HEALTHCARE IN THE
DEVELOPING WORLD
ECON240: ECONOMICS OF
HEALTH AND MEDICINE
GROUP PROJECT PRESENTATION
APRIL 7, 2015
ANDREA MARX
KATIE HERRON
COURTNEY LANG
AMBER HUBERT
Part 1: Africa’s Deadliest Conflict, Doctors Without Border, 3.4.2014
Did you know?
● At least 1 billion people suffer each year because they cannot
obtain the health services they need
● About 150 million people who use health services suffer a
financial catastrophe annually
● 100 million pushed below poverty line to pay for services
● In the next 20 years, 40-50 million new health care workers
will need to be trained and deployed to meet the need
● WHO estimates that $86 per person per year is the minimum
spending to provide essential health-care services
World Health Organization 2015
What is a Developing Country?
SIERRA LEONE
VIETNAM
BOLIVIA
“Developing countries are defined according to their Gross National Income (GNI) per capita per year. Countries with
a GNI of US$11,905 and less are defined as developing”--The International Statistical Institute
Human Development Index
● Summary measure of average achievement in key dimensions of human
development
● Emphasize that people and their capabilities should be the ultimate criteria
for assessing the development of a country
Country
GNI per capita, 2013
HDI Value 2013
Life Expectancy
at birth, 2013
HDI Rank
United
States
52,308
0.914
78.9
5
Bolivia
5,552
0.667
67.3
113
Vietnam
4,892
0.674
75.9
121
Sierra Leone
1,815
0.374
45.6
183
United Nations Development Program
Healthcare Disparities in
Developing Countries
Causes
1. Insufficient system resources
2. Inappropriate allocation of
resources
3. Inadequate quality
4. Insufficient household incomes
5. Lack of access
6. Travel costs
7. Cultural barriers
8. Misperceptions of illness and
effectiveness of care
Problems
1. Effective healthcare
interventions are underutilized
2. Income related disparities
Angola Hospital http://www.medisend.org/pr86.html
Health Expenditure, total
(% of GDP)
US = 17.9
Sierra Leone = 15.1
Vietnam = 6.6
Bolivia = 5.8
World Bank 2015
Out-of-pocket Health Expenditure
(% Private Expenditure on Health)
Sierra Leone = 91.4
Vietnam = 85.0
Bolivia = 82.2
US = 20.7
World Bank 2015
Health Production Function Inputs
Max amount of health that an individual can generate from a
specific set of health-related inputs in a given period of time
Health (level @ time t) = f
1.
2.
3.
4.
5.
Lifestyle: nutrition & exercise
Profile: mental/physical family history and current state
Technology: medical advances
SES: income level, education, social status
Environment: infrastructure & air/water quality
VIETNAM
Independent 1945, population 91.68 million
A doctor examines an old woman in Southern Province of Tay Ninh
http://myvietnamnews.com/tag/healthcare/
Hospital in Vietnam
http://www.talkvietnam.com/2012/12/conference-on-strengtheningmeasures-to-improve-healthcare/
Background
● Socialist Republic of Vietnam
○ Unified under a communist
government after Vietnam
War ended in 1975
● Vietnam War
○ November 1,1955- April 30,
1975
Clockwise, from top left: U.S. combat operations in Ia Drang, ARVN Rangers defending Saigon
during the 1968 Tet Offensive, two Douglas A-4C Skyhawks enroute for airstrikes against
North Vietnam after the Gulf of Tonkin incident, ARVN recapture Quảng Trị during the 1972
Easter Offensive, civilians fleeing the 1972 Battle of Quảng Trị, burial of 300 victims of the
