THE CHANGING AFRICAN LANDSCAPE - WHAT HAS CHANGED IN THE LAST 25 YEARS, DEVELOPMENTS ENVISAGED FOR THE NEXT 25 YEARS

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1 THE CHANGING AFRICAN LANDSCAPE - WHAT HAS CHANGED IN THE LAST 25 YEARS, DEVELOPMENTS ENVISAGED FOR THE NEXT 25 YEARS CAROLINE JEHU-APPIAH (MD, MSc, PhD) PRINCIPAL HEALTH ECONOMIST AFRICAN DEVELOPMENT BANK GROUP (AFDB) 1

2 OUTLINE Africa's changing economic landscape Africa's changing health landscape Africa in 50 years time-projections Challenges and Opportunities Way forward 2

3 CHANGING AFRICAN LANDSCAPE

4 AFRICA RISING: RAPID ECONOMIC GROWTH Africa is growing rapidly at 5-8% per annum 6 out of the 10 fastest-growing economies are in SSA (Angola, Nigeria, Ethiopia, Chad, Mozambique, Rwanda) 12 11,1 10,5 10,3 Annual Average GDP Growth: ,9 8,4 8,2 7,9 7,9 7,7 7, Angola China Myanmar Nigeria Ethiopia Kazakhstan Chad Mozambique Cambodia Rwanda Percent

5 AFRICA S ECONOMIC GROWTH- TRENDS IN GDP 5

6 DECLINING INFANT MORTALITY RATE IN DEVELOPING COUNTRIES (DEATHS PER 1000 BIRTHS) 6

7 INCREASING LIFE EXPECTANCY AT BIRTH IN DEVELOPING COUNTRIES (NUMBER OF YEARS) 7

8 PREVALENCE OF MALNOURISHMENT IN DEVELOPING COUNTRIES BY REGION (PERCENT OF POPULATION) 8

9 MAJOR PROGRESS ON THE MDGS IN AFRICA AND NOT JUST IN HIGH GROWTH COUNTRIES

10 SOME PROJECTIONS. 10

11 AFRICA IN 50 YEARS: GROSS DOMESTIC PRODUCT (US$) 11

12 LIFE EXPECTANCY IN THE NEXT 50 YEARS 12

13 HIGHER NATIONAL INCOME IS ASSOCIATED WITH HIGHER LIFE EXPECTANCY AT BIRTH 13

14 Africa will have the world s largest workforce by billion people today, 2.3 billion by 2050 Africa is the most populous continent after Asia youngest region in the world And will have the largest workforce by 2050 surpassing Million inhabitants Working age population (15-64) in the world Africa SE Asia Europe LAC South America North America China India China and India Source: UNSTAT. World Population Prospects 2010.

15 AFRICA S DEMOGRAPHIC SHIFTS ARE AN OPPORTUNITY FOR CHANGE Female Male 15

16 AFRICA IN 50 YEARS: URBAN POPULATION BY REGION (AS % OF TOTAL) 16

17 AFRICA: UNDER AGE 5 MORTALITY PER 1000 BIRTHS BY REGION Africa Central Africa East Africa North Africa Southern Africa West Africa 17

18 DRIVERS OF AFRICA S ECONOMIC TRANSFORMATION 18

19 BUT CHALLENGES TO OVERCOME Fragility is a major concern Huge infrastructure gap Youth unemployment and underemployment high Low MDG indicators Only 4 African countries score higher than 5 (out of 10) on TI s Corruption Perception Index 19

20 MOST AFRICAN COUNTRIES AT THE BOTTOM OF HDI 20

21 INCOME INEQUALITY IS HIGH GINI INDEX FOR SELECTED AFRICAN COUNTRIES 21

22 HIGH DISEASE BURDEN. Africa accounts for only 12% of the world s population, but 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 Maternaldeaths, 2005 Death of children under five, 2008 Adults and children estimatedto beliving with HIV, 2007 Underweight children under five, 2007 Ref: Science in Action Saving the lives of Africa s mothers, newborns and children. ASADI Eds Kinney MV, Lawn JE, Kerber KJ Data sources: UNAIDS 2007, UNICEF, Lancet nutrition series, World Malaria Report 2009.

23 INCREASING URBANIZATION WILL EXPOSE AFRICANS TO HEALTH RISKS & STRAIN URBAN HEALTH INFRASTRUCTURE 23

24 HEALTH SPENDING IN SSA HAS MORE THAN DOUBLED SINCE 1995 BUT WITH HIGH LEVELS OF PRIVATE SPENDING 24

25 INEFFICIENCIES ABOUND.. Globally, between 20 and 40 percent of health system spending is wasted, with poorer countries wasting even higher proportions WHR 2011 For each one dollar spent on health, significant amount doesn t reach the front line (World Bank) Absenteeism affects 40% of health workers (World Bank} Nonwage funds not reaching schools and health services: Country Mean Chad Senegal Cameroon Rwanda

26 PUBLIC HEALTH SPENDING DISPROPORTIONATELY BENEFITS THE RICH 26

27 HIGH IMPACT INTERVENTIONS: NOT NECESSARILY WHERE THE MONEY GOES

28 KEY LESSONS LEARNED FROM PROGRESS TO DATE Increased wealth does not necessarily lead to improved health, particularly for the poorest segments of society. The changing environmental landscape threatens to increase poverty and health problems in Africa. The ICT revolution is rapidly increasing connectivity and providing opportunities to transform service delivery to improve quality, safety and efficiency International aid flows are likely to decline- need for greater domestic ownership Increased demand for good governance, accountability and results 28

29 OPPORTUNITIES FOR THE NEW AFRICA AND WAY FORWARD IN THE NEXT 50 YEARS Health systems must evolve to meet the needs of the new Africa. Leverage e-health to overcome major challenges in access, financing, human resources, and in the provision of high-quality healthcare services. Leverage Public Private Partnerships Value for money Innovative financing Governments need to be more self-reliant with greater domestic ownership and raise resources internally Developing equitable and sustainable health financing systems South-south collaboration 29

30 WAY FORWARD IN THE NEXT 50 YEARS The post-mdgs Agenda Focus on equity in the use of health service and outcomes Greater attention to social, economic and environmental determinants of health UHC Strategies to reduce out-of-pocket expenditure health sector Strategic initiatives to address the challenge of inadequate human resources in health The health sector will increasingly be viewed as a productive and job-creating sector. 30

31 THANK YOU FOR YOUR ATTENTION!