WHO-AFRO Regional Committee- Yamoussoukro, August 2011 Building Human Capital for Inclusive Growth in Africa: One Billion Opportunities? Agnès SOUCAT Director.

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


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


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

http://www.childinfor.org/

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

Coverage of High Impact Interventions is still low …particularly in Western Africa

SSA still has a low per capita spending on health.. yet not the lowest

6

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

7

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

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 h

ea

lth

ex

pe

nd

itu

re

Private sources -mostly out of pocket - finance more than half of health expenditures

9

10

Average total health spending has more than doubled between 1995 and 2009. ..

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

100

120

140

160

180

South Asia

Africa

US$

Deaths per 1000

Yet scaling up and even fast progress is possible … within a few years

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

0

10

20

30

40

50

60

70

80

2004/5

2005/6

2006/7

2007/8

2008/9

2009/10

0

5000

10000

15000

20000

25000

30000

35000

40000

0

5000000

10000000

15000000

20000000

25000000

30000000

35000000

40000000

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

0

20

40

60

80

100

120

0 200 400 600 800 1000

Total Health Expenditure per capita (USD at Purchasing Power Parity)

0

20

40

60

80

100

120

0 100 200 300 400 500 600 700

Government Health Expenditure per capita (USD at Purchasing Power Parity)


A rapidly changing continent….



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

Africa : a continent of fast economic growth …. Africa : now a continent of fast economic growth ….

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 …


The research agenda….




Growth, productivity and jobs …

Value for money, accountability and voice in service delivery

Social inclusion and cohesion


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)

23

36.3

49.7

34.9

55.6

30.0

40.0

50.0

60.0

Baseline (2006) Follow up (2008)

Prop

ortio

n of

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…


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



Thank You

WHO-AFRO Regional Committee- Yamoussoukro, August 2011 Building Human Capital for Inclusive Growth in Africa: One Billion Opportunities? Agnès SOUCAT Director.

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