1968 Huế Massacre.
http://en.wikipedia.org/wiki/Vietnam_War
Lifestyle/Medical Profile
● Nutrition
● Exercise
● Mental/physical current state
○ Increasing number of
people diagnosed with
treatable long term chronic
diseases
Children drink Vinamilk, a Ho-Chi Minh based dairy product
(http://www.dairyreporter.com/Manufacturers/Tetra-Pak-Vinamilk-Vietnam-dairy)
Forbes
Technology
Medical Advances
● Hospitals lack equipment (Brain Scanners
or Xray Machines)
● Hanoi: population 6.562 million, 5
hospitals
● Houston: population 6.3 million, 18
hospitals
● Overcrowding in urban hospitals: 150-250%
capacity
● Low wages for doctors - $100/month
● Bribes and off-the-book procedures
Overcrowding in Vietnamese hospitals causes beds to be shared
(http://www.economist.com/news/asia/21618894-ordinary-folkare-sick-and-tired-their-public-hospitals-limping-along)
InterNations
Forbes
Economist
SES
● Income level
○ GNI per capita: 4,892.41 PPP
dollars
○ Poverty level: 6.45%
● Education
○ Mean years of schooling: 5.49
● Social Status
○ HDI 2013: 0.638, ranked 121
○ Inequality-Adjusted HDI 0.543
○ Homeless population: 2.031
Ho Chi Minh city's financial district. Vietnam has made huge strides in lifting
people out of poverty, despite the country not being a model of good governance.
http://www.theguardian.com/global-development/povertymatters/2011/jun/29/authoritarian-model-development
UNDP
Environment
Infrastructure
● Historically: based on Soviet
system, dismantled after
economic liberalization
● Currently: divide between
quality/access/affordability in
urban vs. rural
● Poor communication between
government and local agencies
● 6.4% of GDP spent on healthcare
Flooded roads in Vietnam
http://www.talkvietnam.com/2012/07/climate-change-to-attack-infrastructure/
Forbes
Environment
Air/water quality
● Carbon dioxide emissions per capita:
1.73
● Only 39% rural population have access
to safe water & sanitation
● 7 million people at severe risk of arsenic
poisoning
● 80% diseases due to polluted water
Rubbish clogs a river in Vietnam
http://news.xinhuanet.com/english/photo/2012-09/24/c_131870120.htm
UNDP
The Water Project
Looking Forward...
● 2008 law to assist poor and ethnic minorities
● Compulsory participation starts this June
● HDI level improvements
● 1980: 0.463
○ 2013: 0.638
● Projected 20% compound annual growth rate of
pharmaceuticals
● Estimated per capita health expenditure increase
○ $66/year 2008
○ $116/year 2014
Vietname Net Bride more and more domestic pharmaceutical firms
have recently announced plans to expand their production as the
market has shown signs of picking up in recent months.
http://english.vietnamnet.vn/fms/business/108277/pharmaceuticalcompanies-rush-to-expand-business.html
Economist
UNDP
Forbes
SIERRA LEONE
Independent 1961, population 6.09 million
Ebola patients in Sierra Leone
http://www.afronline.org/?p=36555
Health workers in Sierra Leone screen people for the Ebola virus in
Kenema
http://www.theguardian.com/global-development/povertymatters/2014/aug/13/ebola-epidemic-poor-facilities-distrust-healthcare
Background
● Constant internal strife
○ Civil War ended in 2002
● Economy is struggling
○ Receives aid from several countries
● Economic Policy
○ Poverty -reduction efforts
Lifestyle/Medical Profile
●
●
●
●
68 % population lives below poverty line
1/2 population undernourished
176/232 countries with overall quality of life issues
7% HIV/AIDS adult prevalence rate
o 170,000 Sierra Leoneans have this disease
● Life expectancy at birth 45.56
● 4th highest child mortality rate in the world
Encyclopedia of Environment and Science, 2007
UN Human Development Report
World Health Organization, 2015
Technology
Road in Kenema Sierra Leone
http://www.thesierraleonetelegraph.com/?p=2157
● Not enough
skilled workers
● Limited
transportation
to health care
facilities
● Poor Road
Construction
SES
● Mean years of schooling 2.88
● 20.5 % of adult females, 39.8% of adult males can
read and write
○ Difficult to understand health info
● GNI per capita $1,815.1USD(2010)
Encyclopedia of Environment and Science, 2007
UN Human Development Report
Environment
● 43% of population lack sustained access to safe
drinking water
● 61% Lack of access to improved sanitation
● Very high risk of contracting food and waterborne
diseases
Encyclopedia of Environment and Science, 2007
Ebola Outbreak
● One of the largest Ebola
Outbreaks in History
● 36% of Ebola patients in
Sierra Leone
● More than 3,700 cases
confirmed in West Africa
○ Sierra Leone, Liberia,
Guinea, Nigeria, and
Senegal
Burial Team in Freetown, Sierra Leone
http://www.bostonglobe.com/news/world/2014/10/08/sierraleone-ebola-burial-teams-backwork/p4mwAG5FIPA0LmBSEmkCBO/story.html
The Economist Newspaper, 2015
Looking Forward...
