Marseille 2007
| Abstract #256 - The Political, Economic, and Social Factors in the Deficit in Human Resources in Health (HRH) in Sub-Saharan Africa | ||||
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Session: 10.2: Civil society and social ramifications (Parallel) on Monday @ 11.00-12.30 in CP Chaired by Liviana Calzavara, Ted Myers Authors: Presenting Author: Dr John Vincent Fieno - RTI International , United States |
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| Aim: The deficit in human resources in health (HRH) is a serious impediment to the expansion of assess to highly active anti-retroviral treatment (HAART) in sub-Saharan Africa. The WHO HRH standard is one doctor per 5,000 people; of the 43 countries in the region, 32 countries had a rate of one doctor for over 10,000 people. This paper examines five key structural factors that might affect the shortage of medical doctors in sub-Saharan Africa: per capita income, democratic governance, IMF conditionality, civil war/social unrest, and secondary school attainment. | ||||
| Method / Issue: Data were collected on 43 countries from 1970 to 2005 over five-year periods (1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005). A fixed-effect regression model was used in the primary specification. The dependent variable was the ratio of physicians over the population as a share of the WHO standard. The annual democratic ratings from Freedom House were averaged in the previous five years for each period for democratic governance. IMF conditionality was measured by the size of the loan as a share of GDP for the given year. Civil war or social unrest was a dummy variable over the period as confirmed by the Ethnicity, Insurgency, and Civil War database (Fearon and Laitin, 2003). Secondary school attainment data came from the International Data on Educational Attainment (Barro and Lee, 2005). In the main specifications, these independent variables were regressed with ten-year lags. Alternative models used only five-year lags with the independent variables or no lags at all. | ||||
| Results / Comments: Per capita income and democratic governance had a substantially positive effect on the number of medical doctors in sub-Saharan Africa. IMF conditionality had a substantially negative effect on the physician corps. Civil war/social unrest and secondary school attainment had no effect on HRH. The most promising finding is that democratic governance had a positive effect on the production and retention of medical doctors. Whether politicians are acting to ease electoral concerns or address social pressure from civil society, democratic governance might institute formal as well as informal mechanisms of accountability. | ||||
| Discussion: The most distressing finding is that IMF conditionality had a negative effect on the number of physicians, but it would be a mistake, however, to blame international financial institutions for this negative outcome. Receipt of an IMF loan might be due to social unrest or a severe economic crisis that is ultimately reducing the production and retention of medical doctors. The IMF has insisted that its caps on the public sector wage bill-a cornerstone of its fiscal adjustment plans-are not an impediment to an increase in HRH in sub-Saharan Africa. A fiscal analysis of the implications of fiscal adjustment and public employment caps remains long overdue. Finally, it is interesting that civil war/social unrest and secondary school attainment had no effect on HRH. Even though IMF conditionality might serve as an intervening variable for other factors (namely civil war/social unrest), the two variables were not collinear. | ||||
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