Addressing the Challenge of HIV/AIDS: Macroeconomic, Fiscal and Institutional Issues

After decades of neglect the HIV/AIDS epidemic has rightly become one of the highest priorities on the global agenda. Funding pledges from the donors have doubled resource commitments between 2002 and 2004 to over $6 billion. That surge in funding belies the volatile nature of contributions to HIV/AIDS initiatives at the country level. The paper analyzes the impacts of abrupt HIV/AIDS funding on macroeconomic stability, fiscal health and the development of health institutions. The macroeconomic effects are ambiguous, but depend on the overall level of aid flows, as well as those for HIV/AIDS, the management of foreign exchange inflows, and effective spending policies. The fiscal ramifications revolve around the jump in external funding that reached around 1000% in Lesotho and Swaziland, and 650% in Zambia between 2002 and 2004, and the required rapid scale up if resources are to be used productively. At the same time, the new HIV/AIDS monies are swamping public health budgets in some cases exceeding 150% of the government’s total allocations for health. The vertical HIV/AIDS programs and the set aside funding threaten to undermine the very institutions that will need to carry forward the long term HIV/AIDS prevention and treatment agenda for each country. Health systems are already fragile, and governance problems and uneven productivity compound the challenges. Health institutions require funding and attention to strengthen them in the fight against HIV/AIDS. While the committed funds are desperately needed, solutions to the dilemma will require creative options to ensure the flow of funds, manage the economic implications and ensure effective service delivery. These are explored in the concluding section.HIV/AIDS, health institutions, aid flows

The Economic Implications of Epidemics Old and New

The outbreak of Severe Acute Respiratory Syndrome (SARS) in the winter of 2002–03 raised the specter of a new, unknown and uncontrollable infectious disease that spreads quickly and is often fatal. Certain branches of economic activity, notably tourism, felt its impact almost at once, and investor expectations of a safe and controlled investment climate were brought into question. Part of the shock of SARS was the abrupt reversal of a mounting legacy of disease control that had altered societies’ expectations from coping with waves of epidemics of smallpox, cholera, and measles, among other diseases, to complacency with the virtual elimination of disease epidemics. This paper analyzes the economic implications of the Great Plague in the fourteenth century, the 1918–19 influenza epidemic, HIV/AIDS and SARS to demonstrate the short- and long-term effects of different kinds of epidemics.severe acute respiratory syndrome (SARS), infectious disease, epidemics

The private sector and family planning in developing countries

While a private sector exists in every society, the nature of its involvement in family planning service delivery varies widely across countries. This paper reviews the role of the private sector in family planning and discusses how much more of the demand for contraception can be met through the private sector, thereby reducing government's subsidies for contraception. Following the introduction, section 2 discusses the characteristics of private sector supply, with a strong emphasis on for-profit producers and distributors of contraceptives. Section 3 describes the distribution of users across sources and addresses the issue of pricing at public, for-profit and NGO sources of family planning services. In section 4 the experience to date with private sector approaches is outlined to provide a sense of what has been and is currently going on in public and and donor efforts to harness and collaborate with the private sector. Section 5 presents alternative means for government and donors to promote private sector activity in family planning, and suggests some of the costs of a greater private sector role. The final section summarizes and concludes the paper.Health Monitoring&Evaluation,Adolescent Health,Agricultural Knowledge&Information Systems,Health Economics&Finance,ICT Policy and Strategies

Social exclusion and the gender gap in education

Despite a sharp increase in the share of girls who enroll in, attend, and complete various levels of schooling, an educational gender gap remains in some countries. This paper argues that one explanation for this gender gap is the degree of social exclusion within these countries, as indicated by ethno-linguistic heterogeneity, which triggers both economic and psycho-social mechanisms to limit girls'schooling. Ethno-linguistic heterogeneity initially was applied to explaining lagging economic growth, but has emerged in the literature more recently to explain both civil conflict and public goods. This paper is a first application of the concept to explain gender gaps in education. The paper discusses the importance of female education for economic and social development, reviews the evidence regarding gender and ethnic differences in schooling, reviews the theoretical perspectives of various social science disciplines that seek to explain such differences, and tests the relevance of ethnic and linguistic heterogeneity in explaining cross-country differences in school attainment and learning. The study indicates that within-country ethnic and linguistic heterogeneity partly explains both national female primary school completion rates and gender differences in these rates, but only explains average national learning outcomes when national income measures are excluded.Primary Education,Education For All,Gender and Education,Population Policies,Disability

