Topic 5. Poverty and Health - XEA 406

POVERTY AND DEVELOPMENT
TOPIC 5: POVERTY AND HEALTH
A. Poverty as a consequence of ill health.

 Ill health, malnutrition, and high fertility are often reasons why households end up in
poverty, or sink further into it if they are already poor.
 The illness of a household breadwinner and the consequent loss of income can undermine
a poor household’s ability to cope financially.
 Out-of-pocket payments for health services especially hospital care can make the
difference between a household being poor or not.
 High fertility additionally places an extra financial burden on households, by diluting the
resources available to other household members and by constraining earning opportunities,
especially for women.
B. Poverty is also a cause of ill health.

 Poor countries and poor people suffer from a multiplicity of deprivations which translate
into levels of ill health that far exceed the population average
 Most obviously, they lack the financial resources to pay for health services, food, clean
water, good sanitation, and the other key inputs to producing good health.
 It is not just lack of income that causes the high levels of ill health among poor people,
however: the health facilities serving them are often dilapidated, inaccessible, inadequately
stocked with basic medicines, and run by poorly trained staff.
 Furthermore, the poor are also disadvantaged by a lack of knowledge about prevention and
when to seek health care.
 They also tend to live in communities that have weak institutions and have social norms
that are not conducive to good health.
 In short, poor people are caught in a vicious cycle: their poverty breeds ill health; and this
in turn conspires to keep them poor
How governments can improve the health of poor people:

 Health, along with education, is seen as one of the key ultimate goals of development, and
increasingly is seen as a dimension of poverty in its own right.
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 Governments can mitigate the effects of low income on health outcomes by reducing the
price poor people pay for health and other key goods and services, though, for example,
health insurance, fee-waivers, and targeted food subsidies.
 Governments can also reduce the non-income disadvantages faced by poor people:
i. Improve poor people’s access to and knowledge of health services.
ii. Improve the quality of services that poor people use, both in technical terms and by
making them more user-friendly
iii. Get services more focused on the interventions that are relevant to the health profile
of poor people.
How governments can reduce the impoverishing effects of ill health:

 By improving the health of their populations, governments can reduce income poverty.
 They can also reduce income poverty indirectly, by reducing the impact of ill health on
household living standards; for example, by modifying health financing arrangements to
ensure that people do not face large out-of-pocket payments when they fall ill.
 This is sometimes called the financial protection goal of health systems; it is clearly a
secondary goal to that of improving health, but is nonetheless an important one.
 Other parts of government also have a role to play here; for example, by introducing
schemes to provide income support to households where the breadwinner is ill and unable
to work.
The role of government

 Governments cannot do everything, and in the health sphere they never will.
 Good health in any case is not just about what goes on inside health clinics and hospitals
good health can be produced in many ways, and central to this process are people, as
members of households and as members of communities.
 Governments have a key role to play, and fulfilling that role is not just a question of
pumping money into health services.
 Services need to be relevant, accessible, and affordable to poor people. There has to be
coordination between government and the other actors in the health system, such as donors,
NGOs, and community organizations.
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 Actors in the system have to be kept well informed about the costs and benefits of different
health interventions, about best practices in their delivery, about the health risks associated
with certain activities and products, about the opportunities for obtaining care from
different providers, and so on.
The different levels of government action

 The first of these is the macroeconomic level the level of the government’s national budget.
Here the major concern is the amount of resources allocated to health, but an important
secondary concern is the possible reallocations of budgets to reach poor people better.
 The second level is the health system, where the concern is to put together reforms and
improve incentives to get the system to function better for poor people.
 The third level is the microeconomic or service delivery level, where the focus should be
on how to implement specific activities to reach poor people.
 Work at these three levels is interdependent: those working at the project or service
delivery level cannot succeed without the cooperation and assistance of those at the systems
and spending levels.
The Key Stages in Policy Design

1. Diagnostics.
What are the health outcomes of the country in question and how do these vary between poor
people and those that are better off? How far are households put at risk of poverty because of
payments for health care?
2. Analysis.
What explains the bad health outcomes of poor people and the impoverishment associated with ill
health, and how far do existing policies help improve matters?
Health outcomes and impoverishment are the result of the interaction between households,
communities, health services, other sectors, and government.
i. Households
 In effect, it is households that “produce” health, through their consumption of food, their
sanitary and sexual practices, their consumption of health-damaging commodities such as
cigarettes, and their use of preventive and curative health services.
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 Some households seek and manage to obtain health care when ill; others do not. Some
manage to consume the recommended daily amount of different nutrients while others do
not, and so on.
ii. Communities.
 The values and social norms a community shares can make a big difference to health
outcomes; for example, through the use of antenatal and other reproductive health services
by women.
 Communities can also exert a major influence over the way local health services are run.
Involving communities in the running of health services can improve social accountability
and empower the poor, which may be seen as a goal in itself.
iii. Health services
 The question of accessibility: whether or not services are sufficiently close to the
population they serve and whether or not the infrastructure is sufficiently good to enable
access.
 Whether or not the facilities have a sufficient supply of key inputs drugs, vaccines, and so
on. organizational quality, technical quality, and efficiency.
 Throughout, a key question is how the poor are served. Also important is the financing of
health care: How much do different groups have to pay out of pocket?
a) Who is covered by some form of insurance scheme; whether public or private and
for what risks?
b) How far do people with insurance share risks with the insurer through copayments?
c) How is health insurance financed?
iv. Other sectors.
 The market for food, the education sector, the transport and infrastructure sectors, energy,
and water and sanitation. Other examples include pollution, workplace health hazards, and
so on.
v. Government.
 Governments have at their disposal a number of instruments to influence the provision of
health services, in the public sector and also in the private and charitable sectors.
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3. Prioritization
 Resources financial and human are limited, and it is essential to draw up priorities based
on assessment of the likely payoffs associated with various policies, their impact on poor
people, and the resources required to implement them.
 This stage is likely to involve learning from the experiences of other countries and a
dialogue within the country between the various stakeholders.
4. Setting targets, and monitoring and evaluation
 Targets have to be set realistically, and progress toward them needs to be monitored. The
success of policies in terms of moving the country toward those targets also needs to be
evaluated.
DOMINIC AMORO 5

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POVERTY AND DEVELOPMENT

TOPIC 5: POVERTY AND HEALTH

A. Poverty as a consequence of ill health.

B. Poverty is also a cause of ill health.

How governments can improve the health of poor people:

How governments can reduce the impoverishing effects of ill health:

The role of government

The different levels of government action

The Key Stages in Policy Design

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