Improving Health, Nutrition and Population Outcomes in Sub-Saharan Africa: The Role of the World Bank (Sub-Saharan Africa and the World Bank)

300 Pages·2005·2.66 MB·English

by  World Bank

Improving
Health, Nutrition,
and Population
Outcomes in
Sub-Saharan Africa
The Role of the
World Bank

Improving Health, Nutrition,
and Population Outcomes in
Sub-Saharan Africa
The Role of the World Bank

Improving Health, Nutrition,
and Population Outcomes in
Sub-Saharan Africa
The Role of the World Bank
Washington, D.C.
©2005 The International Bank for Reconstruction and Development / The World Bank
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Washington,DC 20433
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Library of Congress Cataloging-in-Publication Data
World Bank.
Improving health,nutrition,and population outcomes in Sub-Saharan Africa :the role of
The World Bank / the World Bank.
p. cm.
Includes bibliographical references and index.
ISBN 0-8213-5963-0
Public health—Africa,Sub-Saharan. 2. Medical economics—Africa,Sub-Saharan. 3.
World Bank. I. Title.
RA552.A357W67 2004
362.1'0967—dc22
2004053004
Cover photos courtesy of Dr. S. René Salgado.
Contents
Preface xiii
Acknowledgments xix
Abbreviations and Acronyms xxi
Executive Summary xxv
Chapter 1:Today’s Realities 1
Health,nutrition,and population outcomes are advancing
too slowly to reach the Millennium Development Goals 1
Africa’s health sector faces special challenges 17
Conclusion 25
Chapter 2:Why and How the World Bank Should Be
Involved 27
Poverty and health in Sub-Saharan Africa
are interrelated 28
Health outcomes are affected in complex ways by a broad
set of determinants 36
The World Bank should focus its work on its areas of
comparative advantage 40
Conclusion 48
Chapter 3:Improving Health,Nutrition,and Population
Outcomes through Economic and Fiscal Policy 49
The Bank can help to ensure that public expenditure
recognizes the role of health,nutrition,and population
in poverty reduction 50
Improved health outcomes and reduced poverty require
more effective policies,implementation,and resource
allocation within the sector 57
v
CONTENTS
The health sector could benefit from working more closely
with central ministries 63
Health sector expertise can help ensure that economic and
fiscal policy contributes to health outcomes 67
Conclusion 71
Chapter 4:Multisector Action to Improve Health,
Nutrition,and Population Outcomes 73
Actions across multiple sectors can affect health,nutrition,
and population outcomes 74
The response to HIV/AIDS sets an example 77
Reducing malnutrition requires multisector action 80
Multisector action can reduce disability and death
from many causes 82
Conclusion 93
Chapter 5:Effective Systems for Delivering Health,
Nutrition,and Population Interventions 95
Health workforce limitations pose the
greatest challenges to health care delivery 97
Access to and use of pharmaceuticals must be improved 105
The institutional and organizational
frameworks must also be right 115
The private sector can play an important role in
service delivery 122
Household and community factors also affect
system effectiveness 129
Conclusion 132
Chapter 6:Sustainable Financing of Health,Nutrition,
and Population Interventions 135
Spending on health,nutrition,and population is lower in
Africa than anywhere else 136
Countries are employing a range of strategies to manage
health financing 146
Countries are trying to improve the efficiency and equity
of health financing 155
Conclusion 164
vi
CONTENTS
Chapter 7:Implications for World Bank Operations 165
World Bank operations in Sub-Saharan Africa aim to achieve
sustainable improvements 165
Lending operations and resource transfers are taking a new
approach 166
Nonlending opportunities can also be exploited 176
The World Bank cannot achieve its objectives without
partnerships 182
Conclusion 186
Notes 187
References 195
Index 221
Figures
1.1 Few African countries are on track to achieve the
MDGs for infant and child mortality and malnutrition 2
1.2 Under-five mortality has declined more slowly in
Africa than in South Asia 4
1.3 Life expectancy at birth declined in the 1990s 5
1.4 Poor and rich experience big differences in under-five
mortality 5
1.5 Poor and rich experience big differences in under-three
mortality 6
1.6 The mortality-plus-disability gap is even wider than
the mortality gap 7
1.7 The burden of disease for the four leading causes
of death is related to the prevalence of AIDS in
Sub-Saharan Africa 8
1.8 Africa’s share of child mortality is rising 10
1.9 World population under age 15 12
1.10 Will Africa have 1.8 billion people in 2050? 13
1.11 Not many married women use modern contraception 15
1.12 Sub-Saharan Africa has the highest fertility rates 15
1.13 The unmet demand for family planning is great in
Sub-Saharan Africa 17
1.14 Africa has the fewest physicians 23
1.15 Tuberculosis cases are rising fast in Sub-Saharan Africa 24
vii
CONTENTS
1.16 Africa has more orphans than Asia or Latin America 25
2.1 Health and poverty are linked in a cycle 28
2.2 Africa’s window of opportunity is still decades away
as dependency rates remain high 32
2.3 Health,nutrition,and population outcomes have many
determinants 38
2.4 The Bank’s institutional comparative advantage overlaps
with the most critical strategic HNP issues faced by
client countries in Africa today 41
2.5 The World Bank can help integrate the matrix of
individual health care initiatives 44
3.1 Health expenditures in Sub-Saharan Africa were flat
in the 1990s 51
3.2 The incidence of illness was lower among children
enrolled in PROGRESA 55
3.3 Public spending on health correlates with under-five
mortality rates 58
3.4 Higher expenditures on health do not always result in
better health outcomes 59
3.5 Few nursing staff are in rural areas 61
3.6 A number of African countries have reduced or
waived taxes and tariffs on bednets,netting material,
and insecticide 66
3.7 Cigarette consumption in South Africa plunges with
higher prices 67
3.8 High proportions of health workers intend to
migrate 70
4.1 The environment-related burden of disease is high in
Sub-Saharan Africa 76
4.2 Environmental factors cause great health damage in
developing countries 77
4.3 The Benin multisector AIDS project supports more
activities in civil society 78
4.4 Malnutrition in the Senegal Community Nutrition
Project was reduced from 60–70 percent to less than
30 percent in six months 82
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