IJAIYA, Muftau Adeniyi
Accounting & Finance
Senior Lecturer
Women Living with HIV/AIDS and Government Spending in Health
Care Services in sub-Saharan Africa. The Indian Journal of
Development Research and Social Action 5 (1-2): 151-161, (A
Publication of Ananya Institute for Development Research and Social
Action, Lucknow, India).
151
Indian Journal of Development Research & Social Action 2009; 5 (1-2): 151 -161
WOMEN LIVING WITH HIV/AIDS AND
GOVERNMENT SPENDING ON HEALTH CARE
SERVICES IN SUB-SAHARAN AFRICA
Gafar T. Ijaiya*, Abdulgafar R. Bello**,
Muftau A. Ijaiya***& Usman A. Raheem****
ABSTRACT
The paper on 'Women Living with HIV/ AIDS and Government Spending on
Health Care Services in Sub-Saharan Africa attempts that how the increase in the
spread of HIV/AIDS and its subsequent effects on morbidity, mortality and
poverty has made it paramount for governments in Sub-Saharan African
countries to increase funds to combat it. Using a linear regression analysis, this
paper first established a link between women living with HIV/AIDS and
government spending on health care services in Sub-Saharan Africa. Secondly,
the paper provides an estimate of additional funds that would be required by the
governments on health care services that would be enough to take care of more
women living with HIV'/AIDS In order to achieve this, measures like increase in
governments budgetary allocation to the health sector, increase in social and
financial support from foreign governments and international donor agencies,
reduction in tribal and civil conflicts in the sub-region and good governance are
therefore suggested.
Introduction
The upsurge in HIV/AIDS pandemic in Sub-saharan African countries has
been a great concern to the governments, non-government organizations,
community-based organizations and individuals, because it is more than just
a health crisis but a development crisis since the most affected and
vulnerable have been the women and children. For instance, the number of
people suffering from HIV/AIDS has been on the increase since the mid
1990s with the global summary of the pandemic in 2001 standing at about 40
million people with 17.5 million and 27 million of them women and children
respectively. Available data on HIV/AIDS also indicated that in 2002 the
* Poverty Analyst and a lecturer in the Department of Economics, University of Ilorin, Ilorin, Nigeria.
**Health Economist and a lecturer in the Department of Economics, University of Ilorin, Ilorin, Nigeria.
***Rural Informal Financial Analyst & a Lecturer in the Dept. of Accounting and Finance, University of
Ilorin, Ilorin, Nigeria.
****Teaches Medical Geography in the Dept. of Geography, University of Ilorin, Ilorin, Nigeria.
152
world witnessed increases in HIV/AIDS with about 42 million people
infected with the disease, out of which 2.4 million deaths were recorded.
Sub-Saharan Africa with less than 11 per cent of the world's population
contains more than 70 per cent of all HIV infected people. Children, men and
women with HIV/AIDS were 9 per cent, 38 per cent and 53 per cent
respectively. At the country level, Botswana, Zimbabwe, Swaziland and
Lesotho recorded 38.8 per cent, 33.7 per cent, 33.4 per cent and 31.0 per cent
respectively of the people infected (Lamptey, et. al 2002; PRB 2003; UNAIDS
2003a; UNAIDS 2003b; World Bank 2003; PRB 2004; PFI/PRB 2004; Masha
2004; World Bank 2005a; World Bank 2005b ).
A number of factors are adjudged to have caused this increase. According
to Bulatao and Bos 1992; World Bank 1997; Bonnel 2000; Lamptey, et.al 2002;
O'Malley 2002; Robalino, et.al 2002; Loevinsohn and Gillespie 2003; MacNeil,
et. al 2004), several economic, socio-culrural and epidemiological variables
accounted for the spread of the HIV/AIDS pandemic. The main economic
variables are poverty, gender inequality, income inequality and the extent of
labour migration. Poverty, gender and labour migration unequal regional
development among countries as well as within countries can induce labour
migration to urban areas or other countries. The resulting concentration of
single men in urban areas or project sites is generally accompanied by a
parallel increase in commercial and casual sex, with a concomitant rise in the
risk of HTV infection. The socio-cultural variables include the type of sexual
relations, religious belief, the structure of societies and conflicts. For instance,
the type of sexual relations is important because it affects the relative spread of
HTV among men and women. In Africa, HTV is mainly spread through
heterosexual relations. The epidemiological variables include cofactors that
increase the risk of sexual contacts resulting in HIV infection. The most
important cofactor is ulcerative sexually transmitted diseases, such as syphilis
and chlamydia infection. The ulcer provides a portal of entry for HIV and the
re-use of contaminated syringes by injecting drug users, infection via birth or
nursing from mother to child, re-use of contaminated needles in medical
settings, and transfusions of contaminated blood or blood products.
