With funds devoted to HIV/AIDS declining, there has not been a better time, at least in the past decade or so, to optimize the use of the limited resources between treatment and prevention.
In the rough, mountainous terrain of Himachal Pradesh, farmers found it difficult to carry their produce to the nearest road for transportation to city markets. Village children had to undertake long and arduous walks to school, and medical help was hard to reach. Faced with few opportunities, young men left their villages to look for for jobs in distant towns.
It took 41 years for the fastest developing 20 countries in the 20th century to achieve basic transformations in the rule of law. However, the World Development Report 2011 suggests that fragile countries cannot afford to wait that long. Instead, in managing disputes, it is imperative for governments and the international community to support arrangements that fit each country context, take into account capacity constraints in government and the local level, and respond to the needs of users. Justice reform should be measured accordingly from a functional perspective—based on the needs of users—rather than abstract modeling of institutions on western approaches.
Health systems are under pressure in Asia. Epidemiological and demographic transitions are taking place much faster than in Europe and America, in the span of a single generation. With the transition comes the non-communicable disease (NCD) epidemic that requires more sophisticated and expensive interventions provided by hospitals, inpatient or outpatient. Rapid economic development in Asia has lifted millions out of poverty and raised peoples’ expectations for services. Between China, India, Thailand, Philippines, Indonesia and Vietnam, expansion of health insurance coverage during the last decade has reached an additional one billion people, making services more affordable and thus increasing demand. Advancing medical technology eagerly awaited by specialist doctors sitting on top of health professional hierarchies further expands possibilities for treatment. The middle class votes with their feet and takes their health problems to medical tourism meccas like those in Bangkok and Singapore, voiding their own countries of additional income to health care providers. Policymakers are scrambling to expand hospital capacity, boost the pay of health professionals, and encourage investment to meet the demand.
But governments do not wait. They are exploring hospital autonomy, decentralization, user fees and private sector participation. These policies often pose risks that need to be mitigated by policies and institutional arrangements. For example, health care providers sometimes order unnecessary procedures to earn additional revenue, thanks to the powerful incentive of the fee-for-service payment mechanism and information asymmetry between the patient and health care provider. This can mean financial ruin for both the patient and new, relatively weak health insurance agencies.
Despite these challenges, hospitals aren’t high on the international health development agenda, save a few initiatives to improve quality and provider payment reform.
Sub-Saharan African countries bucked the slowdown in the global economy and grew at a robust pace in 2011 (see Africia's Pulse, February 2012 Update).
The region’s output expanded by an estimated 4.9 percent, faster than in 2010 and just shy of the pre-crisis (average of 2003-08) level of 5 percent. Excluding South Africa, the regional growth rate was 5.9 percent. Particularly notable is the fact that this growth was widespread: over a third of countries posted 6 percent or higher growth; another 40 percent grew at between 4-6 percent. Equally important is the fact that several countries saw sustained growth rates of over 6 percent a year in both 2010 and 2011.
So what can Sub-Saharan Africa expect in 2012? Barring a serious deterioration in the global economy, the outlook for the region seems bright, with a pickup in GDP growth to 5.3 percent in 2012 and 5.6 percent in 2013. High commodity prices and strong domestic demand, especially buoyant private consumption, are expected to sustain the expansion.
But these factors also point to Africa’s vulnerability.
Important developments today:
1. Portuguese government bonds advance following successful short-term debt auction.
2. Deceleration in Eurozone manufacturing activity slows.
What’s media assistance about anyway? Actually, there’s not really a straightforward answer to this question. I realized that when I listened to Daniel Kaufmann of the Brookings Institute earlier this week at an event hosted by the Center for International Media Assistance (CIMA) and Internews. Kaufmann’s answer was that media assistance is about media freedom. A free media is a necessary, although not a sufficient condition for successful media development.