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Rotterdam Global Health Initiative October 28. Building Human Capital for Inclusive Growth in Africa: One Billion Opportunities?. Agnès SOUCAT Director Human Development Department African Development Bank. Rotterdam Global Health Initiative October 28. Where are we ?.

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Building human capital for inclusive growth in africa one billion opportunities

Rotterdam Global Health Initiative October 28

Building Human Capital for Inclusive Growth in Africa: One Billion Opportunities?

Agnès SOUCAT

Director

Human Development Department

African Development Bank


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

Where are we ?


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

Adults and children estimated to be living with HIV, 2007

Maternal deaths, 2005

Death of children under five, 2008

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.


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.


Coverage of High Impact Interventions isstilllow …particularly in Western Africa



No major increase in allocations to health in ssa between 1995 and 2009
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


External aid used to be an important source of health spending in sub saharan africa but is peaking
External aid 1995 and 2009used to bean important source of health spending in Sub-Saharan Africa but is peaking..



Average total health spending has more than doubled half of health expendituresbetween 1995 and 2009. ..


But ssa child mortality still lagging behind south asia despite similar levels of spending
But SSA half of health expenditureschildmortalitystilllaggingbehind South Asia … despitesimilarlevels of spending

‹#2›

Deaths per 1000

US$


Yet half of health expendituresscaling up and evenfastprogressis possible … within a few years

Ethiopia

Rwanda

Health workers and ITNs

% assisted deliveries


But how money is used and in which system it is injected is an essential question
But how half of health expendituresmoney isused and in which system itisinjectedis an essential question


A rapidly changing continent

HHA half of health expendituresA 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 rapidlychanging continent….


1 half of health expendituresbillion people in Africa today and 2.3 billion people projected for 2050 … the continent’s greatest asset, or a potential risk ?

A strikingly large youth bulge in Africa

Source: CIA World Fact-book 2009 http://www.prb.org/pdf11/2011population-data-sheet_eng.pdf


Africa a continent of fast economic growth
Africa : a continent of fast economic growth …. half of health expenditures

Africa : now a continent of fast economic growth ….


And rapidly evolving technological revolution half of health expenditures…

  • 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..


But problems with growth quality and inclusiveness half of health expenditures…

  • 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)

.


And a growing appetite for democratic processes … half of health expenditures….the lesson of the Arab Spring …

Source :WorlldBank 2010


The research agenda

HHA half of health expendituresA 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

The research agenda….


Rotterdam Global Health Initiative October 28 half of health expenditures

  • Growth, productivity and jobs …

  • Value for money, accountability and voice in service delivery

  • Social inclusion and cohesion


Growth ..and half of health expendituresjobs…

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

  • The demographic dividend


Value for money, accountability and voice in service half of health expendituresdelivery

Incentives

Decentralization and autonomy

Accountability to users

“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)

Delivery at the health facility increased overall in Rwanda, but 7% more in Performance Base Facilities between 2006-2008….


Social Inclusion and Cohesion… half of health expenditures

  • 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


Conclusion
Conclusion half of health expenditures

Rotterdam Global Health Initiative October 28

  • 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 gains


Thank You half of health expenditures


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