The effects of the spread of HIV/AIDS are so massive that the disease is
seen as an economic burden on the countries that are hard hit, since reverses
have been witnessed in social and development goals that were achieved
some 50 years ago. These are against the backdrop of the effects of on rising
morbidity and mortality rates. The rise in morbidity has three immediate
effects: reduction in labour productivity, increase in health care spending
and reduction in savings. The negative labour productivity effect will arise
because sick or worried workers are less productive than happy and healthy
workers are. Even the productivity of those who do not have AIDS may fall
153
as infection and illness rates among friends, families and co-workers rise.
The health care expenditure effect refers to increase expenditures by
households and the (public or private) on health care systems to assist AIDS
patient and their families in coping with deteriorating health. The effects on
saving can be seen from the following: the direct effect of higher medical
expenditures which tend to reduce saving and the growth of per capita, life
expectancy, age structure, and the healthiness of the population. The fall in
domestic saving will imply a reduction in capital formation, and if it were
substantial, it would have a potentially large adverse effect on per capita
income over the long term. On the other hand, the gradual rise in mortality
rates caused by AIDS will have two important demographic aspects with
macroeconomic consequences. First, there will be a slower population
growth rate, which will result in a smaller population at a future date.
Second, a rising number of deaths from AIDS will shift the age structure of
the population toward the younger age cohorts. The shifts in age structure
can be expected to have important effects on both aggregate supply and
aggregate demand. On the supply side, the size of the working -age
population (and perhaps the participation rate of the labour force) will be
reduced. The smaller working-age population will directly reduce potential
output. The loss in output would be exacerbated by a fall in labour force
productivity as the average age and experience of the labour force declines.
On the demand side, the shift in the size and composition of the population
will affect the level and composition of public expenditures as well as the
economy's overall (private and public) saving rates. For example, the smaller
absolute number of young people will place lower demands on the
education system and the overall consumption rates will be higher because
of the younger age structure (Cuddington 1993; World Bank 1993a; World
Bank 1993b; Ainsworth and Over 1994; World Bank 1995; World Bank 1997;
Ainsworth 1998; Over 1998; Squirel998; Barnett and Whiteside 2000; Barrett
and Rugaleman 2001; Wilson 2001; Ainsworth and Filmer 2002; Robalino,
et.al 2002; Bell and Gersback 2003; Birdshall and Hamoudi 2004; Craft and
Haacker 2004; Epstem 2004, Haarcher 2004).
The above instances are indications that much government support in
terms of increase in spending on the health sector is required in order for
more people, most especially women living with HIV/AIDS benefit from the
test and treatment of the disease in Sub-Saharan Africa.
The thrust of this paper therefore, is to examine the amount of money
needed to be spent by the governments of the countries in Sub-Saharan
Africa on health care services that would guarantee an increase in the
number of women living with HIV/AIDS, that would benefit from the test
and the treatment of the disease in Sub-Saharan African countries.
154
The rest of the paper is arranged as follows. Section two provides
materials and methods proposed for the study. Section three provides and
discusses the results. Conclusion and recommendations are contained in the
last section.
Materials and Methods
The variables considered for this study are HIV/AIDS and government
spending on health care services. HTV is the virus that destroys the body
immune system and AIDS is defined as full blown break down of all body
immunity that leads to a group of serious illness and opportunistic infections
such as tuberculosis that develop after being infected with HTV. HIV infection
is caused by two strains of the human immune deficiency virus, HTV-1 and
HTV-2. HIV-1 is the most common form of HTV that is predominating in
'different parts of the world, while HTV-2 is found predominantly in West
Africa with some pockets in Angola and Mozambique. When compared with
HIV-1, HIV-2 is less infectious and its clinical course is slower. Dual infection
with HIV 1 and HIV 2 is possible. Once introduced into the human body, HIV
attacks mainly a subset of immune system cells, which bear a molecule called
Cluster Designation 4 (CD4). Specifically, the virus binds to two types of CD 4bearing cells: Cluster Designation 4 + Lymphocytes (CD4+T)-cells and
macrophages. These cells perform various tasks critical to the normal
functioning of the immune system. CD4+ T-cells organize the overall immune
response by secreting chemicals to help other immune cells work properly,
while macrophages engulf foreign invaders and prime the immune system to
recognize these invaders in the future (see World Bank 1997; Lamptey, et.al
2002; WHO 2003).
