PROGRESS IN HEALTH
During the past 30 years the Latin America & Caribbean region has seen a steady improvement in health indicators, particularly in nutrition, access to contraceptives, and hygiene, as well as external factors that are conducive to illness prevention, such as improved water and sanitation services. Other factors that have contributed to gains in the health sector include successful efforts to educate the public on the causes, prevention, and treatment of disease, and to make interventions more accessible to those who need them.
As a result, regional progress in health indicators include:
• Increasing the vaccination rate from 10 to 90 percent over the last 30 years,
• Increasing life expectancy from an average of a little over 50 years in the sixties to 71 years currently, and
• Reducing under-five mortality rates from 55.3 deaths per 1,000 births in 1980 to 34 deaths per 1,000 in 2002.
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CHALLENGES AHEAD
Although the Latin America and the Caribbean region has the potential to reach many of the Millennium Development Goals, many challenges remain, including demographic and epidemiological changes, shifting economic and political cycles, and pervasive inequality.
Due to the high degree of inequality in the region, health outcomes vary as widely as income distribution, resulting in profound differences on life opportunities and quality. In Brazil for example, children born to households in the poorest fifth of the population are three times as likely to die before they reach the age of five as are children born to households in the richest fifth. In Bolivia, this figure is more than four times as high among the poor, with children in the bottom fifth of the population experiencing under-five mortality
rates of 146.5 per 1,000, compared to the regional average of 34 per 1,000.
Issues contributing to the inequitable coverage and quality of health care services in the region, include:
•Segmentation of the health systems, which has brought high expenditure levels and poor results. When compared to the rest of the world, spending on health services in Latin America is high relative to per capita income, but health outcomes are not commensurate with the spending. The most common explanation is that the development of separate systems of provision for the rich, the working classes, and the poor has created an inefficient physical network of redundant and poorly utilized facilities that reinforce inequalities in access to health services.
•Public sector coordination: Health Ministries need to become more effective at assessing the health status of the population, developing policies to address the needs identified, and assuring that these polices are carried out.
• Rapid demographic changes, such as the aging of the population, and
epidemiological changes have altered the health care landscape in the region. Countries must develop policies to respond to these changes, including providing home care for the chronically ill and bolstering efforts to prevent non-communicable diseases, such as diabetes, heart disease, and cancer, and injuries. |
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Source: World Bank (2003) |
WORLD BANK ASSISTANCE TO HEALTH, NUTRITION AND POPULATION IN THE REGION
Access to quality health care, along with education, food security, water and sanitation, is fundamental to economic development. During fiscal year 2003, the Bank channeled 27 percent of its lending, or $1.57 billion, to support health and critical social services in Latin American and Caribbean (LAC) countries.
World Bank-financed health projects support LAC countries' policies to improve health, nutrition, and population outcomes of poor people and protect people from the impoverishing effects of illness, malnutrition, and high fertility.
The main health goals pursued by the Bank are to:
• Promote equitable access and quality of health services, such as preventive and curative health, nutrition, and population services which are affordable, effective, well managed, of good quality, and responsive to clients.
• Improve the response to HIV/AIDS with the goal of increasing public awareness about the transmission, prevention and treatment of HIV and other sexually-transmitted diseases (STD).
• Support health system reforms to improve the efficiency, impact and management of public health resources.
• Secure sustainable health care financing by mobilizing adequate levels of resources, establishing broad-based risk pooling mechanisms, and maintaining effective control over public and private expenditure.
• Provide emergency support by assisting governments to define and implement emergency reconstruction programs in the health sector, so that natural disasters are used as an opportunity to strengthen disease prevention programs and to improve the organization and functioning of health systems.
HEALTH, NUTRITION AND POPULATION AND THE MILLENIUM DEVELOPMENT GOALS
As part of its mission to eliminate poverty and achieve sustainable development, the World Bank is committed to helping countries achieve the Millennium Development Goals by 2015, which include:
• Halving the proportion of people who suffer from hunger;
• Reducing by two-thirds the under-five mortality rate;
• Reducing by three-quarters the maternal mortality rate; and
• Halting and start reversing the spread and incidence of HIV/AIDS, malaria and other major diseases.
PROJECT ACHIEVEMENTS
Countries in Latin America and the Caribbean have achieved impressive progress on health with support from the World Bank. Recent examples include:
Bolivia In 1999, confronted by some of the most bleak health indicators in Latin America, the Bolivian government asked the World Bank to help it with a program to bring better health care to poor families throughout the country. The World Bank responded by approving a $25 million Health Sector Reform Project that had as its priority reducing high maternal and infant mortality rates. Adopting a results-based approach centered on yearly targets for eight basic health indicators, the project quickly made immunization more widely available and helped the poor gain better access to health care services. Immunization coverage jumped to 86 percent in 2000 from 75 percent in 1998, with government spending on vaccines soaring to $3 million in 2000 from $500,000 in 1999. In response to these results, the World Bank in June 2001 approved $35 million for the project's second phase. The Health Sector Reform Project – Second Phase has as its overall goal a reduction of infant mortality to no more than 48 for every 1,000 babies born by 2008, versus 67 for each 1,000 in 1998. The program also will expand health coverage to an additional 25 percent of the population, or about 2 million people, by assigning new health teams supported by indigenous community agents to the poorest regions of the country.
Brazil
In 1990, Brazil had one of the world's largest numbers of reported AIDS cases in the world. In 1993, the World Bank approved $160 million for an AIDS and Sexually Transmitted Diseases Project that covered prevention, treatment and testing. Between 1993 and 1997, the project helped 175 non-governmental organizations carry out more than 400 grassroots campaigns, educating high-risk groups. They handed out more than 180 million condoms, raised AIDS awareness among more than 500,000 people, and trained 3,800 teachers and 32,500 students in promoting AIDS and drug abuse prevention.
Another $165 million World Bank loan in 1998 supported the Second AIDS and Sexually Transmitted Diseases Project that contributed to a 38 percent drop in the number of AIDS-related deaths since 1993. The program, which focuseson prevention, has helped to set up a nationwide network of 141 AIDS testing and counseling centers.
Mexico
The Second Basic Health Projectsuccessfully provided basic health services to the poorest and most isolated rural communities in the country where services were delivered to about 9 million poor in 19 states, mostly indigenous and often non-Spanish speaking, and in areas of difficult geographic and cultural access.
The majority of the beneficiaries saw a professional health care worker and received health care services for the first time in their lives. Some of the services included injury prevention and emergency care, basic sanitation, diarrhea control, family planning, health and nutrition information, immunization, prenatal care and child delivery, and prevention and control of tuberculosis.
For more information on World Bank health, nutrition and population projects in Latin America & the Caribbean, including lending breakdown and project reports, please see:
Proposed Projects
All Projects Updated April, 2004
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Source: Wold Bank (2003)
Source: Millenium Development Goals
Source: Millenium Development Goals
HIV/AIDS in Latin America
and the Caribbean | With 2 million people living with HIV or AIDS in Latin America and the Caribbean, the human, social and economic toll of the epidemic
has been profound. Around
600,000 people in the region have died from AIDS during the past 20 years and approximately 567 people in the region are infected with the HIV virus every day.
Learn more about the Bank's
initiatives to control the disease.
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