1. WHO-AFRO Regional Committee- Yamoussoukro, August 2011 Building Human Capital for Inclusive Growth in Africa: One Billion Opportunities? Agnès SOUCAT Director Human Development Department African Development Bank Rotterdam Global Health Initiative October 28

2. WHO-AFRO Regional Committee- Yamoussoukro, August 2011 Where are we ? HHA A N e w W a y o f W o r k i n g T o g e t h e r Rotterdam Global Health Initiative October 28

3. Ref: Science in Action – Saving the lives of Africa’s mothers, newborns and children. ASADI 2009. Eds Kinney MV, Lawn JE, Kerber KJ Data sources: UNAIDS 2007, UNICEF, www.childinfor.org, Lancet nutrition series, World Malaria Report 2009.www.childinfor.org Maternal deaths, 2005 Death of children under five, 2008 Adults and children estimated to be living with HIV, 2007 Underweight children under five, 2007 Global Health issues are increasingly about Africa With only 12% of the world’s population, Africa accounts for 57% of the world’s maternal deaths, 49% of child deaths, 85% of Malaria cases, 67% of people with HIV, and 26% of underweight children

4. Yes… Africa has progressed towards the MDG targets.. but slower than in the rest of the world..and progress inequitably shared.. For SSA 20% less under 5 deaths in 2009 compared to 1990. For SSA 26% % less maternal deaths in 2008 compared to 1990. 4

5. Coverage of High Impact Interventions is still low …particularly in Western Africa

6. SSA still has a low per capita spending on health.. yet not the lowest 6

7. No major increase in allocations to health in SSA between 1995 and 2009 THE as % GDP increased from 5% in 1995 to 6% in 2009 GGHE as % total GE increased from 8% in 1995 to 10% in 2009. Very few countries achieved the 15% Abuja commitment 7

8. External aid used to be an important source of health spending in Sub-Saharan Africa but is peaking..

9. Private sources -mostly out of pocket - finance more than half of health expenditures 9

10. 10 Average total health spending has more than doubled between 1995 and 2009...

11. But SSA child mortality still lagging behind South Asia … despite similar levels of spending ‹#2› US$ Deaths per 1000

12. Yet scaling up and even fast progress is possible … within a few years EthiopiaRwanda % assisted deliveries Health workers and ITNs

13. But how money is used and in which system it is injected is an essential question

14. WHO-AFRO Regional Committee- Yamoussoukro, August 2011 A rapidly changing continent…. HHA A N e w W a y o f W o r k i n g T o g e t h e r Rotterdam Global Health Initiative October 28

15. A strikingly large youth bulge in Africa 1 billion people in Africa today and 2.3 billion people projected for 2050 … the continent’s greatest asset, or a potential risk ? Source: CIA World Fact-book 2009 http://www.prb.org/pdf11/2011population-data-sheet_eng.pdf

16. Africa : a continent of fast economic growth …. Africa : now a continent of fast economic growth ….

17.  The total African mobile subscriber base is roughly 281 million and expected to reach 561 million in 2012  Yet Africa laggs behind in connectivity and internet access …only 3 out of 1000 are internet users in Sierra Leone..1 out of 1000 has a computer in Niger.. And rapidly evolving technological revolution …

18.  In 2010, six out of the 10 most unequal countries worldwide were in Sub-Saharan Africa….  The top 3 are Namibia (70), South Africa (65) and Lesotho (63). But problems with growth quality and inclusiveness…

19. Source :Worlld Bank 2010 And a growing appetite for democratic processes … ….the lesson of the Arab Spring …

20. WHO-AFRO Regional Committee- Yamoussoukro, August 2011 The research agenda…. HHA A N e w W a y o f W o r k i n g T o g e t h e r Rotterdam Global Health Initiative October 28

21. WHO-AFRO Regional Committee- Yamoussoukro, August 2011  Growth, productivity and jobs …  Value for money, accountability and voice in service delivery  Social inclusion and cohesion Rotterdam Global Health Initiative October 28

22.  The demographic dividend F Regions on the Demographic Upswing Source: D Bloom and D Canning, “Demographics and Development Policy”, Development Outreach, April 2011  Family planning and early education programs  New institutions and models of training and knowledge dissemination  Climate Change impact Growth..and jobs…

23. “globally, between 20 and 40 percent of health system spending is wasted, with poorer countries wasting even higher proportions” – WHR 2011 Ugandans perceive public health services as being among the most corrupt institutions…(2003).., absenteeism is 35% among medical personnel in primary health care In Chad, 95% of funds allocated never reached health centers.. (Wane et al, 2009) 23 Delivery at the health facility increased overall in Rwanda, but 7% more in Performance Base Facilities between 2006-2008…. Incentives Decentralization and autonomy Accountability to users Value for money, accountability and voice in service delivery

24.  Nutrition: food security, climate change and livelihoods particularly in the Horn of Africa  Safety nets  Health insurance  Conditional Cash Transfers  Social Businesses and productive safety nets Social Inclusion and Cohesion…

25. WHO-AFRO Regional Committee- Yamoussoukro, August 2011 Conclusion  More money is needed but more value for money is needed even more  High potential for high return if right investment is made on  New technologies and knowledge management  Mechanisms for Value for money and accountability  Inclusion  Need to integrate private spending in policymaking  Importance for external aid to be catalytic: need to focus on results and efficiency gains 25 Rotterdam Global Health Initiative October 28

26. WHO-AFRO Regional Committee- Yamoussoukro, August 2011 Thank You