Investing in Health in Africa

1
Investing in Health in Africa

• By
• Dr. Akudo Anyanwu Ikemba MD, MPH

2
Burden of Disease

• Malaria 2 million deaths per year
• TB - 2 million deaths per year

3
Disease Specific Interventions Scale-up

• Drugs, diagnostics, aids
• Malaria ITNs, ACTs, IPT
• TB
• HIV - ARVs
• Childhood illnesses - vaccinations
• Maternal illnesses
• Surgeries

4
Where do Africans Receive health care

• Native Doctors
• Market Chemists
• Pharmacists
• Government Hospitals and clinics
• Private Hospitals
• Abroad

5
Health is Wealth
6
USA Indicators

• Population 291,038,000
• Annual growth rate () 1.1
• Total fertility rate 2.1  
• Life expectancy at birth (years) 79.8

7
Nigeria

• Population 137,253,133
• Annual growth rate () 2.8
• Total fertility rate 5.5  
• Life expectancy 47  

8
USA Indicators

• Total Expenditure on health 13.9 of GDP
• Government expenditure on health as of total
  government expenditure 17.6
• Private expenditure on health as of total
  expenditure on health 55.6  

9
Nigeria Indicators

• Total expenditure on health as of GDP 3.4
• Government expenditure on health as of total
  government expenditure 1.9
• Private expenditure on health as of total
  expenditure on health 76.8

10
USA Indicators

• Under-five mortality rate 9
• Infant mortality rate 7
• Maternal mortality ratio 14
• Malaria mortality rate Per 0  
• Tuberculosis prevalence Per 4

11
Nigeria Indicators

• Under-five mortality rate 183
• Infant mortality rate 98
• Maternal mortality 800
• Malaria mortality 209
• Tuberculosis prevalence 491

12
Human Development Index
13
System Intervention

• Hospitals
• Clinics
• Management information Systems
• Fund management for Health Programs
• Consulting for Health Programs
• Training programs short term, long term/
  various tiers

14
Indirect

• Waste management (sewage and garbage)
• Water purification schemes
• Helmets
• Increased food production agricultural
  technology

15
Challenges

• Lack of policy
• Lack of effective insurance schemes
• Low demand

16
Why Invest

• Disparities create instability
• Productivity is low
• Investing in health fuels other investments
  Increasing life expectancy lower fertility
  rates increased investment in human capital
  increased household saving more investment
• Job creation will decrease brain drain

17
Household expenditure on health US vs Nigeria
18
Non-profit investments
19
Public Health Funds

• The Global Fund
• World Bank
• UNICEF
• IDB
• DFID, USAID, JIKA, GTZ and other bilaterals
• Government Funds

20
Nigeria

• Population
• 137,253,133
• HIV/AIDS prevalence rate
• 5.0 (2003)
• PLHA
• 3.6 million (2003 est.)

21
Approved Nigeria Projects

• Round One
• PMTCT - 27 million USD
• ARV 79 million USD
• Round Two
• Malaria comprehensive efforts in ITN, PPD, IPT
  44 million USD
• Civil society strengthening civil society to
  respond to HIV 1.6 million USD
• Round Four
• Malaria - 86 million USD
• 5yr total 220 million USD

22
Recommendations

• Dont wait until everyone is insured USA
  44million uninsured
• Be close to govt to influence policy
• Demand creation