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Health trends and health goals in the Region

Health trends and health goals in the Region. André Medici Senior health specialist SDS/SOC. Looking back to the nineties…. Financing health : increasing efficiency (health outcomes increased faster than health expenditures);

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Health trends and health goals in the Region

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  1. Health trends and health goals in the Region André Medici Senior health specialist SDS/SOC

  2. Looking back to the nineties… • Financing health: increasing efficiency (health outcomes increased faster than health expenditures); • Great challenges remain: health inequities (poor access health care; bad performance on health indicators; lack of public health facilities and health public goods). • Health reforms: uncompleted, huge conflicts of interests among stakeholders; without consensus and facing financial and budgetary shortages; • Conclusion: dissatisfaction with performance of health sector and with the process of health reforms

  3. Health Expenditures in LAC as a share of GDP (1990-1998) Health expenditures in LAC high-medium income countries felt from 6.3% to 5.8%. In other world countries with same income level health expenditures increased from 2.7% to 4.6%. In LAC medium income countries, health expenditures increased from 5.8% to 7.0% of the GDP, meanwhile in other world countries with same level of income they increased from 3.0% to 3.7%. Health Expenditures as a share of GDP Source: IDB

  4. MDG 4 - Infant and Child Mortality Child Mortality rate under 5 years old in LAC 53 • Goal: Reducing in two thirds the infant mortality between 1990 and 2015. • Indicators • Child mortality rate under 5 years old; • Infant mortality rate; • Measles immunization (< one year old) • 1990 - 77% • 2001 - 91% 34 18 Infant Mortality Rate in LAC 28 14

  5. MDG 5 - Maternal Mortality Maternal mortality rates in LAC • Goal: Reducing in 3/4, between 1990 and 2015, maternal mortality rates • Indicators • Maternal mortality rate (p/100 thousand births); • % of deliveries assisted by skilled personal. • 1989 - 74% • 1999 - 81%

  6. MDG 6 - Fight against HIV/AIDS Incidence rates of HIV/AIDS among Women aged between 15-24 years old – 1996 • Stop and start to reduce the HIV/AIDS transmission by 2015 • Indicators • HIV/AIDS prevalence in pregnant women between 15 and 24 years old. • Use of contraceptives % use of contraceptive methods among women In reproductive age – 1998

  7. MDG 6 - Fight against malaria and other communicable diseases • Stop and start to reduce the malaria and other transmissible diseases by 2015 • Mortality and morbidity rates by malaria; • Population living in risk areas with promotion, prevention and adequate treatment; • Mortality and morbidity by TB; • Cases detected and treated by DOTS as a share of estimated cases TB in LAC - 1999 Incidence per 1000 inhabitants: 8 (Jamaica) to 361 (Haiti) Cases detected and treated by DOTS : 4% (Brasil) to 100% (Jamaica)

  8. MDG 8Global aliance to development • Access to essential drugs to development countries. • Indicator • Population with stable access to essential drugs with affordable prices. Estimation of population covered by essential drugs by Country – end of Nineties Less than 50% (Brazil, Ecuador, Guyana, Haiti, Honduras, Nicaragua) From 50% to 80% (Antigua y Barbuda, Argentina, Bolivia, Dominican Republic, Guatemala, Peru, Saint Kitts y Nevis, Santa Lucia, Trinidad y Tobago, Uruguay). More than 80% (Bahamas, Barbados, Belize, Chile, Colombia, Costa Rica, Cuba, Dominica, El Salvador, Granada, Jamaica, México, Panama, San Vicente y Granadines, Surinam, Venezuela)

  9. Epidemiological Heterogeneity Different levels of development Different phases in the epidemiological transition; Diversity of institutions and cultures affecting the organization of health services; MDG+ Inequality on access Income level; Geography Institutions; Political economy not in favor to target process; Challenges to achieve the MDGs in LAC

  10. Health services access inequality

  11. Inequality in MDGs by income quintiles

  12. Intra-regional inequities in the MDGs Argentina: Maternal Mortality Rates (by 100 thousand) in some, Provinces and Buenos Aires City – 2002

  13. Social Exclusion in the MDGs Brazil: Population with access to safe water by ethnic groups - 1996 Indigenous: 33.8% Black: 60.6% White: 79.9%

  14. Equitable access to publichealth services How health expenditure benefits the population By income quintile (Chile and Ecuador)

  15. The IDB health agenda • Customize the implementation of health reforms; • Emphasize health reforms linked to country specific health needs and objectives incorporating the MDG´s; • Phase health reforms according to country possibilities; • Raise the profile of public health;

  16. Customize the implementation of health reforms • Understanding the politics (political economy context); • Seek consensus, use local talent and set realistic and explicit objectives and time frames; • Reducing health gaps between reach and poor using public resources to target health needs • Tailoring services to increase access and utilization; • Reducing inadequacies in human resources, infrastructure and supplies (more training linked with health needs; • Tailoring reform to respect and include cultural and ethnic diversity; • Promoting good management practices; • Providing financing options;

  17. Emphasize health reforms linked to country specific health needs and objectives incorporating the MDG´s • Health reforms are not an end in themselves but only an instrument to achieve health goals; • Weight MDG´s considering the epidemiological profile of each country and including other emergent health issues according countries´ needs (non communicable diseases, violence, etc); • Emphasize gender perspective in service delivery and utilization. • Promote the efficiency of using public resources in health; • Promoting decentralization of health services through more autonomous local management when necessary.

  18. Phase health reforms according to country possibilities; • Social possibilities • Institutional possibilities • Financial possibilities • Consensus building is key

  19. Raise the profile of public health • Increasing the effectiveness of reforms on the public health in preventing and control health conditions and improve its relationship with health delivery systems; • Rising the role and visibility of public health and primary care; • Improving health risk prevention and the promotion of healthy lifestyles as a national policy; • Promoting community based health systems; • Achieving better balance between disease prevention and control

  20. Health Project of the IDB • Health Sector: 5,2% of the operations in execution and 3,4% of the value of loans; • Since 1973: 62 loans for US$ 2,8 thousand millions; • 40% of the portfolio is in execution representing 70% of the approved amount; • Other Social Projects with Health Components

  21. Financial and no financial products to improve health in LAC • The IDB Health Strategy • Investment Loans • Innovation loans • Performance based loans • Sector Wide Approach Programs (SWAP) • Sector Loans • Technical Assistance – TC funds • Social Development Fund

  22. THANK YOU Email: andrem@iadb.org Phone: (202) 623-1972

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