Overview

Because poor health, malnutrition, and high fertility drive poverty, the World Bank is commited to improving health, nutrition, and population outcomes among the poor. The suffering brought by ill health and its consequence to families, societies, and economies is especially grave in Africa. Health improvements in Africa have lagged behind other regions, and some countries are even experiencing reversals. Making any progress towards reaching the poverty, health (and likely education) Millenium Development Goals in Africa is now in jeopardy.

	The average life expectancy in Sub-Saharan Africa in the era of AIDS is now less than 47 years, in comparison to 77 years in OECD countries.
	Under-five mortality rates are worsening in 18 of the 38 countries where data is available, in stark contrast to the marked improvements made by countries in the South Asia Region.
	Africa is the only region where both the number and proportion of malnourished children is on the rise, and is the single biggest risk factor in the burden of disease. Forty-seven million Africa children under the age of five showed signs of chronic malnutrition in 2000. The proportion of underweight children was reported at 27 percent in 1990 and only 29 percent in 2000.
	Total fertility rates are stagnant or only very slowly coming down, but many countries show contraceptive prevalence use in the single digits. The high fertility rate and excessive population growth in Africa creates a very young population and high dependency ratio, requiring greater investment in the basic needs of dependents.
	Maternal deaths in Sub-Saharan Africa account for about half the world's total, the two leading contributors being unsafe abortion and anemia (due mainly to malaria). While coverage of skilled obstetric care at delivery improved in all other regions, it has remained stagnant in Africa. An average of 1 in 16 women still die in childbirth in SSA, compared to 1 in 3,500 in OECD countries.
	Communicable diseases continue to be the main cause of mortality, with five conditions accounting for more than half of all deaths: AIDS, respiratory infections, malaria, diarrhea disease, and childhood illnesses.
	The significantly lower health gains in Africa over the last 20 years seem to be largely accounted for by a very low level of progress in delivering health services to the poor.

There are, of course, exceptions to these generalizations, but relative to other regions, Africa faces special challenges:

	Geography, environment, culture and conflict all have distinctive effects on the prevalence of disease and on the supply of, and demand for, health services.
	Institutional capacity in Africa is limited.
	Donors influence the health sector more than in any other region.
	AIDS puts an insupportable burden on health systems, in ways both quantitatively and qualitatively different from other regions.