Session 4: Reaching the Poor: The Post MDG Agenda

Date: 04 July 2012
Time: 14:45-15:45
Venue: Tunis, Tunisia

SESSION AIM
Engage finance and health ministers in a discussion of successful innovations to reach the poor to overcome inequalities in health service delivery and coverage.

BACKGROUND
Despite strong economic growth in Africa, inequities in health outcomes by socioeconomic quintile are prevalent and widening in some countries. For example, poverty tends to be a major barrier to women’s utilization of health services in Sub-Saharan Africa, with those in the poorest quintile being the least likely to receive care during pregnancy and childbirth. Only 25.6% of women in the poorest quintile receive professional medical care during delivery as compared to 82.5% of those in the richest quintile. Under-five mortality of the bottom quintile was also on average 2.2 times higher than that of the wealthiest quintile in Sub-Saharan Africa. The burden of communicable diseases also falls most heavily on the poorest. This session will describe promising examples from Africa and around the world of innovations in health financing and delivery which can increase access by the poor.

Since the MDGs measure an average among the whole population of a country, they do not take into account inequities in the provision of health services and achievement of health outcomes amongst different segments of the population. It is therefore feasible that a country could achieve the MDGs without much improving the indicators for the poorest groups. A 2010 UNICEF report found that health MDG indicators are typically worst among the poorest, in rural areas, among children of less educated mothers and for boys (Under-5 mortality).

Recent data suggest that despite general improvements within disease categories, the distribution of deaths by cause for the total population of low income countries indicates that the burden of communicable diseases continues to fall heavily on the poorest, who are far more likely to die of communicable diseases than the richest quintile of the population. In the future, it is likely that the burden of communicable diseases will fall (and the burden of non-communicable diseases will rise), but it is likely that the communicable disease burden will remain highest for the poorest segments of the population, who are most exposed.

The most important reasons for these inequities include the inequitable access to key health inputs such as immunizations, oral rehydration therapy, antenatal care and treatment for common infectious diseases. Often, the poor are the last to be reached through efforts to expand the coverage of basic health services, since, for example, they may live in remote areas, or difficult to access urban slums. Even when services are available, social conditions may prevent access. This need not happen, however, and successful examples in Africa of increasing health care access by the poor will be discussed in other sessions of the conference. This session will provide an overview several program and policy options which, the evidence shows, can help ensure that the poor share fully in the benefits of expanded coverage at every stage of the expansion process.

KEY DISCUSSION TOPICS

• What is the experience to date at the international and country levels?
• What are the most promising tools and what are the challenges?
• What is the role of civil society and the private sector?
• How can best practice be shared amongst countries, and which agencies can assist?

CHAIRS & SPEAKERS

Chair: Ms Letty. Chiwara, Chief, Africa Division, UNWomen
Co-Chair: Hon. Ntoateng Lebona, Minister of finance, Lesotho

Key note speaker:
Hon. Bethel Amadi, President, Pan African Parliament (10 min)

Dave Gwatkin, Senior Fellow, Results for Development, and Senior Associate at the John’s Hopkins Bloomberg School of Public Health (10 mins)

Hon. Tabu Manirakiza, Minister of Finance, Burundi (10 mins)

Hon. President Bethel Amadi, President of the Pan African Parliament (10 mins)

Rotimi Sankore, Coordinator, Africa Public Health Alliance & 15% Plus Campaign and Secretary, Africa Public Health Parliamentary Network (10 mins)

Elhadj As Sy, Regional Director, UNICEF WCARO (10 mins)

Open discussion (30 mins)