On the hand, government spending is the cost of carrying out the function
of government in respect to the quantity and quality of goods and services to
produce and distribute. Government spending as it appears in the national
income account is thus represented by two broad categories of government
activities. First, there are exhaustive government spending that correspond to
the government purchase of current goods and services (i.e. labour,
consumption, etc.) and capital goods and services (i.e. public sector
investment in social services like health care, water, sanitation, education and
infrastructure e.g. roads) and second is transfer spending which are
government spending on pensions, subsidies, debt interest, unemployment
benefits, etc. These spending do not represent a claim on the society's
resources by the public sector as in the case of exhaustive government
spending. Instead, transfers are a redistribution of resources between
individuals in the society with the resources flowing through the public sector
as intermediary (Brown and Jackson 1990; Lindauer and Velenchik 1992).
155
In the course of determining the amount of money needed to be spent by
the governments of the countries in the Sub-Saharan Africa on health care
services that would guarantee an increase in the number of women living
with HIV/AIDS, that would benefit from the test and the treatment of the
disease, a cross-country data drawn from 38 countries for the period 2002
(see Appendix 1), a linear regression analysis of the Ordinary Least Square
(OLS) and a calibration analysis were used. The data were obtained from the
African Development Bank Selected Statistics on African Countries for the
year 2002, African Development Bank Gender, Poverty and Environmental
Indicators for African Countries for the year 2003, World Bank African
Development Indicators and World Bank World Development Indicators for
the year 2005.
The first step in the use of OLS method is the specification of the model
as indicated below:
(1)
WAIDS = f (GSHcs, SPf) With a linear
relationship such as:
WAIDS = 0 + j lnGSHcs+ 2SPf + U
(2)
Where
WAIDS - number of women living with HIV/AIDS in sub-Saharan Africa.
InGSHcs = log of government spending on health care services in subSaharan Africa in US$.
SPf = socio-political factors with dummy 1 for stable socio-political
situations and dummy 0 for otherwise. Note that, socio-political factors are
assumed to be constant since they are interaction variables between
government spending on health care services and the number of women
living with HIV/AIDS in Sub-Saharan Africa.
0 = intercept
-1 and 2 = the estimation parameters associated with the influence of
the independent variables (InGSHcs and SP f) on the dependent variable
(WAIDS).
U= error terms.
To estimate the model, a multiple linear regression analysis is used in
order to reflect the explanatory nature of the variables. To verify the validity
of the model, two major evaluation criteria are used: (i) the a -priori
expectation criteria which is based on the signs and magnitude of the coefficient of the variables under investigation; and (ii) statistical criteria based
on statistical theory which in other words is referred to as the First
156
Order Least Square Test consisting of R-square ( R2), F- statistic and t-test.
The R-square (R2) is concerned with the overall explanatory power of the
regression analysis, the F-statistic is used to test the overall significance of
the regression analysis and the t-test is used to test the significant
contribution of each of the independent variables (Oyeniyi 1997).
Drawn from the above model, our a-priori expectations or the expected
pattern of behaviour of the independent variables (GSHcs and SP f) on the
dependent variable (WAIDS) are: GSHcs > 0, SP f > 0 i.e. the more
governments spend on health care services the more the number of women
living with HIV/AIDS would receive attention and treatment from the
disease and the more stable the socio-political situations in the countries the
more the number of women living with HIV/AIDS would receive attention
and treatment from the disease. The tests are conducted at 5% level of
significance.
Results and Discussion
The results of the regression analysis are presented in Table 1. f
Table 1
Regression Results of Women Living with HIV/AIDS and
Government Spending on Health Care Services in sub-Saharan Africa
Variables
Co-efficient and t-values
Intercept (t)
8.56 (1.81)
LnGSHcs (t)
1.71 (2.34)*
SPf (t)
0.77(0.42)
R:
.0.59
F
The t-values are in parenthesis.
* Statistically significant at 5 per cent.
3.74
A look at the model shows that it has an R2 of 59 per cent. At 5 per cent level
of significance the F-statistic shows that the model is useful in determining
the influence of government spending on health care services on the number
of women living with HIV/AIDS as the computed Fc statistic of 3.74 is greater
than the tabulated Ft statistic valued at 3.34.
For the individual variables, co-efficient estimates and the associated tvalues showed that government spending on health care services and sociopolitical variables are positively related to the number of women living with
HIV/AIDS, thus satisfying our a-priori expectations. Statistically only
government spending on health care services is significant at 5 per cent level.
The positive signs of government spending on health care services and sociopolitical stability are indications that the more the government spend on
health care services and the more stable the socio-political situations in the
157
sub-region the more the women living with HIV/AIDS would benefit from
test and treatment of the disease.
Given the above results, the calibration analysis of government spending
on health care services and the number of women living with HIV/AIDS in
Sub-Saharan Africa is represented thus:
WAIDS = 8.56 + 1.71 InGSHcs + 0.77 SP,
(3)
Since our concern is to find out how influential government spending on
health care services is on the number of women living with HIV/AIDS in
Sub-Saharan Africa, we therefore hold socio-political factors constant.
