Poverty and Health:. ...an impossible combination and the solution thereof. Dr Reuben Esena, PhD 25 th FAMSA Summit – UG, Legon –Accra, Ghana Monday 17 th May 2010 University of Ghana, Business School. Introduction 1.
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...an impossible combination and the solution thereof
Dr Reuben Esena, PhD
25th FAMSA Summit – UG, Legon –Accra, Ghana
Monday 17th May 2010
University of Ghana, Business School
Current Health Crisis
Schistosomiasis, Guinea worm
Also leads to poor distribution of resources
Over 2,000 South African nurses registered in UK a year following policy not to poach, twice as many as before
By far, the most accepted definition is that of the World Health Organization:
“[Health is] the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948) and the “extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources as well as physical capabilities” (WHO, 1984).
Health Indicators, Part I
Broad holistic definition
Narrow organic definition
What is health ?
Why is health important?
As a right
As a consumption good
As an investment good
Roemer MI. National health systems of the world, volume 1. New York, Oxford University Press, 1991
World Health Report 2000
All nations struggle to
balance access to healthcare
with quality and cost efficiency.
Is there one perfect solution for all nations?
Quality of life
EnvironmentHealth System Model used to assess HFA
The WestFour survival patterns and transitions between them
Abuja: Government spending on health should be at least 15% of total government spending
East Asia & Pacific: 10.1%
Latin America and the Caribbean: 12.5%
Commission on Macroeconomics & Health (CMH): Estimated $34 per capita for a basic package of health service
East Asia & Pacific: $62 (current US$)
Latin America and the Caribbean: $272 (current US$)
Are targets meaningful? Relevant?
Sources: Disease Control Priorities Project, 2007; and African Development Bank, 2002.
Source: African Union. Progress Report on the Implementation of the Plans of Action of the Abuja Declarations for Malaria, HIV/AIDS and Tuberculosis; Revised Final Draft, 22 December 2005.
Few countries spend $34+
The CMH Target
Source: WHO SIS
Note: Countries spending >$90 total per capita on health were excluded to improve graph’s readability. These countries include Swaziland, Mauritius, Namibia, Gabon, South Africa, and Botswana.
Source: World Bank, WDI 2007; author’s calculations.
Notes: Disbursements include PEPFAR, GFATM, and World Bank MAP funding.
Source: Heller, Peter. “Pity the Finance Minister”: Issues in Managing a Substantial Scaling up of Aid Flows. IMF Working Paper WP/05/180. September 2005.
Source: Rwanda NHA 1998-2006
Capacity Building/ Institutional Strengthening
Majority of population covered through publicly funded schemes (e.g. general taxation, social insurance)
Increasing public share of health financing through targeted coverage for vulnerable populations
Limited Public Funding (for vulnerable)
Private insurance for secondary
Private Insurance pools cover other segments of the population
Out-of-pocket payments predominate
Potential Model Towards Universal Coverage(WHO)
And undernutrition implicated in 50% of child deaths
Source: State of the World’s Children, UNICEF 2008
Bryce et al. WHO estimates of the causes of death in children. Lancet 2005
1970 1990 2004 2015
Source: The State of the World’s Children, 2006
Source: WHO/UNICEF/UNFPA/The World Bank estimates, App. 15, pub 2007
The chance of a woman dying as a result of pregnancy is 200 x greater in sub-Saharan
Africa than it is in the United States
Source: WHO/ UNICEF/UNFPA, The WorldBank. Maternal Mortality Estimates 2005,App 8, pub 2007
Other direct causes include embolism, ectopic pregnancy, anesthesia-related. Indirect causes include: malaria, heart disease.
Source:Adapted from " WHO Analysis of causes of maternal deaths: A systematic review.” The Lancet, vol 367, April 1, 2006.
... The richest fifth of the world’s population have 74 times the income of the poorest fifth.
..The top three billionaires have assets greater than the combined GNP of all least developed countries and their 600 million people.
Obstacles to progress
by ensuring that “external assistance” projects and programmes are absorbed early into national system
A systematic, data-based method for improving the quality of work processes
TQM (continuous improvement)
It uses team decision-making to improve processes that affect the quality of products and services for a customer.
Improving quality by promoting a culture of safety through Value-Driven Health Care
Information-rich, patient-focused enterprises
Information and evidence transform interactions from reactive to proactive (benefits and harms)
Evidence is continually refined as a by-product of care delivery
21st Century Health Care
Actionable information available – to clinicians AND patients – “just in time”
“Never doubt that a small group of committed citizens can change the world; indeed it is the only thing that ever has!”