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);

• 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

Health Expenditures in LAC as a share of GDP (1990-1998)

Health Expenditures as a share of GDP

2.5

3.5

4.5

5.5

6.5

7.5

1990 1991 1992 1993 1994 1995 1996 1997 1998

Years

%G

DP

LAC HMI

OTHERS HMI

LAC MI

OTHERS MI

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%.

Source: IDB

MDG 4 - Infant and Child Mortality

• 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%

0

10

20

30

40

50

60

1990 1995 2000 2005 2010 2015

Ocurred Expected

Child Mortality rate under 5 years old in LAC

Infant Mortality Rate in LAC

0

5

10

15

20

25

30

35

40

45

1990 1995 2000 2005 2010 2015

Ocurred Espected

42

53

34 18

28

14

• 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%

0

50

100

150

200

250

1990 1995 2000 2005 2010 2015

190 190

47.5

MDG 5 - Maternal Mortality

Maternal mortality rates in LAC

MDG 6 - Fight against HIV/AIDS

• 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

Incidence rates of HIV/AIDS amongWomen aged between 15-24 years old – 1996

0.3

2.912.78

1.661.36

0.92

0.40.280.270.240.170.080.060.060

0.5

1

1.5

2

2.5

3

LAC HA RD HO PA GU JA BR ES AR PE CH ME NI

% use of contraceptive methods among women In reproductive age – 1998

71399

2311

510

24

18

7059

5856

4146

4841

4845

27

0 20 40 60 80 100

BrasilColombia

ALCM exico

P eruEcuador

El SalvadorP araguay

R. Domenic. Nicaragua

Bolivia

Traditional M odern

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

Malaria en ALC en 2000: Población en áreas de riesgo (emmil habitantes)

Sin información, 2000

PoblaciónPoblaciónen areas deen areas de

riesgoriesgomoderadomoderado

41,44441,444

Riesgo moderado

Población enPoblación enareas de altoareas de alto

riesgoriesgo

35,32935,329

Alto riesgo

Población enPoblación enareas de bajoareas de bajo

riesgoriesgo

131,387131,387

Bajo riesgo

* en miles

TB in LAC - 1999

Incidence per 1000 inhabitants: 8 (Jamaica) to 361 (Haiti)

Cases detected and treated by DOTS : 4% (Brasil) to 100% (Jamaica)

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 byCountry – 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)

Challenges to achieve the MDGs in LAC

• 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;

Health services access inequality

Inequality in MDGs by income quintiles

Richest quintile divided by poorest quintile

País Child Mortality

Rate Under 5 years old

Infant Mortality

rates

Children under 5

years old receiving

the complete

immunization cycle

Birth deliveries attended by

skilled personnel

Use of contraceptives in

women aged between 15 and

49 years old

Brasil 3.7 2.9 0.8 0.2 0.7 Bolivia 4.6 4.2 0.7 0.7 0.2 Colombia 2.2 2.5 0.7 0.6 0.6 Dom. Rep. 3.4 2.9 0.5 1.0 0.8 Perú 5.0 4.0 0.8 0.4 0.5 Guatemala 2.7 1.6 1.0 0.5 0.1 Haití 1.5 1.3 0.4 0.7 0.2 Paraguay 2.8 2.7 0.4 0.7 0.4 Nicaragua 2.3 2.0 0.8 0.4 0.6

Intra-regional inequities in the MDGs

Argentina: Maternal Mortality Rates (by 100 thousand) in some, Provinces and Buenos Aires City – 2002

9

43

87

139159

197

0

50

100

150

200

250

BuenosAires

Argentina San J uan Formosa Chaco J ujuy

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%

Equitable access to publichealth services

05

101520253035

Chile Ecuador

How health expenditure benefits the population By income quintile (Chile and Ecuador)

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;

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;

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.

Phase health reforms according to country possibilities;

• Social possibilities

• Institutional possibilities

• Financial possibilities

• Consensus building is key

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

Health Project of the IDBHealth 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

Health Projects of the IDB: 1973-2004

0

2

4

6

8

10

12

14

16

18

1973/76 1977/811982/861987/911992/961996/002001/04

Years

0

100

200

300

400

500

600

700

800

900

Projects Value

Health Portfolio 1995-2004

0.00

50.00

100.00

150.00

200.00

250.00

300.00

350.00

400.00

450.00

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

U$S

Milli

ons

0

1

2

3

4

5

6

Amount

Number

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

THANK YOU

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