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

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CHANGING AFRICAN LANDSCAPE

2013 – 2022…

2013

2001

3

AFRICA RISING: RAPID ECONOMIC GROWTH

4

11,110,5 10,3

8,98,4 8,2

7,9 7,9 7,7 7,6

0

2

4

6

8

10

12

Ango

la

Ch

ina

Myan

ma

r

Nig

eri

a

Eth

iopia

Kazakhsta

n

Ch

ad

Mo

za

mb

iqu

e

Ca

mbo

dia

Rw

anda

Perc

ent

Annual Average GDP Growth: 2001-2011

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)

AFRICA’S ECONOMIC GROWTH-TRENDS IN GDP

5

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

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

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

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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$)

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LIFE EXPECTANCY IN THE NEXT 50 YEARS

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HIGHER NATIONAL INCOME IS ASSOCIATED WITH HIGHER LIFE EXPECTANCY AT BIRTH

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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

China and India -

200

400

600

800

1.000

1.200

1.400

1.600

1950

1960

1970

1980

1990

2000

2010

2020

2030

2040

2050

Mil

lio

n in

hab

itan

ts

Working age population (15-64) in the world

Africa

SE Asia

Europe

LAC

South America

North America

China

India

Source: UNSTAT. World Population Prospects 2010.

AFRICA’S DEMOGRAPHIC SHIFTS ARE AN OPPORTUNITY FOR CHANGE

15

100 80 60 40 20 0 20 40 60 80 100

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100+

Female Male

2010

2060

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

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0

50

100

150

200

2000 2010 2020 2030 2040 2050 2060

Africa Central Africa East Africa North Africa Southern Africa West Africa

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AFRICA: UNDER AGE 5 MORTALITY PER 1000 BIRTHS BY REGION

DRIVERS OF AFRICA’S ECONOMIC TRANSFORMATION

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… 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

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20

MOST AFRICAN COUNTRIES AT THE BOTTOM OF HDI

INCOME INEQUALITY IS HIGHGINI INDEX FOR SELECTED AFRICAN COUNTRIES

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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

Maternal deaths,

2005

Death of children

under five, 2008

Adults and children

estimated to be living

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.

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

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

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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}

Country Mean

Chad 2004 95

Senegal 2003 60

Cameroon 2004 70

Rwanda 2003 40

Nonwage funds not reaching

schools and health services:

PUBLIC HEALTH SPENDING DISPROPORTIONATELY BENEFITS THE RICH

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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

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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.

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THANK YOU FOR YOUR ATTENTION!