Equation (3) thus becomes:
WAIDS = 8.56 + 1.711nGSHcs
(4)
The approximate (1 -co) 100 per cent prediction interval for WAIDs
when lnGSHcss is WAIDS ± t oo/r SnWAIDS, where the distribution of t is
based on (n - 2) degree of freedom. The results of the calibration conducted at
5, 10,15 and 20 per cent increase in government spending on health care
services, on the average of $ 2456.6 million are presented in column 3 and 4 of
Table 2.
Table 2
Calibration Results of Women Living with HIV/AIDS and Government Spending on
Health Care Services in Sub-Saharan Africa
Level of Calibration
Annual average of
the total amount of
government
spending on Health
Care Services
($2456.6 million)
5% increase
10% increase
15% increase
20% increase
Source: The Authors.
Level of the
amount of
government
spending
on Health
Care Services
($ million)
2580.0
2702.0
2825.0
2948.0
95% prediction
Point estimate of
the number of interval of the number
of women living
women living with
HIV/AIDS that would
with HIV/AIDS
that would benefit
benefit from HIV/
AIDS treatment (million)
from HIV/AIDS
treatment
(million)
3.03
3.02-3.03
4.63
4.84
5.05
4.52-4.63
4.83-1.84
5.04-5.06
As indicated in Table 2, the governments of Sub-Saharan African
countries will require about $2580.0 million (which is 5 per cent of the annual
average of government spending on health care services) for 3.03million
women living with HIV/AIDS to get treated and possible cured from the
disease. At this amount, there is a 95 per cent confidence that the women
living with HIV/AIDS that would likely get attention and treatment would
lied between 3.02 and 3.03 million per annual.
158
If the governments of Sub-Saharan African countries decide to increase,
spending on health care services to about $2948.0 million, representing 20
per cent increase in spending on health care services, the number of women
living with HIV/AIDS that will get treated and possible cure from the
disease would likely increase to 5.05 million. The 95 per cent prediction
interval of the number of women living with HIV/AIDS that would likely
get treated and possible cure would therefore lie between 5.04 and 5.06
million per annual.
Conclusion and Recommendations
Having established a link between government spending on health care
services and the number of women living with HW/AIDS in Sub-Saharan
Africa and the estimated amount of money needed on health care services
that would guarantee an increase in the number of women that would get
treated and possible cure from the disease, it is important to draw the
attention of the governments in the sub-region and international donor
agencies on the need to put in place appropriate measures that would help
improve government finances in the health sector and finances in combating
the spread of the disease in Sub-Saharan Africa.
Some of these measures should include: increase in government budgetary
allocation to the health sector with a substantial amount of the money spent
on HIV/AIDS diagnostic test, vaccine development and distribution, blood
donor screening, provision of sterilized needles, provision of condom,
provision of information, education and communication about the disease
and on the use of condom and the need for one sexual partner. These
measures are essential because they could help lessen the socio-economic
effects that go with the disease. Essentially too, is the increase in social and
financial support to victims and increase in individual countries response
capacity to mobilize more resources and encourage both local and
international research into HIV/AIDS.
Foreign governments and international donor agencies should also
help provide sufficient funds to the affected countries in the sub-region,
with some of the funds used to set- up national, regional and local
programmes and projects that would be used to combat the menace of the
disease, purchase antiretroviral or generic drugs which could be made
available and avoidable (possibly free) to the women most of them very
poor to cope with the high cost of the drugs and the high cost of managing
the disease.
The fight against the disease should go hand-in-hand with combating
the menace of tribal and civil conflicts in the sub-region. Combating tribal
and civil conflicts that have besiege the sub-region is essential given it effects
159
on the further spread of HIV/AIDS among women and children who are the
most affected and the diversion of funds meant for combating the disease for
prosecution of wars and for the provision of humanitarian assistance to the
war torn countries.
The fight against the disease should also be a matter of national
governance and the fight against corruption which has respectively eluded
and ruined most countries in the sub-region. To tackle the disease,
accountability, openness and transparency in the delivery of funds and
drugs to fight the disease must be the watch word of the governments and
international donor agencies in charge of the delivery of the drugs and
equipment for combating HIV/AIDS and in the campaign for the reduction
in the spread of the disease.
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Appendix 1
The Number of Countries Selected for the Study in Sub-Saharan Africa
Angola
Chad Congo Gambia
Malawi Mali Rwanda
Uganda
Benin
Congo D.R
Ghana
Mauritania
Senegal
Zambia
Botswana
Cote d' Ivoire Guinea
Mozambique South Africa Zimbabwe
Purkina Faso Eritrea
Kenya
Namibia
Sudan
Burundi
Ethiopia
Lesotho
Niger Nigeria Swaziland
Cameroon
Gabon
Liberia
Tanzania
Africa Rep
Madagascar
Togo