims reflect a very partial picture. The Africa data are from the Demographic Health Survey which captures only treatment for (outpatient) maternal and child health services (MCH); it also covers only the developing world, and only the poorer part of it. Some claims reflect data for just one country. I’ve heard a lot about India, but these data (obviously) cover just India, and only outpatient visits.

Shared Prosperity, Poverty Mitigation and the Art of Reasoning

Kaushik Basu's picture

The growth v. inequality debate attracts such widespread participation because, at entry level, it makes such minimal demands on the human intellect. But the debate can be conducted at many levels, leading us into some intricate and indeed treacherous terrain. The newly-declared goals of the World Bank Group—to end extreme poverty in the world by 2030 and to promote shared prosperity in all societies—take the Bank into this disputed terrain and compel it to join in this important policy debate. I have just published a paper to elaborate on the meaning of these goals, examine their strengths and weaknesses, and to initiate a discussion of what kinds of policies these goals push us towards.

Poverty and Disasters—Why resilience matters

Jun Erik Rentschler's picture
Family whose home floods every year. Colombia | Photo: © Scott Wallace / World Bank
Family whose home floods every year. Colombia
Photo: © Scott Wallace / World Bank

It is an alarming trend: extreme weather events and disasters recorded around the globe are increasing in frequency, and in the magnitude of overall economic losses they cause. The recent devastation left by Taiphoon Haiyan in the Philippines is a tragic reminder that many countries around the world continue to be highly vulnerable to natural hazards. While low- and high-income countries alike experience extreme natural events, it is particularly in lower income countries where such events result in economic and humanitarian disasters.

However, the statistics on casualties and economic losses reported in the media fail to give us the full picture of a much more complex, extensive, and prolonged tragedy — which is mainly experienced bythe poorest.

Reflections from the WDR road show

Rasmus Heltberg's picture

Since the WDR 2014 launched in early October, members of the WDR team have been travelling to many cities in different countries to present the Report. These trips are colloquially known as the "road show"—a grossly misleading term since travel is mostly by air and the events are more characterized by discussion among professionals than by show-bizz.

I would like to take the time to reflect on what I have been hearing at three very interesting and well-attended events held recently at the Institute for the Study of International Development at McGill University in Montreal, United Nations  in Geneva, and at the Independent Evaluation Group (IEG), World Bank, Washington D.C. (full disclosure: I work there now).

​Friday Round up: USAID on ending poverty, Helping after Haiyan, Reforms in China, debate on liquidity traps

LTD Editors's picture
'Ending Extreme Poverty' was the focus of an impassioned, thoughtful speech by USAID Administrator Rajiv Shah on November 21 at the Brookings Institution. Related to that, Laurence Chandy draws heavily on World Bank estimates to make his own interactive analysis of what it will take to end poverty by 2030.