1. HEALTHCARE IN THE DEVELOPING WORLD
ECON240: ECONOMICS OF HEALTH AND MEDICINE
GROUP PROJECT PRESENTATION
APRIL 7, 2015
Developing countries account for 84% of world population and 93% of the worldwide burden of disease; however, they account for only 18 percent of global income and 11 percent of global health spending.
ANDREA MARX
KATIE HERRON
COURTNEY LANG
AMBER HUBERT

2. Part 1: Africa’s Deadliest Conflict, Doctors Without Border, 3.4.2014

3. 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, 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

4. 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

5. 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

6. Healthcare Disparities in Developing Countries
Causes
Problems
Insufficient system resources
Inappropriate allocation of resources
Inadequate quality
Insufficient household incomes
Lack of access
Travel costs
Cultural barriers
Misperceptions of illness and effectiveness of care
Effective healthcare interventions are underutilized
Income related disparities
Angola Hospital

7. Health Expenditure, total (% of GDP)
US = 17.9
Sierra Leone = 15.1
Sierra Leone due to Ebola outbreak but more importantly HIV/AIDS
Vietnam = 6.6
Bolivia = 5.8
World Bank 2015

8. Out-of-pocket Health Expenditure (% Private Expenditure on Health)
Sierra Leone = 91.4
Vietnam = 85.0
Bolivia = 82.2
35% in US funded by private health insurance
US = 20.7
World Bank 2015

9. 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 time t) = f
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

10. Independent 1945, population 91.68 million
VIETNAM
Independent 1945, population million
A doctor examines an old woman in Southern Province of Tay Ninh
Hospital in Vietnam

11. Background Socialist Republic of Vietnam
Unified under a communist government after Vietnam War ended in 1975
Vietnam War
November 1,1955- April 30, 1975
thats over 19 years of guerilla warfare
left 100s of thousands, if not millions, dead
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.

12. Lifestyle/Medical Profile
Nutrition
Exercise
Mental/physical current state
Increasing number of people diagnosed with treatable long term chronic diseases
hard to know, but given the level of poverty, not so good
heart disease, diabetes--could be easily prevented with appropriate nutrition and exercise
Children drink Vinamilk, a Ho-Chi Minh based dairy product (
Forbes

13. Overcrowding in Vietnamese hospitals causes beds to be shared
Technology
Medical Advances
Hospitals lack equipment (Brain Scanners or Xray Machines)
Hanoi: population million, 5 hospitals
Houston: population 6.3 million, 18 hospitals
Overcrowding in urban hospitals: % capacity
Low wages for doctors - $100/month
Bribes and off-the-book procedures
causes patients to travel long distances (difficult in countries with poor infrastructure)
less focus on maintenance care, more on vital immediate issues
Doctors are scarce in rural areas, most go to urban areas, yet there is still overcrowding
big problems with off the book out of pocket payments to secure care
patient demand is far higher than the supply of doctors, but also demand from underpaid doctors to go through illegal avenues as well as work at private clinics for expats and the very wealthy
very difficult for low income patients
bribes: by the account of one doctor (?) $1/injection, $2/bath, $5 to cut a line
Overcrowding in Vietnamese hospitals causes beds to be shared (
InterNations
Forbes
Economist

14. 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
The total domestic and foreign output per capita
poverty-- the percent of the population in multidimensional poverty
education-- not even past elementary school level, no basis for a good understanding of nutrition and basic level of health
SES-- inequality-adjusted HDI “the measure of the average level of human development of people in a society once inequality is taken into account”
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.
UNDP

15. Flooded roads in Vietnam
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
both China and Vietnam were structured with influences from Soviet healthcare
The communist Party of Vietnam pledged healthcare reform in the 1920s
they did a good job with basic primary care in rural areas
however, when the economy was liberalized and such practices, quality and affordability began to suffer
high level policies are very difficult to put into motion on the ground
although this is less than developed countries, it is actually relatively high compared to Vietnam’s neighbors
Myanmar-- 2% on healthcare
Laos--4.5%
Cambodia--5.6%
Flooded roads in Vietnam
Forbes

16. Rubbish clogs a river in Vietnam
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
arsenic poisoning can cause cancer
according to the Ministry of Naural Resources and Environment, 80% of diseases caused by polluted water, such as cholera, typhoid, dysentery, malaria
Rubbish clogs a river in Vietnam
UNDP
The Water Project

17. 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
due to such a lack of infrastructure and how hard it is to enact high level policies, this hasn’t made huge differences, but still the right track
in order to get poor and black market workers who have avoided paying for insurance
huge increase in HDI since the 80s
its very difficult for developing countries to determine how much money to spend on healthcare, so it’s great news that Vietnam is increasing that percent of GDP spending
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.
Economist
UNDP
Forbes

18. Independent 1961, population 6.09 million
SIERRA LEONE
Independent 1961, population 6.09 million
Health workers in Sierra Leone screen people for the Ebola virus in Kenema
Ebola patients in Sierra Leone

19. Background Constant internal strife Civil War ended in 2002
Economy is struggling
Receives aid from several countries
Economic Policy
Poverty -reduction efforts
Many public institutions just started to be rebuilt after the Civil War that ended in 2002
The International Monetary Fund, as well as countries such as the United States, the United Kingdom, Italy, and Germany continue to provide aid to Sierra Leone.
Recently, the country’s economic policy has shifted from post-conflict stabilization to poverty-reduction efforts

