who-afro regional committee- yamoussoukro, august 2011 building human capital for inclusive growth...
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WHO-AFRO Regional Committee- Yamoussoukro, August 2011
Building Human Capital for Inclusive Growth in Africa: One Billion Opportunities?
Agnès SOUCATDirector
Human Development Department African Development Bank
Rotterdam Global Health Initiative October 28
WHO-AFRO Regional Committee- Yamoussoukro, August 2011
Where are we ?
HHA A N e w W a y o f W o r k i n g T o g e t h e r
Rotterdam Global Health Initiative October 28
Ref: Science in Action – Saving the lives of Africa’s mothers, newborns and children. ASADI 2009. Eds Kinney MV, Lawn JE, Kerber KJData sources: UNAIDS 2007, UNICEF, www.childinfor.org, Lancet nutrition series, World Malaria Report 2009.
Maternal deaths, 2005
Death of children under five, 2008
Adults and children estimated to be living
with HIV, 2007
Underweight children under five, 2007
Global Health issues are increasingly about Africa
With only 12% of the world’s population, Africa accounts for 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
Yes… Africa has progressed towards the MDG targets.. but slower than in the rest of the world ..and progress inequitably shared..
For SSA 20% less under 5 deaths in 2009 compared to 1990.
For SSA 26% % less maternal deaths in 2008 compared to 1990.
4
No major increase in allocations to health in SSA between 1995 and 2009
THE as % GDP increased from 5% in 1995 to 6% in 2009
GGHE as % total GE increased from 8% in 1995 to 10% in 2009. Very few countries achieved the 15% Abuja commitment
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External aid used to be an important source of health spending in Sub-Saharan Africa but is peaking..
External aid as % of total health spending (2002)
0
2
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East Asia &Pacific
Eastern Europe& Central Asia
Latin America &the Caribbean
Middle East &North Africa
South Asia Sub-SaharanAfrica
Region
Pe
rce
nt
of
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ea
lth
ex
pe
nd
itu
re
But SSA child mortality still lagging behind South Asia … despite similar levels of spending
‹#2›
Per Capita health spend-ing
Life Expectancy Child Mortality0
20
40
60
80
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180
South Asia
Africa
US$
Deaths per 1000
Yet scaling up and even fast progress is possible … within a few years
1990
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10000000
15000000
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25000000
30000000
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Graduated HEWs
Distibuteed ITNs
Ethiopia Rwanda
% assisted deliveriesHealth workers and ITNs
But how money is used and in which system it is injected is an essential
question
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Total Health Expenditure per capita (USD at Purchasing Power Parity)
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Government Health Expenditure per capita (USD at Purchasing Power Parity)
WHO-AFRO Regional Committee- Yamoussoukro, August 2011
A rapidly changing continent….
HHA A N e w W a y o f W o r k i n g T o g e t h e r
Rotterdam Global Health Initiative October 28
A strikingly large youth bulge in Africa
1 billion people in Africa today and 2.3 billion people projected for 2050 … the continent’s greatest asset, or a potential risk ?
Source: CIA World Fact-book 2009 http://www.prb.org/pdf11/2011population-data-sheet_eng.pdf
The total African mobile subscriber base is roughly 281 million and expected to reach 561 million in 2012
Yet Africa laggs behind in connectivity and internet access …only 3 out of 1000 are internet users in Sierra Leone..1 out of 1000 has a computer in Niger..
And rapidly evolving technological revolution …
In 2010, six out of the 10 most unequal countries worldwide were in Sub-Saharan Africa….
The top 3 are Namibia (70), South Africa (65) and Lesotho (63)
.
But problems with growth quality and inclusiveness…
Source :Worlld Bank 2010
And a growing appetite for democratic processes …….the lesson of the Arab Spring …
WHO-AFRO Regional Committee- Yamoussoukro, August 2011
The research agenda….
HHA A N e w W a y o f W o r k i n g T o g e t h e r
Rotterdam Global Health Initiative October 28
WHO-AFRO Regional Committee- Yamoussoukro, August 2011
Growth, productivity and jobs …
Value for money, accountability and voice in service delivery
Social inclusion and cohesion
Rotterdam Global Health Initiative October 28
The demographic dividend
F Regions on the Demographic Upswing
Source: D Bloom and D Canning, “Demographics and Development Policy”, Development Outreach, April 2011
Family planning and early education programs
New institutions and models of training and knowledge dissemination
Climate Change impact
Growth ..and jobs…
“globally, between 20 and 40 percent of health system spending is wasted, with poorer countries wasting even higher proportions” – WHR 2011
Ugandans perceive public health services as being among the most corrupt institutions…(2003).. , absenteeism is 35% among medical personnel in primary health care
In Chad, 95% of funds allocated never reached health centers .. (Wane et al, 2009)
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36.3
49.7
34.9
55.6
30.0
40.0
50.0
60.0
Baseline (2006) Follow up (2008)
Prop
ortio
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of i
nstit
ution
al d
eliv
erie
s
Control facilities Treatment (PBF facilities)
7.3 % increasedue to PBF
Delivery at the health facility increased overall in Rwanda, but 7% more in Performance Base Facilities between 2006-2008….
Incentives
Decentralization and autonomy
Accountability to users
Value for money, accountability and voice in service delivery
Nutrition: food security, climate change and livelihoods particularly in the Horn of Africa
Safety nets Health insurance
Conditional Cash Transfers
Social Businesses and productive safety nets
Social Inclusion and Cohesion…
WHO-AFRO Regional Committee- Yamoussoukro, August 2011
Conclusion More money is needed but more value for money is needed even more
High potential for high return if right investment is made on
New technologies and knowledge management Mechanisms for Value for money and accountability Inclusion
Need to integrate private spending in policymaking Importance for external aid to be catalytic: need to focus on results
and efficiency gains25
Rotterdam Global Health Initiative October 28