Governance in health care delivery : raising performance

The impacts of health care investments in developing and transition countries are typically measured by inputs and general health outcomes. Missing from the health agenda are measures of performance that reflect whether health systems are meeting their objectives; public resources are being used appropriately; and the priorities of governments are being implemented. This paper suggests that good governance is central to raising performance in health care delivery. Crucial to high performance are standards, information, incentives and accountability. This paper provides a definition of good governance in health and a framework for thinking about governance issues as a way of improving performance in the health sector. Performance indicators that offer the potential for tracking relative health performance are proposed, and provide the context for the discussion of good governance in health service delivery in the areas of budget and resource management, individual provider performance, health facility performance, informal payments, and corruption perceptions. What we do and do not know about effective solutions to advance good governance and performance in health is presented for each area, drawing on existing research and documented experiences.Health Monitoring&Evaluation,Health Systems Development&Reform,Public Sector Expenditure Policy,Health Economics&Finance,Health Law

Health investments and economic growth : macroeconomic evidence and microeconomic foundations

This paper reviews the correlations and potential links between health and economic growth and summarizes the evidence on the role of government in improving health status. At the macroeconomic level, the evidence of an impact of health on growth remains ambiguous due both to difficulties in measuring health, and to the methodological challenges of identifying causal links. The evidence on the micro linkages from health investments to productivity and income are robust. Progress in life expectancy over the past two centuries has been spectacular, fueled by: improved agriculture that has increased food quantity; knowledge of disease transmission, and effective public health interventions that have controlled communicable diseases such as malaria, yellow fever, and hookworm; and, most recently and importantly, investments in very young children that pay off in healthier and more productive adults. Whether public investments in medical care affect health hinges on the quality of health institutions. In much of the developing world, factors such as chronic absenteeism among public providers, poor budget execution, ineffective management, and virtually no accountability weaken public efforts. Institutional issues are central in efforts to enhance public health investments, which in turn have a direct impact on the population's welfare and, perhaps over the long term, improvements in national income.Health Monitoring&Evaluation,Health Systems Development&Reform,Population Policies,Health Economics&Finance,Disease Control&Prevention

Effects of additional anterior body mass on gait

BACKGROUND: Gradual increases in mass such as during pregnancy are associated with changes in gait at natural velocities. The purpose of this study was to examine how added mass at natural and imposed slow walking velocities would affect gait parameters. METHODS: Eighteen adult females walked at two velocities (natural and 25 % slower than their natural pace) under four mass conditions (initial harness only (1 kg), 4.535 kg added anteriorly, 9.07 kg added anteriorly, and final harness only (1 kg)). We collected gait kinematics (100 Hz) using a motion capture system. RESULTS: Added anterior mass decreased cycle time and stride length. Stride width decreased once the mass was removed (p < .01). Added mass resulted in smaller peak hip extension angles (p < .01). The imposed slow walking velocity increased cycle time, double limb support time and decreased stride length, peak hip extension angles, and peak plantarflexion angles (p < .01). With added anterior mass and an imposed slow walking velocity, participants decreased cycle time when mass was added and increased cycle time once the mass was removed (p < .01). CONCLUSIONS: Gait adaptations may be commensurate with the magnitude of additional mass when walking at imposed slow versus natural velocities. This study presents a method for understanding how increased mass and imposed speed might affect gait independent of other effects related to pregnancy. Examining how added body mass and speed influence gait is one step in better understanding how women adapt to walking under different conditions.K12 HD055931 - NICHD NIH HHS; K23 AR063235 - NIAMS NIH HH