20. 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
170,000 Sierra Leoneans have this disease
Life expectancy at birth 45.56
4th highest child mortality rate in the world
The UN Development Programme’s Human Development Reports rank Sierra Leone 176 of 232 countries on overall quality-of-life issues.
Aids has killed 11,000 people since 2001
High disease incidences have produced a lower-than-normal life expectancy
174 deaths per 1,000 live births
Encyclopedia of Environment and Science, 2007
UN Human Development Report
World Health Organization, 2015

21. Road in Kenema Sierra Leone
Technology
Not enough skilled workers
Limited transportation to health care facilities
Poor Road Construction
Only around 100 doctors
Road in Kenema Sierra Leone

22. 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)
Only 20.5 percent of adult females and 39.8 percent of adult males can read and write English, Mende, Temne, or Arabic makes it difficult to disseminate health information, contributing to the high fertility rate of 6.5 children per female.
Encyclopedia of Environment and Science, 2007
UN Human Development Report

23. 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
Some 43 percent of the population lack sustained access to safe drinking water, and 61 percent lack access to improved sanitation
In 2000, Sierra Leone passed the Environment Protection Act and charged the Minister of Lands, Housing, Country Planning, and the Environment
with planning, implementing and enforcing environmental laws and regulations that are aimed at sustainable development and conservation of resources.
The ministry faces the daunting task of protecting Sierra Leone’s environment from further damage in the midst of renewed economic activity in the post-war years
Encyclopedia of Environment and Science, 2007

24. Burial Team in Freetown, Sierra Leone
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
Because it is not known exactly how people are infected with Ebola, few primary prevention measures have been established and no vaccine exists.
Burial Team in Freetown, Sierra Leone
The Economist Newspaper, 2015

25. 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
Government spending on health care has increased from 7% to 11% of total expenditure in the 2014 budget

26. 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
Government lacked ability to organize something as complex as provision of free health care
Individuals entitled to free health care claim to still be charge or sent to a private pharmacies to buy drugs

27. Independent 1825, population 10.67 million
BOLIVIA
Independent 1825, population million
Bolivian doctor checks child for an ear infection
Bolivians wait for medical treatment in the highland of the Amazon Region

28. 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:

29. 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

30. 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

31. 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

32. 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

33. Environment Deforestation Soil erosion Overgrazing
Deforestation in the Bolivian countryside:

34. 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

35. Key Points Possibility Production Frontier Challenges: A3
Accessibility
Availability
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 Non-Health Capital Goods
Possibility Production Frontier
Output of Consumer Health Goods

36. 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

37. The World Bank Apr.14

38. Questions and Answers

39. Bibliography
Bernstein, Lenny. "Twenty-eight Countries Have Worse Health Care Systems than Liberia’s." The Washington Post, 3 Mar Web. 29 Mar
C., Ledo, and Soria R. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, Web.
Country Programme Plurinational State of Bolivia ( ). United Nations: World Food Programme, Web.
DeNoble, Damjan P. "The Vietnam Healthcare Moment - Health Intel Asia." Health Intel Asia. N.p., 11 June Web. 30 Mar
Frakt, Austin. "Hospitals Are Wrong About Shifting Costs to Private Insurers." The New York Times. The New York Times, 23 Mar Web. 26 Mar
Frakt, Austin. "Hospitals Are Wrong About Shifting Costs to Private Insurers." The New York Times. The New York Times, 23 Mar Web. 26 Mar "Healthcare in Vietnam." Healthcare in Vietnam. N.p., n.d. Web. 30 Mar
"Healthcare." Sierra Leone Makes Progress on Free Health Care Initiative. Web. 29 Mar
"Health Expenditure per Capita (current US$)." The World Bank. N.p., Web.
"Human Development Reports." UNDR. United Nations, n.d. Web. 30 Mar
"It's up to You." The Economist. The Economist Newspaper, 4 Feb Web. 29 Mar
"Limping along." The Economist. The Economist Newspaper, 20 Sept Web. 30 Mar
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, Print.
"Much Worse to Come." The Economist. The Economist Newspaper, 18 Oct Web. 29 Mar

40. 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, Print.
"Much Worse to Come." The Economist. The Economist Newspaper, 18 Oct Web. 29 Mar
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 (2008): Willey Online Library. Web. 29 Mar
Robbins, Paul, ed. “Sierra Leone.” Encyclopedia of Environment and Society. Vol. 4. Thousand Oaks, CA: SAGE Publications, –1605. Gale. Web. 29 Mar
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 World Bank. Out-of-pocket Health Expenditure Web. 30 March
"The Bolivian Health System and Its Impact on Health Care Use and Financial Risk Protection." World Health Organizaton (n.d.): n. pag Web.
"Water In Crisis - Spotlight Vietnam." The Water Project. N.p., n.d. Web. 30 Mar
"What Is Universal Health Coverage?" Universal Health Coverage. World Health Organization, Sept Web. 29 Mar
World Bank. Health Expenditure, Public Web. 30 March
World Bank. Health Expenditure, Total Web. 30 March
World Bank. Out-of-pocket Health Expenditure Web. 30 March