Evaluating Health Care Financing Reforms in Africa

markdownabstract__Abstract__ Africa is on a steady economic growth path. Over the last decade, most Sub-Saharan African (SSA) countries outperformed European and North-American countries’ growth rates, as shown in Figure 1. A number of SSA countries are among the fastest growing economies in the world, coming from very low income levels, and moderate growth is predicted for most of these countries (International Monetary Fund, 2014; Rodrik, 2014). However, trends in the health status of the African population are lagging behind. Since 1990, most regions in the world have achieved a reduction in child mortality of at least 60 percent and Eastern Asia even reduced the number of children not reaching their fifth birthday by 74 percent. Over that same period, SSA achieved a reduction of only 45 percent (calculations based on Millennium Development Goals Report (2014)). Not only do trends in health status lag behind in SSA, the levels are also considerably lower. Almost half of all child deaths worldwide occur in SSA and disparities in child mortality between the poor and the better off are increasing. SSA has the highest maternal mortality ratio with 510 deaths per 100,000 live births, 70 percent of new HIV infections occur in this region (United Nations, 2014) and frequent outbreaks of other infectious diseases like Ebola create an important threat to population health. In addition to these infectious diseases, increased levels of non-communicable diseases associated with economic development create a “double burden of disease” (Maher et al., 2010). This combination of a high disease burden and steady economic growth creates both the need and the opportunity for health care financing reforms to improve equitable access to good quality health care, the topic of this thesis