Unit 9 - Explaining Trends In Capability Poverty Flashcards
It is difficult to reach the children who are most marginalized in developing countries, which are:
Girls
Children in rural communities
Children from the poorest 20% of society
Progress on MDG 6
HIV / AIDS - declined between 2001-2009 with almost 25%
33% live with HIV (27% increase sinds 1999)
SSA 69% of newly infected, 68% of all HIV and 72% of all AIDS
23% is
Identified priorities in addressing the child mortality MDGs
Parallel needs for medical and systemic investment
Medical priorities:
- Diarrhea (17% of infant deaths)
- pneumonia (19% of infant deaths)
- measles
- malaria
- HIV/AIDS
- TB
Systematic priorities:
- neo-natal care and nutrician
- maternal education
- ensuring universal access to health care.
Maternal eduction
- Provide appropriate care for newborns / postnatal care
- Raising awareness of the issues linking maternal mortality with childbearing
- Encouraging adoption of preventative medicine at the family and community level.
- Highlighting the link between health and nutrition
Undernutrician is 1/3 of these deaths (before 28 days) in SSA and Southern Asia.
Regional progress in primary eduction
Sub-Sahara Africa - best improvement
From 53% in 1991 to 79% in 2015 (+26%)
30% drop outs
32m children not in school
Southern Asia - also good improvement From 75% to 95% (1991-2015) (+20%) Especially access for girls - 1991 76 girls for every 100 boys - 2015 102 girls for every 100 boys 16m children not in school
Other in 2015: LA 95% Caribbean 82% Northern africa almost 100% (from 81%) Caucasus / central asia 95%
Progress on MDG 5
Reduction of maternal mortality
Target = reduction of 75%
However between 2000 and 2013 it dropped 38%, from 370 to 230 per 100.000 deaths.
SSA and southern asia accounted for 87% of worldwide maternal deaths in 2008.
What are the factors that stand in the way of reaching the outstanding international goals on health?
- International procurement of medicines and medical resources
- National distribution of medicines and medical resources to those most at risk
- Weakness in national health communications and distribution infrastructure
- Weaknesses in infrastructure for health care provision
- Insufficient numbers of trained staff
- National capacity for training and recruitment to reach numbers
- Insufficient resources to monitor and ensure good basic health practice at community/hh level
Causes of lack of health workforce
- Number of people being trained and educated (example ethiopia only 200 doctors per year)
- Poor working conditions
- Large salary differences between public and private sector
- International migration
Community health workers should…
- be paid and trained
- have skills and training on health promotion, prevention and curative interventions
- be supervised by professionals
- be linked to national health structure as integral part of the formal health system
- have opportunities for further training and professional advancement.
Increase of enrolment in primary eduction worldwide between 1991 and 2015
From 80% in 1991 to 91% in 2015
Most rapid increase in sub saharan africa, net enrolment rate still lowest with caribbean and south asia (excl. india)
Poverty and education - the underlying barriers to access
- indirect cost of education
- Quality of education
- Health and long-term educational access (school feeding programmes)
- Long-term eductional participation
- Education, employment and poverty
Addressing access/procurement of medical resources
Advocacy & lobbying of IO’s and citizens:
- provide updated lists of essential medical resources
- try to ensure governments make committment to access these essentials
- national health services can adopt
- policies for promoting generic medicines
- alternative financing mechanisms
- hold pharmaceutical companies accountable
Common barriers to educational access that are specific to rural settings are:
- Low number and poor distribution of schools across rural regions
- Distance to school
- High number of children per class
- High teacher:pupil ratio
Progress on MDG 4
Reduce child mortality
From 100 per 1000 in 1990 to 50 in 2013 (underestimated)
Target was reduction of 2/3 - so not met, a reduction of almost 50% was met.
Souther Asia - 60 per 1000 in 2013 (or 1 in 17)
Factors that influence the levels of health care that the poorest sections of society are able to access
- Geographical location
- Number of health facilities
- Distances to health facilities
- Availability of care (frequency treatment, speed of access)
- Cost
- Workforce availability and quality
- Poverty levels of community
- Health level of community
- Social and cultural profiles
Measuring children’s participation in education in SSA (Lewin, 2009) - variety of intersecting factors:
- Gender
- Urban vs rural
- Regional demographics - incl. Regional populations and dispersal of schools
- Income and poverty levels of pupils
The range of approaches to ensure universal primary eduction (which involves the hardest-to-reach children as well
- Targeted policy decisions designed to lower pre-existing barriers and encourage enrolment (Abolition of fees, subsidies etc)
- instruments in infrastructure (school building programs, girl friendly designs)
- investment in HR
Addressing health workforce shortages
- Government needs to address recruitment and retention issues through policies, salary, working conditions and professional opportunity
- Address current levels of health worker training and education, increase numbers and change the modes.
- Who should be trained, selection.
- Community health workers for low level medical interventions
Access to and procurement of medical resources
1/3 of world population has no regular access to medicines and medical resources
- procurement sometimes upto 11x the reference prices
- purchase 9-25x the reference prices
Supply comes through private sector & payment throug out-of-pocket payments»_space; exclusing the poor and vulnerable
Approaches used in addessing international health goal
- Programmes of immunisation and vaccination
- Low-cost prevention and treatment
- Maternal education programmes
10x more mosquito nets resulted in 44% fewer child deaths of malaria.
Key interventions in health care
- Immunisation and vaccinations programmes
- Low-cost prevention and treatment
- Health education
The health MDG’s
- Reduce child mortality
- Improve maternal health
- Combat HIV/AIDS, malaria and other diseases
Approaches used in seeking attainment of universal primary eduction
- Abolition of school fees
- Expanding access in remote and rural areas (school building programs, teacher recruitment programmes, targeted initiatives)
- Promotion of eduction for girls
- Addressing social attitutes
- Financial incentives
- Teacher recruitment and training practises
- ‘Girl-friendly’ eductional infrastructure
- ‘Girl-friendly’ registration policies
Challenges in delivering approaches associated with the international health goals
- Access to and procurement of medical resources
- Local health facilities and distribution systems
- Shortage of health workforce
Barriers that prevent the poor from access to medical services
- Geographic accessibility
- Financial accessibility
- Availability of care (frequency and speed)
- Quality of care
- Acceptability of care
primary eduction completion rate in development regions
Only 73 out of 100 children in development regions complete primary eduction.
In half of the LDC’s, 40% drops out before reaching the last grade.
Vertically vs horizontally oriented health care models
Vertically: focus on one disease, encourages approaches to tackle a disease and not improve the health system.
Horizontally:
- seek to identify parallel requirements between various diseases, illnesses and conditions
- capitalise on these synergies with overall improvement in systematic care delivery
