Effects of Maternal Mortality on Gross Domestic Product (GDP) in the WHO African Region

WHO African region has got the highest maternal mortality rate compared to the other five regions. Maternal mortality is hypothesized to have significantly negative effect on the gross domestic product (GDP). The objective of the current study was to estimate the loss in GDP attributable to maternal mortality in the WHO African Region. The burden of maternal mortality on GDP was estimated using a doublelog econometric model. The analysis is based on cross-sectional data for 45 of the 46 Member States in the WHO African Region. Data were obtained from UNDP and the World Bank publications. All the explanatory variables included in the doublelog model were found to have statistically significant effect on per capita gross domestic product (GDP) at 5level in a t-distribution test. The coefficients for land (D); capital (K); educational enrolment (EN) and exports (X) had a positive sign; while labor (L); imports (M) and maternal mortality rate (MMR) were found to impact negatively on GDP. Maternal mortality of a single person was found to reduce per capita GDP by US$ 0.36 per year. The study has demonstrated that maternal mortality has a statistically significant negative effect on GDP. Thus; as policy-makers strive to increase GDP through land reform programs; capital investments; export promotion and increase in educational enrolment; they should always remember that investments in maternal mortalityreducing interventions promises significant economic returns

Health Economics: Potential Applications in HIV/AIDS Control in Africa

There is growing evidence that HIV/AIDS has enormous negative impact on health status and economic development of individuals; households; communities and nations in the African region [33]. Thus; there is urgent need for various disciplines to demonstrate how they can contribute in curbing the spread of this deadly disease in the African region. This paper; using an extended version of Professor Alan Williams [32] schema as the conceptual framework; attempts to demonstrate how health economics can be used to inform policy and managerial choices related to HIV/AIDS advocacy; prevention; treatment and management. It argues that the discipline of health economics (and economics generally) is extremely valuable in: measuring health impacts of the disease and interventions; evaluating the relationships between health care-seeking behaviour of individuals and health system specific attributes; the estimation of determinants of compliance of HIV/AIDS patients with treatment regimen; establishing of health institutions efficiency in combating AIDS; guiding choices of HIV/AIDS interventions; assessing the relationships between HIV/AIDS; development; poverty; and trade; programme planning; monitoring and evaluation; and assessing health system's overall performance. The paper is a modest attempt to show how the discipline of health economics can elucidate; and help in resolving practical and conceptual issues in HIV/AIDS control in Africa

Household composition and expenditures on human capital formation in Kenya.

"Expenditures on human capital determinants in Kenya are analyzed using microdata. Specific expenditures on food, schooling, and medical care provide evidence of human capital formation activities of households. The analysis is focused on expenditure and distributional effects of household composition dimensions. To determine empirical magnitudes of the effects, a flexible form of a household expenditure function is estimated. The results of the analysis show that gender and age composition are important determinants of the level and distribution of human capital investments in a household. In addition, household budget allocation favors boys over girls for secondary school education. The policies implied by the findings are discussed."

User charges in government health facilities in Kenya: effect on attendance and revenue.

In this paper we study demand effects of user charges in a district health care system using cross-sectional data from household and facility surveys. The effects are examined in public as well as in private health facilities. We also look briefly at the impact of fees on revenue and service quality in government facilities. During the period of cost-sharing in public clinics, attendance dropped by about 50%. This drop prompted the government to suspend the fees for approximately 20 months. Over the 7 months after suspension of fees, attendance at government health centres increased by 41%. The suspension further caused a notable movement of patients from the private sector to government health facilities. The revenue generated by user fees covered 2.4% of the recurrent health budget. Some 40% of the facilities did not spend the fee revenue they collected, mainly due to cumbersome procedures of expenditure approvals. The paper concludes with lessons from Kenya's experience with user charges.

Health care reform in Kenya: a review of the process.

The paper looks at the process of health care reform in Kenya during the past 30 years, with a focus on implementation strategies. The data are from official documents of the government. The main finding is that development plans served as the medium through which the government announced its intentions as well as its decisions to implement reforms. A decision to implement a reform was normally accompanied by an implementation budget, whereas an announcement of an intention typically lacked such support. Some of the reforms were implemented speedily and firmly, whereas others suffered delays and reversals. Reforms were implemented with speed and firmness when research provided clear guidance on key policy issues or when political will and skill existed. Donor influence on the timing of reforms might have been excessive. Policy lessons from the process are indicated.

Agricultural land use patterns and malaria conditions in Kenya.

