Benchmarks for health expenditures, services and outcomes in Africa during the 1990s.

There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s. We intend to make statistical information available for national level comparisons. National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews. The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison. There is wide variation in scale and outcome of health care spending between African countries, with poorer countries tending to do worse than wealthier ones. From 1990-96, the median annual per capita government expenditure on health was nearly US$ 6, but averaged US$ 3 in the lowest-income countries, compared to US$ 72 in middle-income countries. Similar trends were found for health services and outcomes. Results from individual countries (particularly Ethiopia, Ghana, Côte d'Ivoire and Gabon) are used to indicate how the data can be used to identify areas of improvement in health system performance. Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management. Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries.

Combatting AIDS and other sexually transmitted diseases in Africa : a review of the World Bank's Agenda for Action

This paper reevaluates and updates the 1988 World Bank agenda for action on Acquired Immunodeficiency Syndrome (AIDS) in Africa. What was seen previously as largely a disease of urban populations is now spreading in rural areas. The paper concludes that African countries can do much to combat AIDS. New efforts need to be made to change behavior among high-risk groups. The treatment of other sexually transmitted diseases merits increasing emphasis. The core financial and planning agencies of African governments need to focus on AIDS and its implications for development