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

1. 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

2. 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 ?

3. 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.

4. 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.

5. Coverage of High Impact Interventions isstilllow …particularly in Western Africa

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

7. 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

8. External aid used to bean important source of health spending in Sub-Saharan Africa but is peaking..

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

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

11. But SSA childmortalitystilllaggingbehind South Asia … despitesimilarlevels of spending ‹#2› Deaths per 1000 US$

12. Yetscaling up and evenfastprogressis possible … within a few years Ethiopia Rwanda Health workers and ITNs % assisted deliveries

13. But how money isused and in which system itisinjectedis an essential question

14. HHAA 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….

15. 1 billion 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

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

17. And rapidly evolving technological revolution … • 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..

18. But problems with growth quality and inclusiveness… • 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) .

19. And a growing appetite for democratic processes …….the lesson of the Arab Spring … Source :WorlldBank 2010

20. HHAA 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….

21. Rotterdam Global Health Initiative October 28 • Growth, productivity and jobs … • Value for money, accountability and voice in service delivery • Social inclusion and cohesion

22. Growth ..and jobs… 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

23. Value for money, accountability and voice in service delivery 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….

24. Social Inclusion and Cohesion… • 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

25. Conclusion 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

26. Thank You