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Health

How can we improve access and get more value from drug expenditures in Africa?

Patricio V. Marquez's picture

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.

Can Tanzania afford 100 million citizens in 2035?

Kristoffer Welsien's picture

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:

Tanzania: Water is life, but access remains a problem

Jacques Morisset's picture

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:

“Seven” is the world’s defining number: what does it mean for Kenya?

Wolfgang Fengler's picture

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.

Is this a woman's world? Gender equality in Tanzania

Waly Wane's picture

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.

Country policy and institutional assessment: How well are African countries doing?

Punam Chuhan-Pole's picture

Every year, the World Bank’s country teams and sector experts assess the quality of IDA countries’ policy and institutional framework across 16 dimensions to measure their strenght and track progess.  

The latest country policy and institutional assessment (CPIA) results show that despite difficult global economic conditions, the quality of policies and institutions in a majority of Sub-Saharan African countries remained stable or improved in 2011.

DOWNLOAD the indicators here: www.worldbank.org/Africa/CPIA

For several countries the policy environment is the best in recent years. Of the 38 African countries with CPIA scores, 13 saw an improvement in the 2011 overall score by at least 0.1. Twenty countries saw no change, and five witnessed a decline of 0.1 or more. The overall CPIA score for the region was unchanged at 3.2.  

In short, despite a challenging global economic environment, African countries continued to pursue policies aligned with growth and poverty reduction. 

Kenya’s education dividend

Wolfgang Fengler's picture

Despite positive news and the talk of an African “renaissance,” many still doubt whether the continent is ready for take-off. Rapid population growth and the resulting “youth bulge” remain major concerns in a context of widespread un(der)employment. How can a country like Kenya create one million jobs each year, just to accommodate new entrants into the labor force? 

 

But young people don’t just need jobs, they also create them. Therefore, what matters most is to make sure that the education system delivers the skills needed in emerging economies, and incubates entrepreneurs. In turn, as people become more educated and healthier, they will have fewer children. This is already happening: As Kenya continues to welcome about a million new citizens each year, family size is slowly declining. 

Ending the Communicable and Non-communicable Disease Divide in Africa

Patricio V. Marquez's picture

Co-authored with Jill Farrington

The 2011 UN Summit on Non-communicable Diseases (NCDs) elevated the importance of NCDs as a pressing global health challenge.  While this recognition was long overdue, are we at risk of establishing a new vertical program, in direct competition for scarce funding with existing communicable diseases control programs and health system strengthening initiatives?

 

If we pay close attention to available evidence, that should not be the case.  The health situation in sub-Saharan Africa nicely illustrates this point, as we have learned from an extensive review of the literature.

 

While the focus in this region has been on communicable diseases and maternal, perinatal and nutritional causes of morbidity and mortality, less attention has been paid to the extent to which these conditions contribute to the growing NCD burden and to potential common intervention strategies. Indeed the biggest increase in NCD deaths globally in the next decade is expected in Africa, where they are likely to become the leading cause of death by 2030. 

Slums dwellers need opportunities not hand-outs

Wolfgang Fengler's picture

The International School of Kenya just hosted its last football tournament of the year. Teams from Nairobi’s poor neighborhoods dominated the event. Rain was pouring and many of the players were playing barefoot, but they still thrived, outperforming many teams from schools where the rich take their children.

In the 10-11 age group, the top three places went to teams from destitute neighborhoods, including Kibera, which some people have (wrongly) dubbed as the world’s largest slum. Kibera Sports Academy stood at the top of the podium, while second and third places went to Inspiration Kenya and Peace Academy respectively. 

Many people, including Kenyans, consider slums the epitome of misery. The common wisdom is they breed disease, crime and many other forms and manifestations of poverty. Why then are slums growing bigger, with people migrating to them in ever increasing numbers?

Do small countries do it better?

Apurva Sanghi's picture

In development circles, people talk about “countries that are too big to fail and too small to succeed”.  The jury may be out on the former but a new book by Shahid Yusuf and Kaoru Nabeshima, “Some Small Countries Do It Better” dispels the notion that countries can be too small to succeed.

Three small countries studied in the book - SIFIRE (SIngapore, FInland, IREland) – not only grew at high rates but were able to sustain them.

The book – which concludes with a section on implications for African countries – contends that growth recipes for SIFIRE were not tightly bound to the East Asian model of extremely high rates of savings and investment (although arguably, Singapore was in many ways the epitome of that model, thanks to its mandatory savings scheme which led to gross national savings in the neighborhood of 50 percent for decades).

The larger point is that these three countries augmented physical investment with healthy doses human capital and knowledge; by “opening their windows and letting it [knowledge in various forms, for example, that embodied in FDI] stream in”. And even though the book does not explicitly discuss it, they did so without massive infusions of foreign aid. Or perhaps it was the lack of aid that forced them to be nimble, agile, and forward-looking?

What precisely did SIFIRE get right? 

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