● Free Health Care given to pregnant and breast
feeding women, and children under 5 years of age
○ Britain donated 24 million in funding
● 2 new maternity health care centers have been
built
● Government spending on health care increased
Problems Remain
● Government lacks ability to organize Free Health
Care
● Individuals complain about free health care
● Drugs and equipment have gone missing
● Hospitals and built roads neglected
BOLIVIA
Independent 1825, population 10.67 million
Bolivian doctor checks child for an ear infection
http://www.projects-abroad-la.org/volunteer-projects/medicine-andhealthcare/volunteer-bolivia/
Bolivians wait for medical treatment in the highland of the Amazon Region
http://mariestopes.org/news/20-years-cairo
Background
● Bolivia is the
poorest and one of
the least developed
of the Latin
American countries
● Illegal drug trade
Rural poor in Bolivia standing outside of their home:
http://cs.mcgill.ca/~rwest/wikispeedia/wpcd/wp/b/Bolivia_Floods_280207.htm
Lifestyle/Medical Profile
● High infant mortality rate
○ Maternal-infant mortality rate 2003: 420 in
100,000
● Population poverty share (%)
○ Near poverty= 17.3%
○ In severe poverty= 7.8%
○ Below income poverty line= 15.6%
World Health Organization 2015
UN Human Development Report
Health Care Profile
● Doctor presence
○ Only 3.7 doctors per 10,000 people in urban areas
○ Only 1.3 doctors per 10,000 widely dispersed
people in rural locations
● Bolivian health system:
○ Social Security funds
○ Payment options and funding
○ Government health expenditure vs. out-of-pocket
payment
World Health Organization 2015
Technology
● Lack of clean water
○ Lack of proper sewage and garbage systems
● Much of the population does not live near hospitals
or medical facilities
○ Inadequate transportation systems from rural to
urban areas
SES
● HDI:
○ Value= .667
○ World rank= 113
● Income level:
○ GNI per capita= 5,750 PPP dollars
● Life expectancy at birth:
○ 67.9 years
● Expected years of schooling:
○ 13.2 years
World Health Organization 2015
Environment
● Deforestation
● Soil erosion
● Overgrazing
Deforestation in the Bolivian countryside: http://rainforestgg.tripod.com/id2.html
Looking Forward...
● Areas of focus to strengthen the health care system:
● Support for child and maternal health programs
● Providing health services to isolated population
○ Strengthened operations systems and participatory
management at all levels
○ Increased access to and improved quality of intercultural
health care
○ Underserved rural population empowered to seek and
obtain “culturally appropriate” health care
Key Points
Output of Non-Health
Capital Goods
Possibility Production Frontier
Challenges: A3
1. Accessibility
2. Availability
3. Accountability
Precautionary Saving: occurs in
response of uncertainty regarding
future income
● Everyone in insurance market
not in precautionary saving
allows for more spending in
general economy
● Smooths out household
consumptions
Output of Consumer
Health Goods
What is Universal Health Coverage?
Universal health coverage (UHC) means that all people
receive the health services they need without suffering
financial hardship when paying for them (health promotion,
prevention and treatment, rehabilitation and palliative care).
● Majority out-of-pocket: poor unable to obtain services and
rich eventually exposed to financial hardship in event of
severe or long-term illnesses
● Need for cross subsidy from rich-poor and from healthy-ill
The
World
Bank
Apr.14
Questions and
Answers
Bibliography
Bernstein, Lenny. "Twenty-eight Countries Have Worse Health Care Systems than Liberia’s." The Washington Post, 3 Mar. 2015. Web. 29 Mar. 2015.