This paper studies the problem of malaria control in irrigation and non-irrigation areas in Kenya. Empirical results show that in both areas, households' level of awareness of malaria as a health problem, including its cause, was very high. However, attempts to trace the direct effects of malaria upon income or upon agricultural production were not statistically important. This does not imply that malaria has no consequence on household welfare. It is possible that the model equations were mis-specified--aggregate variables (total family size, total family income) and failure to quantify land in the production relationships may have contributed to these results. In addition, poor separation of malaria as a disease, from malaria as an infection, may have underestimated the effect of the disease on production. Thirdly, labour substitution (hiring or within-family substitution) was not measured in this early study, but was taken into account in subsequent research. Finally, labour requirements in the annual crop production schedules and the co-relation between these labour requirements and the pattern of adult morbidity were not longitudinally monitored. Cross-section data would bias the findings, particularly in those areas where the peak transmission season is short, where the crop grown does not require major labour input during this transmission season, and where acquisition of immunity would reduce the clinical impact of malaria upon adult labour. These vulnerabilities in the specification of the model and the data collected, probably affect the results obtained. Our empirical work raises a number of interesting and important questions which should be taken into account in future research.

A comment on Kenyan migration movements.

PIP: The author comments on an article by Richard E. Bilsborrow, John O. Oucho, and John W. Molyneaux concerning the economic, geographic, and ethnic factors affecting migration in Kenya. In particular, he criticizes the model of migration developed in the original study.^ieng

Economics of essential drugs schemes: the perspectives of the developing countries.

Essential drug schemes in the Third World countries face many problems. These include dependency on imported drugs in the face of chronic shortages of foreign exchange, inadequate manpower and technical capability for selection and procurement of drugs, competition between generic and brand drugs, weak local drug procurement and distribution systems and inability to commence local manufacturing even in situations where there may exist comparative advantage. Many of these problems relate to each other and are compounded by the domination of the pharmaceutical industry by multinational firms. Third World countries are in a very weak position in the international pharmaceutical industry. It is suggested that the essential drug situation would improve in Third World countries if certain strategies and policies were adopted. These include: intensification of personnel training in pharmaceuticals, deliberate use of generic drugs rather than brand name drugs, the involvement of the public sector in the procurement and distribution of drugs, buying drugs in bulk, changing drug prescription and consumption practices through continuous education, changing or instituting regulations to guard against unfavourable patents and commencing domestic production of essential drugs where this is not in conflict with the principle of comparative advantage.

Health care financing in Kenya: a simulation of welfare effects of user fees.

This paper examines the efficiency and equity effects of introducing user fees in public health facilities in Kenya. These effects are studied with the aid of a simulation technique. It is found that through their favourable effects on quality of medical services, the user fees in public clinics would yield welfare gains. However, these gains might involve unacceptable equity trade-offs. Thus, in general, the net welfare effects of user charges on medical services is ambiguous. More specifically, if the user fees were imposed across the board in government health facilities, the equity trade-offs would be large, and for that reason, the user fees would be socially and politically unacceptable. But, if the user charges are restricted to government hospitals, the attendant equity problem would not be too difficult to manage.

Health care decisions at the household level: results of a rural health survey in Kenya.

The observed visits to health care providers are an outcome of patients' health care decision-making process. Unlike the visits, this process is not observable. The paper first outlines this process, and then presents patterns of patients' visits to health care providers in a particular rural area in Kenya. The visit patterns are shown to vary greatly according to type of illness and to the stage of the illness. The paper has two main results. The first result is that in the study area, the majority of the patients sought medical treatment outside the 'free' government health care system. The other finding is that for a given illness episode, there is a very high likelihood of a patient consulting more than one provider for advice or treatment.

Economics of health and nutrition in Kenya.

This paper starts by outlining the present state of health and nutrition in Kenya. Health status for Kenyans has shown spectacular improvement since Kenya's attainment of independence in 1963. Both the infant mortality and crude death rates fell by about 30% between 1963 and 1982. Life expectancy at birth has risen dramatically from 40 years to 54 years over the same period. However, this picture could be misleading because it is possible for the morbidity rate to have risen, or declined only slightly, over the twenty-year period during which mortality rates in Kenya fell substantially. It is further indicated that despite Kenya having per capita availability of nutrients exceeding that recommended by FAO/WHO; about one-third of Kenya's population is unable to meet its food or nutritional requirements.

Essential national health research : a situational analysis

The purpose of the study was to set an agenda for essential national health research for socio-economic development. An overview of health research in Kenya is given. Discussions on this study led to the establishment of a National Health Research and Development Centre to cater for essential national health research issues in Kenya