Health care for the world's poorest: Is voluntary (private) health insurance an option?

Poverty reduction, Hunger, Health care financing, Poor Services for, Government spending policy, Public-private partnership,

Trends in social indicators and social sector financing

Over the past three decades, per capita GDP has increased worldwide. The authors examine whether this has resulted in better quality of life in developing countries. This paper documents the evolution of social indicators (health, education, nutrition), private consumption, and government expenditure on the social sectors. They conclude that developing countries made uneven progress in the quality of life in the period under study. Key findings include: (a) health indicators showed stable improvements in all regions, but Africa's rates were the slowest; (b) of all social indicators, education made the greatest gains, however, net enrollment ratios actually decreased in Africa in the 1980s; (c) while developing nations as a group enjoyed improved indices of undernutrition in 1965-85, the degree of undernutrition worsened in more than one-third of sub-Saharan African countries; (d) Africa and Latin America and the Caribbean also saw declines in average per capita private consumption during the 1980s; and (e) the share of total government expenditure on health remained stable in all regions, but that of education declined in Africa, South Asia, and Latin America and the Caribbean. The authors also note that any effort to assess trends is severely hampered by lack of information. The quality of existing data is not systematically trustworthy, and there are many gaps.Health Economics&Finance,Early Childhood Development,Demographics,Health Monitoring&Evaluation,Early Child and Children's Health

Structural adjustment and living conditions in developing countries

The authors compare trends in per capita private consumption, social sector indicators, and government spending in the social sectors, between countries that received Bank adjustment loans and countries that did not. They point out that there is little reason to believe that the poor are being hurt by adjustment because absorption is reduced. But there is still cause for concern : real per capita spending in the social sectors decreased in many countries, especially those adjusting intensely. Improving the living conditions of the poor calls for growth oriented policies, the effects of which will be felt only in the long run. During adjustment, immediate interventions are needed to mitigate short run welfare losses experienced by readily identifiable groups.Environmental Economics&Policies,Poverty Assessment,Inequality,Health Economics&Finance,Economic Theory&Research

An Integrated Scientific Framework for Child Survival and Early Childhood Development

Building a strong foundation for healthy development in the early years of life is a prerequisite for individual well-being, economic productivity, and harmonious societies around the world. Growing scientific evidence also demonstrates that social and physical environments that threaten human development (because of scarcity, stress, or instability) can lead to short-term physiologic and psychological adjustments that are necessary for immediate survival and adaptation, but which may come at a significant cost to long-term outcomes in learning, behavior, health, and longevity. Generally speaking, ministries of health prioritize child survival and physical well-being, ministries of education focus on schooling, ministries of finance promote economic development, and ministries of welfare address breakdowns across multiple domains of function. Advances in the biological and social sciences offer a unifying framework for generating significant societal benefits by catalyzing greater synergy across these policy sectors. This synergy could inform more effective and efficient investments both to increase the survival of children born under adverse circumstances and to improve life outcomes for those who live beyond the early childhood period yet face high risks for diminished life prospects

The Role of Social Capital in Early Childhood Development: Evidence from Rural India

