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
OUTLINE Africa's changing economic landscape Africa's changing health landscape Africa in 50 years time-projections Challenges and Opportunities Way forward 2
CHANGING AFRICAN LANDSCAPE 2013 2022 2013 2001 3
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: 2001-2011 10 8 8,9 8,4 8,2 7,9 7,9 7,7 7,6 6 4 2 0 4 Angola China Myanmar Nigeria Ethiopia Kazakhstan Chad Mozambique Cambodia Rwanda Percent
AFRICA S ECONOMIC GROWTH- TRENDS IN GDP 5
DECLINING INFANT MORTALITY RATE IN DEVELOPING COUNTRIES (DEATHS PER 1000 BIRTHS) 6
INCREASING LIFE EXPECTANCY AT BIRTH IN DEVELOPING COUNTRIES (NUMBER OF YEARS) 7
PREVALENCE OF MALNOURISHMENT IN DEVELOPING COUNTRIES BY REGION (PERCENT OF POPULATION) 8
MAJOR PROGRESS ON THE MDGS IN AFRICA AND NOT JUST IN HIGH GROWTH COUNTRIES
SOME PROJECTIONS. 10
AFRICA IN 50 YEARS: GROSS DOMESTIC PRODUCT (US$) 11
LIFE EXPECTANCY IN THE NEXT 50 YEARS 12
HIGHER NATIONAL INCOME IS ASSOCIATED WITH HIGHER LIFE EXPECTANCY AT BIRTH 13
Africa will have the world s largest workforce by 2050 1 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 1.600 1.400 1.200 1.000 Working age population (15-64) in the world 800 600 400 200 Africa SE Asia Europe LAC South America North America China India China and India - 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Source: UNSTAT. World Population Prospects 2010.
AFRICA S DEMOGRAPHIC SHIFTS ARE AN OPPORTUNITY FOR CHANGE 100+ 95-99 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 2010 2060 100 80 60 40 20 0 20 40 60 80 100 Female Male 15
AFRICA IN 50 YEARS: URBAN POPULATION BY REGION (AS % OF TOTAL) 16
AFRICA: UNDER AGE 5 MORTALITY PER 1000 BIRTHS BY REGION 200 150 100 50 0 2000 2010 2020 2030 2040 2050 2060 Africa Central Africa East Africa North Africa Southern Africa West Africa 17
DRIVERS OF AFRICA S ECONOMIC TRANSFORMATION 18
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
MOST AFRICAN COUNTRIES AT THE BOTTOM OF HDI 20
INCOME INEQUALITY IS HIGH GINI INDEX FOR SELECTED AFRICAN COUNTRIES 21
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 2009. Eds Kinney MV, Lawn JE, Kerber KJ Data sources: UNAIDS 2007, UNICEF, www.childinfor.org, Lancet nutrition series, World Malaria Report 2009.
INCREASING URBANIZATION WILL EXPOSE AFRICANS TO HEALTH RISKS & STRAIN URBAN HEALTH INFRASTRUCTURE 23
HEALTH SPENDING IN SSA HAS MORE THAN DOUBLED SINCE 1995 BUT WITH HIGH LEVELS OF PRIVATE SPENDING 24
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 2004 95 Senegal 2003 60 Cameroon 2004 70 Rwanda 2003 40
PUBLIC HEALTH SPENDING DISPROPORTIONATELY BENEFITS THE RICH 26
HIGH IMPACT INTERVENTIONS: NOT NECESSARILY WHERE THE MONEY GOES
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
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
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
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