Unit 9 - Explaining Trends In Capability Poverty

Question 1

It is difficult to reach the children who are most marginalized in developing countries, which are:

Answer 1

Girls
Children in rural communities
Children from the poorest 20% of society

Question 2

Progress on MDG 6

Answer 2

HIV / AIDS - declined between 2001-2009 with almost 25%
33% live with HIV (27% increase sinds 1999)
SSA 69% of newly infected, 68% of all HIV and 72% of all AIDS
23% is

Question 3

Identified priorities in addressing the child mortality MDGs

Answer 3

Parallel needs for medical and systemic investment

Medical priorities:

• Diarrhea (17% of infant deaths)
• pneumonia (19% of infant deaths)
• measles
• malaria
• HIV/AIDS
• TB

Systematic priorities:

• neo-natal care and nutrician
• maternal education
• ensuring universal access to health care.

Question 4

Maternal eduction

Answer 4

1. Provide appropriate care for newborns / postnatal care
2. Raising awareness of the issues linking maternal mortality with childbearing
3. Encouraging adoption of preventative medicine at the family and community level.
4. Highlighting the link between health and nutrition

Undernutrician is 1/3 of these deaths (before 28 days) in SSA and Southern Asia.

Question 5

Regional progress in primary eduction

Answer 5

Sub-Sahara Africa - best improvement
From 53% in 1991 to 79% in 2015 (+26%)
30% drop outs
32m children not in school

Southern Asia - also good improvement
From 75% to 95% (1991-2015) (+20%)
Especially access for girls
- 1991 76 girls for every 100 boys
- 2015 102 girls for every 100 boys
16m children not in school

Other in 2015:
LA 95%
Caribbean 82%
Northern africa almost 100% (from 81%)
Caucasus / central asia 95%

Question 6

Progress on MDG 5

Answer 6

Reduction of maternal mortality

Target = reduction of 75%

However between 2000 and 2013 it dropped 38%, from 370 to 230 per 100.000 deaths.

SSA and southern asia accounted for 87% of worldwide maternal deaths in 2008.

Question 7

What are the factors that stand in the way of reaching the outstanding international goals on health?

Answer 7

1. International procurement of medicines and medical resources
2. National distribution of medicines and medical resources to those most at risk
3. Weakness in national health communications and distribution infrastructure
4. Weaknesses in infrastructure for health care provision
5. Insufficient numbers of trained staff
6. National capacity for training and recruitment to reach numbers
7. Insufficient resources to monitor and ensure good basic health practice at community/hh level

Question 8

Causes of lack of health workforce

Answer 8

1. Number of people being trained and educated (example ethiopia only 200 doctors per year)
2. Poor working conditions
3. Large salary differences between public and private sector
4. International migration

Question 9

Community health workers should…

Answer 9

• be paid and trained
• have skills and training on health promotion, prevention and curative interventions
• be supervised by professionals
• be linked to national health structure as integral part of the formal health system
• have opportunities for further training and professional advancement.

Question 10

Increase of enrolment in primary eduction worldwide between 1991 and 2015

Answer 10

From 80% in 1991 to 91% in 2015

Most rapid increase in sub saharan africa, net enrolment rate still lowest with caribbean and south asia (excl. india)

Question 11

Poverty and education - the underlying barriers to access

Answer 11

1. indirect cost of education
2. Quality of education
3. Health and long-term educational access (school feeding programmes)
4. Long-term eductional participation
5. Education, employment and poverty

Question 12

Addressing access/procurement of medical resources

Answer 12

Advocacy & lobbying of IO’s and citizens:

• provide updated lists of essential medical resources
• try to ensure governments make committment to access these essentials
• national health services can adopt
  
  • • policies for promoting generic medicines
  • • alternative financing mechanisms
• hold pharmaceutical companies accountable

Question 13

Common barriers to educational access that are specific to rural settings are:

Answer 13

1. Low number and poor distribution of schools across rural regions
2. Distance to school
3. High number of children per class
4. High teacher:pupil ratio

Question 14

Progress on MDG 4

Answer 14

Reduce child mortality
From 100 per 1000 in 1990 to 50 in 2013 (underestimated)
Target was reduction of 2/3 - so not met, a reduction of almost 50% was met.

Souther Asia - 60 per 1000 in 2013 (or 1 in 17)

Question 15

Factors that influence the levels of health care that the poorest sections of society are able to access

Answer 15

1. Geographical location
2. Number of health facilities
3. Distances to health facilities
4. Availability of care (frequency treatment, speed of access)
5. Cost
6. Workforce availability and quality
7. Poverty levels of community
8. Health level of community
9. Social and cultural profiles

Question 16

Measuring children’s participation in education in SSA (Lewin, 2009) - variety of intersecting factors:

Answer 16

1. Gender
2. Urban vs rural
3. Regional demographics - incl. Regional populations and dispersal of schools
4. Income and poverty levels of pupils

Question 17

The range of approaches to ensure universal primary eduction (which involves the hardest-to-reach children as well

Answer 17

1. Targeted policy decisions designed to lower pre-existing barriers and encourage enrolment (Abolition of fees, subsidies etc)
2. instruments in infrastructure (school building programs, girl friendly designs)
3. investment in HR

Question 18

Addressing health workforce shortages

Answer 18

1. Government needs to address recruitment and retention issues through policies, salary, working conditions and professional opportunity
2. Address current levels of health worker training and education, increase numbers and change the modes.
3. Who should be trained, selection.
4. Community health workers for low level medical interventions

Question 19

Access to and procurement of medical resources

Answer 19

1/3 of world population has no regular access to medicines and medical resources

• procurement sometimes upto 11x the reference prices
• purchase 9-25x the reference prices

Supply comes through private sector & payment throug out-of-pocket payments»_space; exclusing the poor and vulnerable

Question 20

Approaches used in addessing international health goal

Answer 20

1. Programmes of immunisation and vaccination
2. Low-cost prevention and treatment
3. Maternal education programmes

10x more mosquito nets resulted in 44% fewer child deaths of malaria.

Question 21

Key interventions in health care

Answer 21

• Immunisation and vaccinations programmes
• Low-cost prevention and treatment
• Health education

Question 22

The health MDG’s

Answer 22

4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases

Question 23

Approaches used in seeking attainment of universal primary eduction

Answer 23

1. Abolition of school fees
2. Expanding access in remote and rural areas (school building programs, teacher recruitment programmes, targeted initiatives)
3. Promotion of eduction for girls
   - Addressing social attitutes
   - Financial incentives
   - Teacher recruitment and training practises
   - ‘Girl-friendly’ eductional infrastructure
   - ‘Girl-friendly’ registration policies

Question 24

Challenges in delivering approaches associated with the international health goals

Answer 24

1. Access to and procurement of medical resources
2. Local health facilities and distribution systems
3. Shortage of health workforce

Question 25

Barriers that prevent the poor from access to medical services

Answer 25

1. Geographic accessibility 2. Financial accessibility 3. Availability of care (frequency and speed) 4. Quality of care 5. Acceptability of care

Question 26

primary eduction completion rate in development regions

Answer 26

Only 73 out of 100 children in development regions complete primary eduction. In half of the LDC's, 40% drops out before reaching the last grade.

Question 27

Vertically vs horizontally oriented health care models

Answer 27

Vertically: focus on one disease, encourages approaches to tackle a disease and not improve the health system. Horizontally: - seek to identify parallel requirements between various diseases, illnesses and conditions - capitalise on these synergies with overall improvement in systematic care delivery