Abdo S. Yazbeck - Böcker

This volume presents eleven case studies that document how well or poorly health, nutrition, and population programs have reached disadvantaged groups in the countries of Africa, Asia, and Latin America where they were undertaken. The studies were commissioned by the Reaching the Poor Program, undertaken by the Word Bank in cooperation with the Bill and Melinda Gates Foundation and the Dutch and Swedish governments, in an effort to find better ways of ensuring that health, nutrition, and population programs benefit the neediest. These case studies, reinforced by other material gathered by the Reaching the Poor Program, indicate clearly that health programs do not have to be inequitable. Although most health, nutrition, and population services achieve much lower coverage among disadvantaged groups than among the better-off, many significant and instructive exceptions exist. These show that the poor can be reached much more effectively than at present and point to potentially promising strategies for doing so.

While women in developing countries continue to die in large numbers in child birth, Population and Reproductive Health specialists and advocates around the world are struggling to keep the policy agenda focused on the rights and needs of poor women. The 1994 Cairo Conference and Program of Action changed how we do business, and opened many doors, but the agenda is not complete and has stalled in a number of ways. At the country level, governments and donors are making difficult choices about how and where to allocate scarce human and financial resources. Funding approaches have moved away from the implementation of narrowly directed health programs to a broader approach of health system development and reform. At the same time, countries are also centering their development agenda on the broad goal of poverty reduction. This volume addresses a large knowledge and capacity gap in the Reproductive Health community and provides tools for key actors to empower faster positive change. It is a synopsis of the materials developed for WBI's learning program on Achieving the Millennium Development Goals: Poverty Reduction, Reproductive Health and Health Sector Reform.The volume brings together knowledge about epidemiology, demography, economics, and trends in global financial assistance. The volume also introduces practical tools such as benefit incidence analysis, costing, and stakeholder analysis to strengthen the evidence base for policy and to address the political economy factors for reform.

The last 10 years have seen a resurgence in interest and research around inequalities in the health sector. While a disproportionate share of the new research has focused on measuring inequality in the health sector, work is emerging on how to understand the causes of inequality and on identifying successful approaches for tackling the problem. This book summarizes the operational lessons emerging from this new focus. It is intended to be an operational resource for change agents within and outside government in low and middle countries committed to improve access and use of critical health services to income poor and social vulnerable populations.

Health and economic development are interconnected. Over the past decades, the health sector has become an increasingly important component of the global economy, evidenced by the growing trend of health expenditures as a share of GDP. The interconnectivity of health and economic development and the cyclical nature of economic performance have emphasised the critical need to build health sector resilience to prepare for inevitable economic downturns. The objective of the book is to raise awareness of the challenges that health systems, in both developing and developed countries, face in times of economic crisis and provide an Assessment, Tracking and Mitigation (A.T. M.) framework by which governments and policy makers can meet the critical challenge of health sector stabilisation and resilience building. The A.T.M. framework emphasises the importance of the interdependence of these three pillars for effective crisis response and strengthening health system resilience to economic shocks. The framework proposes that, in order to be effective in mitigation, governments and policy makers must possess or develop: (i) Tools to assess the health sector vulnerability to economic crisis. (ii) Tools, information systems, and data sources to track system and population level effects quickly during the crisis. (iii) Ability to implement effective policies to mitigate effects when a crisis hits.In conclusion, while the links between health and the overall economy are increasingly understood and appreciated, the role of health in an economic downturn is still not well understood or planned for. This book builds on the lessons of the most recent global financial crisis, especially in Europe and Central Asia and proposes a more effective role for the health sector as part of a safety net function and as a stabiliser for the population during a crisis. To mitigate the impacts of crises on vulnerable populations and assume the role of a stabiliser, the health sector must use assessment tools to identify system vulnerabilities, track to detect early impacts, and build targeted systems that are prepared to meet the challenges of the future. The experience and instruments in the Social Protection sector offer lessons and opportunities for collaboration with health.

Africa is poised on the edge of a potential takeoff to sustained economic growth. This takeoff can be abetted by a demographic dividend from the changes in population  age  structure.  Declines  in  child  mortality,  followed  by  declines in fertility, produce a 'bulge' generation and a large number of working age people, giving a boost to the economy. In the short run lower fertility leads to lower youth dependency rates and greater female labor force participation outside the home. Smaller family sizes also mean more resources to invest in the health and education per child boosting worker productivity. In the long run  increased  life  spans  from  health  improvements  mean  that  this  large, high-earning  cohort  will  also  want  to  save  for  retirement,  creating  higher savings  and  investments,  leading  to  further  productivity  gains.  Two  things are required for the demographic dividend to generate an African economic takeoff. The first is to speed up the fertility decline that is currently slow or stalled in many countries. The second is economic policies that take advantage of  the  opportunity  offered  by  demography.  While  demographic  change  can produce more, and high quality, workers, this potential workforce needs to be productively employed if Africa is to reap the dividend. However, once underway, the  relationship  between  demographic  change  and  human  development works in both directions, creating a virtuous cycle that can accelerate fertility decline, social development, and economic growth. Empirical evidence points to three key factors for speeding the fertility transition: child health, female education, and women’s empowerment, particularly through access to family planning. Harnessing the dividend requires job creation for the large youth cohorts  entering  working  age,  and  encouraging  foreign  investment  until domestic savings and investment increase. The appropriate mix of policies in each country depends on their stage of the demographic transition.