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THE CHANGING AFRICAN LANDSCAPE - WHAT HAS CHANGED IN THE LAST 25 YEARS, DEVELOPMENTS ENVISAGED FOR THE NEXT 25 YEARS
CAROLINE JEHU-APPIAH (MD, MSc, PhD)
PRINCIPAL HEALTH ECONOMIST
AFRICAN DEVELOPMENT BANK GROUP (AFDB)
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OUTLINE
• Africa's changing economic landscape
• Africa's changing health landscape
• Africa in 50 years time-projections
• Challenges and Opportunities
• Way forward
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CHANGING AFRICAN LANDSCAPE
2013 – 2022…
2013
2001
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AFRICA RISING: RAPID ECONOMIC GROWTH
4
11,110,5 10,3
8,98,4 8,2
7,9 7,9 7,7 7,6
0
2
4
6
8
10
12
Ango
la
Ch
ina
Myan
ma
r
Nig
eri
a
Eth
iopia
Kazakhsta
n
Ch
ad
Mo
za
mb
iqu
e
Ca
mbo
dia
Rw
anda
Perc
ent
Annual Average GDP Growth: 2001-2011
Africa is growing rapidly at 5-8% per annum 6 out of the 10 fastest-growing economies are in SSA (Angola, Nigeria, Ethiopia, Chad, Mozambique, Rwanda)
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AFRICA’S ECONOMIC GROWTH-TRENDS IN GDP
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DECLINING INFANT MORTALITY RATE IN DEVELOPING COUNTRIES(DEATHS PER 1000 BIRTHS)
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INCREASING LIFE EXPECTANCY AT BIRTH IN DEVELOPING COUNTRIES (NUMBER OF YEARS)
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PREVALENCE OF MALNOURISHMENT IN DEVELOPING COUNTRIES BY REGION(PERCENT OF POPULATION)
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MAJOR PROGRESS ON THE MDGS IN AFRICA …AND NOT JUST IN HIGH GROWTH COUNTRIES
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SOME PROJECTIONS….
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AFRICA IN 50 YEARS: GROSS DOMESTIC PRODUCT (US$)
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LIFE EXPECTANCY IN THE NEXT 50 YEARS
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HIGHER NATIONAL INCOME IS ASSOCIATED WITH HIGHER LIFE EXPECTANCY AT BIRTH
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Africa will have the world’s largest workforce by 2050
1 billion people today, 2.3
billion by 2050
Africa is the…
� most populous
continent after Asia
� youngest region
in the world
• And will have the
largest workforce
by 2050 surpassing
China and India -
200
400
600
800
1.000
1.200
1.400
1.600
1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
Mil
lio
n in
hab
itan
ts
Working age population (15-64) in the world
Africa
SE Asia
Europe
LAC
South America
North America
China
India
Source: UNSTAT. World Population Prospects 2010.
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AFRICA’S DEMOGRAPHIC SHIFTS ARE AN OPPORTUNITY FOR CHANGE
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100 80 60 40 20 0 20 40 60 80 100
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
100+
Female Male
2010
2060
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AFRICA IN 50 YEARS: URBAN POPULATION BY REGION (AS % OF TOTAL)
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0
50
100
150
200
2000 2010 2020 2030 2040 2050 2060
Africa Central Africa East Africa North Africa Southern Africa West Africa
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AFRICA: UNDER AGE 5 MORTALITY PER 1000 BIRTHS BY REGION
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DRIVERS OF AFRICA’S ECONOMIC TRANSFORMATION
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… BUT CHALLENGES TO OVERCOME
• Fragility is a major concern
• Huge infrastructure gap
• Youth unemployment and underemployment high
• Low MDG indicators
• Only 4 African countries score higher than 5 (out of 10)
on TI’s Corruption Perception Index
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MOST AFRICAN COUNTRIES AT THE BOTTOM OF HDI
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INCOME INEQUALITY IS HIGHGINI INDEX FOR SELECTED AFRICAN COUNTRIES
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HIGH DISEASE BURDEN….
• Africa accounts for only 12% of the world’s population, but
57% of the world’s maternal deaths, 49% of child deaths,
85% of malaria cases, 67% of people with HIV, and 26% of
underweight children
Maternal deaths,
2005
Death of children
under five, 2008
Adults and children
estimated to be living
with HIV, 2007
Underweight children
under five, 2007
Ref: Science in Action – Saving the lives of Africa’s mothers, newborns and children. ASADI 2009. Eds Kinney MV, Lawn JE, Kerber KJ
Data sources: UNAIDS 2007, UNICEF, www.childinfor.org, Lancet nutrition series, World Malaria Report 2009.
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INCREASING URBANIZATION WILL EXPOSE AFRICANS TO HEALTH RISKS & STRAIN URBAN HEALTH INFRASTRUCTURE
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HEALTH SPENDING IN SSA HAS MORE THAN DOUBLED SINCE 1995 BUT WITH HIGH LEVELS OF PRIVATE SPENDING
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INEFFICIENCIES ABOUND…..
• Globally, between 20 and 40 percent of health system spending is wasted, with poorer countries wasting even higher proportions –WHR 2011
• For each one dollar spent on health, significant amount doesn’t reach the front line (World Bank)
• Absenteeism affects 40% of health workers (World Bank}
Country Mean
Chad 2004 95
Senegal 2003 60
Cameroon 2004 70
Rwanda 2003 40
Nonwage funds not reaching
schools and health services:
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PUBLIC HEALTH SPENDING DISPROPORTIONATELY BENEFITS THE RICH
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HIGH IMPACT INTERVENTIONS: NOT NECESSARILY WHERE THE MONEY GOES
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KEY LESSONS LEARNED FROM PROGRESS TO DATE
• Increased wealth does not necessarily lead to improved health, particularly for the poorest segments of society.
• The changing environmental landscape threatens to increase poverty and health problems in Africa.
• The ICT revolution is rapidly increasing connectivity and providing opportunities to transform service delivery to improve quality, safety and efficiency
• International aid flows are likely to decline- need for greater domestic ownership
• Increased demand for good governance, accountability and results 28
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OPPORTUNITIES FOR THE ‘NEW’ AFRICA AND WAY FORWARD IN THE NEXT 50 YEARS
• Health systems must evolve to meet the needs of the new Africa.
• Leverage e-Health to overcome major challenges in access, financing, human resources, and in the provision of high-quality healthcare services.
• Leverage Public–Private Partnerships
• Value for money
• Innovative financing
• Governments need to be more self-reliant with greater domestic ownership and raise resources internally
• Developing equitable and sustainable health financing systems
• South-south collaboration
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WAY FORWARD IN THE NEXT 50 YEARS
• The post-MDGs Agenda
• Focus on equity in the use of health service and outcomes
• Greater attention to social, economic and environmental
determinants of health
• UHC
• Strategies to reduce out-of-pocket expenditure health sector
• Strategic initiatives to address the challenge of inadequate
human resources in health
• The health sector will increasingly be viewed as a productive
and job-creating sector.
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THANK YOU FOR YOUR ATTENTION!