Friday, January 23, 2015

Larger, targeted investments needed in healthcare

The recently published Global Burden of Disease Study 2013 reveals three important things. HIV/AIDS remains significant health challenge in sub-Saharan, non-communicable diseases are the most critical threat to public health in the developing world and global child mortality declined by 52 per cent.  

The Institute for Health Metrics and Evaluation, which led the study, utilized an unprecedented volume of input data. Analysis of the so-called big data in fields ranging from genomics to marketing has become a major driver of knowledge and evidence discovery for decision-making. Data science, the analysis of big data, is critical to the assessment of the global burden of disease. Understanding the causes and distribution of the global burden of disease, injury, disability and mortality is key to rationalizing investments in prevention and care.

Life expectancy for men and women increased from 65.3 years in 1990 to 71.5 years in 2013. Globally, the top five causes of years of life lost include, heart disease, lower respiratory infections, stroke and diarrhea. The top five causes of years of life lost in Kenya include, HIV/AIDS, lower respiratory infections, diarrhea, tuberculosis and preterm birth complications. Years of life lost is an indicator of premature mortality.

Globally, mortality for children under 5 dropped by 52 per cent. Diarrheal diseases, lower respiratory infections, neonatal causes, and malaria are still the top five causes of child mortality. Communicable and nutritional causes accounted for more than three-quarters of deaths, while lower respiratory infections and malaria accounted for more than a third of the deaths.

However, half of the improvements in child survival have occurred in two countries; China and India. A majority of countries in the sub-Saharan Africa have seen either no change or an increase in absolute numbers of newborn and under-5 mortality. Post 2015, the moment is right for making healthcare an economic and political priority, both nationally and globally.    

Public health experts have argued that achieving convergence in health outcomes between high and low income countries is possible within a generation. The Global Burden of Disease Study 2013 reveals that grand epidemiological convergence between developed and developing countries remains a distant mirage. Health outcomes, across all age groups, for sub-Saharan Africa are deplorable, albeit significant improvements in the last two decades. We have work to do before we can get Africa firmly on a health convergence path with Asia and the rest of the world.

Two questions are worth are asking. Why should governments invest in health? What specifically should governments invest in? Achieving health equity is an important dimension of social justice and a fundamental human right. But this justice and rights argument would not convince the finance minister to allocate more resources for health care.

Leading economists have estimated that malaria is responsible for an annual “economic growth penalty” of up to 1.3 per cent in malaria-endemic African countries. Malaria costs African countries an estimated US$12 billion per year (circa 36% of Kenya’s annual GDP) in lost productivity. Treatment of severe episodes takes up to 25% of household income and accounts for up to 40 per cent of public sector health expenditures in sub Saharan Africa.

The World Development Report 1993, Investing in Health, demonstrated that well targeted health expenditures are investment in economic prosperity, not an economic drain. Recent analysis reveals that reductions in mortality accounted for about 11 per cent of economic growth in low-income countries. Moreover, about 24 per cent growth in income in low-income countries resulted from value of additional life years gained in the last decade. Healthier is wealthier. A healthy population is more productive, earns more, and consumes more, generating a positive impact on GDP.

A recent report, Investing in Health for Africa, argues that an average additional average spending in Sub-Saharan Africa of US$ 29 could by 2015 save over 3 million lives, 90 per cent of which would be children and women, generating US$100 billion in economic benefits. For Kenya, this translates to a modest additional spending of US$1.2 billion dollars annually.


Increased investment in health should focus on the main contributors to the burden of death, namely child and maternal mortality, HIV/AIDS, TB, malaria, lower respiratory infections and non-communicable diseases. Significant public and private investments must be targeted at strengthening health delivery systems, inter-professional coordination, expanding access to and enhancing functional capacity of points of care, while ensuring equity and social inclusion in health service delivery.

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