1 African Development Bank Agnes Soucat, MD, Ph.D Director Department of Human Development African Development Bank Agnes Soucat, MD, Ph.D Director Department.
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African Development BankAfrican Development BankAgnes Soucat, MD, Ph.D Agnes Soucat, MD, Ph.D
DirectorDirectorDepartment of Human DevelopmentDepartment of Human Development
The promise of RBF to reach the The promise of RBF to reach the Health MDGs and the Evidence Gap: Health MDGs and the Evidence Gap: How Impact Evaluation Can Inform How Impact Evaluation Can Inform
Policy Dialogue Policy Dialogue
2
2.9 3.2 3.5 4.1 4.6 4.9
2
5.1
13.510.9
8.3 75.1 4.1
2.2
3
4.1
3.6
2.7
1.8
1.41.1
0.8
0.1
0
5
10
15
20
25
1960 1970 1980 1990 2000 2005 2015 withachievement of
MDGs
2015 withcurrent Trend
Africa Asia Other
Progress towards the health MDGs is Progress towards the health MDGs is inadequate inadequate
Number of children dying before the age of 5
33
Source: Demographic and Health Surveys
Treated fever among children under 5 by wealth quintile
44
Most mortality causes still avoidable with low Most mortality causes still avoidable with low cost interventionscost interventions
Cause-specific proportional mortality in the Africa region
21%
17%
4%
21%
6%2%
7%
17%
Neonatal
HIV/AIDS
Diarrhoealdiseases
Measles
Malaria
Respiratoryinfections
Injuries
Others
55
$151.0
$89.0
$48.0
$-
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
$140.0
$160.0
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Comprehensive Medium Focussed
Billio
ns o
f US$
2009
-15
Progress towards MDGs, Marginal Cost, and Fiscal Space
MDG 1 MDG7MDG 6MDG 5MDG 4
The Health MDGs are within reach…. The Health MDGs are within reach….
Source : high Level Task Force on Innovative Financing, 2009
66
And money is here… Africa is growing at 5% a And money is here… Africa is growing at 5% a year and external aid is an important source of year and external aid is an important source of health spending in Sub-Saharan Africa…health spending in Sub-Saharan Africa…
External aid as % of total health spending (2002)
0
2
4
6
8
10
12
14
16
18
20
East Asia &Pacific
Eastern Europe& Central Asia
Latin America &the Caribbean
Middle East &North Africa
South Asia Sub-SaharanAfrica
Region
Pe
rce
nt
of
tota
l he
alt
h e
xp
en
dit
ure
77
But increasing public spending is also not enough
* Percent deviation from rate predicted by GDP per capitaSource: Spending and GDP from World Development Indicators database. Under-5 mortality from Unicef 2002
But more money does not always give better results
88
Countries use well-designed Countries use well-designed policies to achieve growth and policies to achieve growth and human development outcomeshuman development outcomes
Health, Education,
PovertyBut…
* Service
s
Gover
nments/
donors
99
Comm
uniti
es
Government
Providers
Loca
l Gov
t.Clie
nts
Leakage of Funds
Bad policyPoor budget handling
Primary education
Sub-optimal spending(Big salary bills but insufficient commodities)
Financing problemsInformation & monitoringLocal govt. incentives skewedLocal capacity issues
Low quality servicesProvider incentives unclear, absenteeismHard to monitor, users helpless
Lack of demandExternalitiesCommunity normsBudget constraintsIntra-household behavior
But, what looks good on paper seems to break down in practice…
1010
Expenditure incidenceExpenditure incidence
Health
Source: Filmer 2003b
Public Money Benefits Richer Groups
1111
Nonwage funds not reaching health services: Nonwage funds not reaching health services: Evidence from PETS (%)Evidence from PETS (%)
Country MeanChad 2004 95
Senegal 2003 60 Cameroon 2004 70
Rwanda 2003 40
Source: World Bank
Health
Public Money Does Not Reach the Frontline
1212
And the Results Chain to achieving the MDGs And the Results Chain to achieving the MDGs has missing links… has missing links…
Upstream diagnostic
Country Status Report on Health, Poverty, Health Systems and the MDGs
Policy dialogue
One country, one costed plan for country supported by all partners (IHP+)
Financing Programs
Focused funds:,Malaria HIV/AIDS, Tuberculosis etc.
Problem specific and health system focused operations (eg: SWAPs, PBS, PRSC)
Joint Bank-Partners Programs (eg: Results-based financing)
Health Systems
Health Financing Human Resources For Health
Supply Chain and Pharmaceuticals
Governance and Service Delivery
Infrastructure and ICT
Health Systems Outcomes
Immunization, ORTARI treatment, ExclusiveBreastfeeding, Vitamin A supplementation,ITNs,Antimalarial treatment,Attended Deliveries, AntenatalCare, Contraception, etc…
Health Outcomes
Nutrition (MDG1)Child health (MDG4)
Maternal Health and mortality (MDG5)
Malaria,AIDS, TB, prevalence and mortality (MDG6)
Financial protection
Control of Non Communicable Diseases
Control of Neglected Tropical Diseases
Multisectoral Outcomes
Female EducationAccess to waterIncomeSchool Health
1313
“ “ the missing middle” problem….the missing middle” problem….
MDGs
Other outcomes
Health systems Outcomes
Nutrition (MDG1)
Child health (MDG4)
Maternal Health and mortality (MDG5)
Malaria,AIDS, TB, prevalence and mortality (MDG6)
Financial protection
Non Communicable Diseases
Access to safe waterFemale educationIncome
Other sectors Outcomes
Education
Water
Social Protection
Financing
Focused funds:,Malaria HIV/AIDS, Tuberculosis etc.
Problem specific and health system focused operations (eg: SWAPs, PBS, PRSC)
Joint Bank-Partners Programs (eg: Results-based financing)
Health systems
Human Resources For Health
Supply chain
Governance and Service Delivery
Public finance and health insurance
Infrastructure and ICT
Immunization ORTARI treatment Exclusivebreastfeeding Vitamin A supplementationITNsAntimalarial treatmentAttended Deliveries AntenatalCare Contraception etc…
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