The literature on social capital clearly shows the significant relationship between social capital and individual outcomes such as educational attainment. However, there is little evidence so far on outcomes of very young children. This report studies the role of social capital in enhancing child outcomes. It investigates two potential sources of social capital. At the individual level, the authors consider social capital as the resources and information residing in the social networks of a child's parents. At the community level, we analyze social capital as the willingness of a community to cooperate and engage in collective action. We study the Mahila Samakhya programme in rural Bihar (India), a women's empowerment programme that emphasizes female education. The findings strongly suggest that the programme is successful in increasing parental awareness on the value of preschool and primary education. In other words, the programme seems to increase the informational resources of parents on education, a social capital effect. Moreover, the results indicate that programme members are significantly more likely than non- participants in their village to participate in school management and school activities, and to contribute to the construction of schools and preschools. That is, the results are highly suggestive of increased collective action as well. A second main finding is that these results do not remain limited to programme participants. We find that non-participating women in programme villages are significantly more aware of the importance of (preschool) education than women in control villages. In addition, non- participating households in programme villages are also significantly more likely to participate in school management and activities, and to contribute to school construction. These results suggest that the programme not only increases social capital among its members, but has potentially strong spillover effects to other community members as well. The programme seems to increase individual and community social capital throughout the wider community. Next, we study the relationship between the Mahila Samakhya programme and preschool and primary school enrolment. Controlling for child, household and community characteristics, we find that children in programme villages are significantly more likely to be enrolled in preschool. The number of preschools, itself strongly correlated with the presence of the programme, is highly predictive of enrolment. We also find a significant and additional relationship between individual participation in the programme and preschool enrolment. Finally, the evidence suggests that children living in programme villages, whose mothers do not participate themselves, are significantly more likely to be enrolled as well. In short, the programme seems to have a direct relationship with preschool enrolment For primary school the findings are approximately similar. The main difference is that the spillovers of the programme are much less visible. Only girls and children from the lowest castes seem to benefit of the presence of the programme regardless of whether their mother participates herself. A similar analysis of immunization coverage again shows the large spillovers of the programme: children in programme villages are significantly more likely to be immunized against tuberculosis, diphtheria and measles, regardless of the active participation in the programme. Surprisingly, this result is stronger than for individual membership. The differences in immunization coverage between the member households and non-member households are insignificant (except for measles). Note that the programme does not have any correlation with the immunization against polio. The impact of the recent mass polio campaigns organized by the government may obscure any programme effects. Finally, the report analyses the relationship of the programme with health indicators. In particular, it studies the partial correlations of programme village and programme membership on the prevalence of diarrhea. However, the logistic estimation does not confirm any significant relationship. In contrast, participants in the programme do have better knowledge on how to treat diarrhea once it occurs than control households. Again, this relationship is also significant for non-participants although its size is smaller. In summary, the evidence is strongly suggestive of the positive relationship between the Mahila Samakhya programme and increased individual and community social capital. In addition, the findings strongly suggest a positive relationship with pre- and primary school enrolment. Not only on members, but on non-members as well. We find similar results for immunization and the treatment of diarrhea, a proxy for health practices.social capital early childhood development education immunization health india evaluation

Health, human rights and mobilization of resources for health

BACKGROUND: There has been an increased interest in the role of a human rights framework to mobilize resources for health. DISCUSSION: This paper argues that the human rights framework does provide us with an appropriate understanding of what values should guide a nation's health policy, and a potentially powerful means of moving the health agenda forward. It also, however, argues that appeals to human rights may not necessarily be effective at mobilizing resources for specific health problems one might want to do something about. Specifically, it is not possible to argue that a particular allocation of scarce health care resources should be changed to a different allocation, benefiting other groups. Lack of access to health care services by some people only shows that something has to be done, but not what should be done. SUMMARY: The somewhat weak claim identified above together with the obligation to realize progressively a right to health can be used to mobilize resources for health

Incidence of HIV in Windhoek, Namibia: Demographic and Socio-Economic Associations

To estimate HIV incidence and prevalence in Windhoek, Namibia and to analyze socio-economic factors related to HIV infection. In 2006/7, baseline surveys were performed with 1,753 private households living in the greater Windhoek area; follow-up visits took place in 2008 and 2009. Face-to-face socio-economic questionnaires were administrated by trained interviewers; biomedical markers were collected by nurses; GPS codes of household residences were recorded. The HIV prevalence in the population (aged>12 years) was 11.8% in 2006/7 and 14.6% in 2009. HIV incidence between 2007 and 2009 was 2.4 per 100 person year (95%CI = 1.9-2.9). HIV incidence and prevalence were higher in female populations. HIV incidence appeared non-associated with any socioeconomic factor, indicating universal risk for the population. For women a positive trend was found between low per-capita consumption and HIV acquisition. A HIV knowledge score was strongly associated with HIV incidence for both men and women. High HIV prevalence and incidence was concentrated in the north-western part of the city, an area with lower HIV knowledge, higher HIV risk perception and lower per-capita consumption. The HIV incidence and prevalence figures do not suggest a declining epidemic in Windhoek. Higher vulnerability of women is recorded, most likely related to economic dependency and increasing transactional sex in Namibia. The lack of relation between HIV incidence and socio-economic factors confirms HIV risks for the overall urban community. Appropriate knowledge is strongly associated to lower HIV incidence and prevalence, underscoring the importance of continuous information and education activities for prevention of infection. Geographical areas were identified that would require prioritized HIV campaignin