Working Paper 38 - Health Development in Africa

The aim of this paper is to provide a framework that national governments and international agencies can use to accelerate health development in Africa. It shows the respective roles of socioeconomic, political and medical factors in the determination of health status of a population. Using measures of health development such as infant mortality, crude death rate, fertility and longevity, the paper finds that there has been progress in health development in Africa over the past 15 years. In particular, life expectancy for the whole continent increased by some 5 years, a finding consistent with a steady decline in infant mortality over the same period. Even so, the level of health development in the continent remains quite low compared with measures of health status in continents at similar stages of socioeconomic development. Moreover, the quality of life in Africa may not have improved at the same rate as the indicators of health development because of probable increases in morbidity and in psycho-social stress due to economic hardships of the continent over the past 15 years.

Financing health services in Africa : an assessment of alternative approaches

This paper outlines a strategy for financing health services in sub-Saharan Africa. The individual components of the strategy are as follows: general tax revenues, international finance, a system of user charges, community finance, health insurance, and contributions from nongovernmental organizations, including the private sector. The author states that financial positions of public health care systems in sub-Saharan Africa would be greatly enhanced if governments in the region were to adopt policies that would use each of the above sources of finance. Since a strong financial base is a prerequisite for an effective health care system, such policies would considerably improve the health status of the population. It is important that for each country different policies be pursued at various levels of society, and in different sectors of the economy.Health Systems Development&Reform,Health Monitoring&Evaluation,Housing&Human Habitats,Health Economics&Finance,Pharmaceuticals&Pharmacoeconomics

The Effects of Agricultural Extension on Farm Yields in Kenya

The paper examines effects of agricultural extension on crop yields in Kenya controlling for other determinants of yields, notably the schooling of farmers and agro-ecological characteristics of arable land. The data we use were collected by the Government of Kenya in 1982 and 1990, but the estimation results reported in the paper are based primarily on the 1982 data set. The sample used for estimation contains information about crop production, agricultural extension workers (exogenously supplied to farms), educational attainment of farmers, usage of farm inputs, among others. A quantile regression technique was used to investigate productivity effects of agricultural extension and other farm inputs over the entire conditional distribution of farm yield residuals. We find that productivity effect of agricultural extension is highest at the extreme ends of distribution of yield residuals. Complementarity of unobserved farmer ability with extension service at higher yield residuals and the diminishing returns to the extension input, which are uncompensated for by ability at the lower tail of the distribution, are hypothesized to account for this U-shaped pattern of the productivity effect of extension across yield quantiles. This finding suggests that for a given level of extension input, unobserved factors such as farm management abilities affect crop yields differently. Effects of schooling on farm yields are positive but statistically insignificant. Other determinants of farm yields that we analyze include labour input, farmer experience, agro-ecological characteristics of farms, fallow acreage, and types of crops grown.agricultural extension, economic effects

Labor Unions and the Distribution of Wages and Employment in South Africa

Labor unions are an important economic and political force in South Africa. Inequality in wage rates is among the largest in the world in South Africa, with African and white workers receiving wages that differ by a factor of five. The complex role of unions in closing and creating this wage gap is assessed in this paper. Union membership among Africa male workers is shown to be associated in 1993 with their receiving wages that are 145 percent higher than comparable nonunion workers in the bottom decile of the wage distribution, and 19 percent higher in the top decile of the wage distribution. Quantile regression estimates also indicate the returns to observed productive characteristics of workers, such as education and experience, are larger for nonunion than union workers. If the large union relative wage effect were reduced in half, we estimate employment of African youth, age 16-29, would increase by two percentage points, and their labor force participation rate would also increase substantially.Labor Unions, Wages and Employment, South Africa

Referral systems and health-care-seeking behaviour of patients: an economic analysis

The paper studies medical referral systems of developing countries in relation to patients' health-care-seeking behaviour. It is shown that the vertical referral structures are consistent with patients' cost-minimizing behaviour in their search of medical treatments. This consistency is a consequence of a common desire among patients and health planners, to minimize costs of treating illnesses so as to get the most from their limited resources. The conditions under which the medical referral system reflects treatment seeking behaviour of patients are specified. Since these conditions do not hold exactly in the real world, the referral system has some major weaknesses as a model of how National Health Service delivery systems actually function. Reforms that can be undertaken to rectify these weaknesses are suggested

Health Economics for Low-Income Countries

Good health is a determinant of economic growth and a component of well-being. This paper discusses and synthesizes economic models of individual and household behavior, showing how they may be used to illuminate health policy making in low-income countries. The models could help address questions such as: How can the health of the poor be improved, and what are the economic consequences of better health? What policies would improve intra-household distribution of health outcomes? An extensive literature on health human capital and household models, and on related field experiments is reviewed in an attempt to answer these questions. It is found that there are large returns to health improvements in low-income countries. Moreover, health improvements in poor nations can be achieved through implementation of simple interventions such as dietary supplements, control of parasitic diseases, and pro-poor social expenditures. The paper concludes with a discussion of these policy options.Health Production, Health Care Markets, Household Production and Intrahousehold Allocation, Health Economics, Low-income countries

Why Did Abolishing Fees Not Increase Public School Enrollment in Kenya?- Working Paper 271

A large empirical literature has shown that user fees significantly deter public service utilization in developing countries. While most of these results reflect partial equilibrium analysis, we find that the nationwide abolition of public school fees in Kenya in 2003 led to no increase in net public enrollment rates, but rather a dramatic shift toward private schooling. Results suggest this divergence between partial- and general-equilibrium effects is partially explained by social interactions: the entry of poorer pupils into free education contributed to the exit of their more affluent peers.