C., Ledo, and Soria R. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, 2010. Web.
Country Programme Plurinational State of Bolivia 200381 (2013-2017). United Nations: World Food Programme, 2012. 2014. Web.
DeNoble, Damjan P. "The Vietnam Healthcare Moment - Health Intel Asia." Health Intel Asia. N.p., 11 June 2014. Web. 30 Mar. 2015.
Frakt, Austin. "Hospitals Are Wrong About Shifting Costs to Private Insurers." The New York Times. The New York Times, 23 Mar. 2015. Web. 26 Mar. 2015.
Frakt, Austin. "Hospitals Are Wrong About Shifting Costs to Private Insurers." The New York Times. The New York Times, 23 Mar. 2015. Web. 26 Mar. 2015."Healthcare in Vietnam."
Healthcare in Vietnam. N.p., n.d. Web. 30 Mar. 2015.
"Healthcare." Sierra Leone Makes Progress on Free Health Care Initiative. Web. 29 Mar. 2015.
"Health Expenditure per Capita (current US$)." The World Bank. N.p., 2014. Web.
"Human Development Reports." UNDR. United Nations, n.d. Web. 30 Mar. 2015.
"It's up to You." The Economist. The Economist Newspaper, 4 Feb. 2012. Web. 29 Mar. 2015.
"Limping along." The Economist. The Economist Newspaper, 20 Sept. 2014. Web. 30 Mar. 2015.
Maeda, Akiko, Cheryl Cashin, Joseph Harris, Naoki Ikegami, and Michael Reich. Universal Health Coverage for Inclusive and Sustainable Development: A Synthesis of 11 Country Case
Studies. Washington, DC: World Bank, 2014. Print.
"Much Worse to Come." The Economist. The Economist Newspaper, 18 Oct. 2014. Web. 29 Mar. 2015.
Bibliography
Maeda, Akiko, Cheryl Cashin, Joseph Harris, Naoki Ikegami, and Michael Reich. Universal Health Coverage for Inclusive and Sustainable Development: A Synthesis of 11 Country Case Studies.
Washington, DC: World Bank, 2014. Print.
"Much Worse to Come." The Economist. The Economist Newspaper, 18 Oct. 2014. Web. 29 Mar. 2015.
Peters, David H., Anu Garg, Gerry Bloom, Damian G. Walker, William R. Brieger, and M. Hafizur Rahman. "Poverty and Access to Health Care in Developing Countries." Annals of the New York
Academy of Sciences 1136.1 (2008): 161-71. Willey Online Library. Web. 29 Mar. 2015.
Robbins, Paul, ed. “Sierra Leone.” Encyclopedia of Environment and Society. Vol. 4. Thousand Oaks, CA: SAGE Publications, 2007. 1603–1605. Gale. Web. 29 Mar. 2015.
The Global Road Warrior. "Sierra Leone: Country Snapshot." The Global Road Warrior. World Trade Press. Web. 29 March 2015.
Shobert, Benjamin. "Healthcare In Vietnam -- Part 1." Forbes. Forbes Magazine, n.d. Web. 30 Mar. 2015.World Bank. Out-of-pocket Health Expenditure. 2015. Web. 30 March. 2015.
"The Bolivian Health System and Its Impact on Health Care Use and Financial Risk Protection." World Health Organizaton (n.d.): n. pag. 2006. Web.
"Water In Crisis - Spotlight Vietnam." The Water Project. N.p., n.d. Web. 30 Mar. 2015.
"What Is Universal Health Coverage?" Universal Health Coverage. World Health Organization, Sept. 2014. Web. 29 Mar. 2015.
World Bank. Health Expenditure, Public. 2015. Web. 30 March. 2015.
World Bank. Health Expenditure, Total.. 2015. Web. 30 March. 2015.
World Bank. Out-of-pocket Health Expenditure. 2015. Web. 30 March. 2015.