The Health Impact of Water and Sanitation Utilities Privatization and Regulation in Sub-Saharan Africa

2021 ◽  
Author(s):  
Lisa Bagnoli ◽  
Salvador Bertomeu-Sanchez ◽  
Antonio Estache
Keyword(s):  
Large Scale ◽  
Health Impact ◽  
Sub Saharan Africa ◽  
Water And Sanitation ◽  
Middle Income ◽  
Imperfect Data ◽  
High Population Growth ◽  
Sub Saharan ◽  
Rural Access ◽  
The Impact

As of 2017, the urban access rate to safe water sources in 2017 stood at 84% while rural access was still around 45%. The rates for sanitation were 44% and 22%, respectively. Since the 1980s many high-profile reforms supported by international organizations have been implemented in the region in an attempt to close the access gaps in the water and sanitation sector (WSS). Two recommendations with high international exposure were an increased role for large-scale private sector participation in the management and financing of national or regional utilities and the creation of separate sector regulatory agencies to increase the independence of regulation. Both reforms seemed to contribute to improved water access rates, at least for the urban population, but not enough to catch up with the demands of a fast-growing population; and both failed to deliver on sanitation. The progress these initiatives allowed was correlated with improvements in the average health outcomes for some indicators (i.e., under-five mortality associated to diarrhea) but once again, it was not enough and was not fairly distributed. Indeed, improvements seem to have mostly benefited upper- and middle-income groups. Unfortunately, an evaluation of the health effects of these two reforms have not yet been fully established empirically, which is why it seems prudent to talk about correlations rather than causal effects. Most of the statistically robust evidence on the impact of utilities and regulatory reforms on health is incomplete because details of several dimensions of these reforms and their context are not measured consistently across countries or within countries. In addition, the small amount of econometric evidence available is based on pre-2010 data for SSA. The imperfect data is however solid enough to suggest that without further governance changes in the region, the health risks are likely to increase. This is because due to the high population growth rate of the region, closing the access gaps is likely to get tougher considering current investment levels and technological choices. The necessary changes require improving the match between policy and technological choices, including service delivery technologies that are consistent with the ability to pay and the tariff and subsidy levels adopted to ensure cost recovery without excluding any category of users.

HIV/AIDS

2020 ◽  
pp. 901-933
Author(s):  
Sarah Fidler ◽  
Timothy E.A. Peto ◽  
Philip Goulder ◽  
Christopher P. Conlon
Keyword(s):  
Large Scale ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
African Countries ◽  
Global Pandemic ◽  
The People ◽  
Reduce Life Expectancy ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).

scholarly journals Impact of Feed the Future initiative on nutrition in children aged less than 5 years in sub-Saharan Africa: difference-in-differences analysis

BMJ ◽  
2019 ◽  
pp. l6540 ◽  
Author(s):  
Theresa Ryckman ◽  
Margaret Robinson ◽  
Courtney Pedersen ◽  
Jay Bhattacharya ◽  
Eran Bendavid
Keyword(s):  
Sub Saharan Africa ◽  
Difference In Differences ◽  
Large Country ◽  
Middle Income ◽  
National Differences ◽  
Low Weight ◽  
The Future ◽  
Sub Saharan ◽  
Feed The Future ◽  
The Impact

AbstractObjectiveTo evaluate the impact of the US government’s Feed the Future initiative on nutrition outcomes in children younger than 5 years in sub-Saharan Africa.DesignDifference-in-differences quasi-experimental approach.SettingHouseholds in 33 low and lower middle income countries in sub-Saharan Africa.Population883 309 children aged less than 5 years with weight, height, and age recorded in 118 surveys conducted in 33 countries between 2000 and 2017: 388 052 children were from Feed the Future countries and 495 257 were from non-Feed the Future countries.Main outcome measuresA difference-in-differences approach was used to compare outcomes among children in intervention countries after implementation of the initiative with children before its introduction and children in non-intervention countries, controlling for relevant covariates, time invariant national differences, and time trends. The primary outcome was stunting (height for age >2 standard deviations below a reference median), a key indicator of undernutrition in children. Secondary outcomes were wasting (low weight for height) and underweight (low weight for age).ResultsAcross all years and countries, 38.3% of children in the study sample were stunted, 8.9% showed wasting, and 21.3% were underweight. In the first six years of Feed the Future’s implementation, children in 12 countries with the initiative exhibited a 3.9 percentage point (95% confidence interval 2.4 to 5.5) greater decline in stunting, a 1.1 percentage point (0.1 to 2.1) greater decline in wasting, and a 2.8 percentage point (1.6 to 4.0) greater decline in underweight levels compared with children in 21 countries without the initiative and compared with trends in undernutrition before Feed the Future was launched. These decreases translate to around two million fewer stunted and underweight children aged less than 5 years and around a half million fewer children with wasting. For context, about 22 million children were stunted, 11 million children were underweight, and four million children were wasted in the Feed the Future countries at baseline.ConclusionsFeed the Future’s activities were closely linked to notable improvements in stunting and underweight levels and moderate improvements in wasting in children younger than 5 years. These findings highlight the effectiveness of this large, country tailored initiative focused on agriculture and food security and have important implications for the future of this and other nutrition interventions worldwide.

Anxiety, isolation and diminishing resources: the impact of COVID-19 pandemic on residential care home facilities for older people in south-east Nigeria

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prince Chiagozie Ekoh
Keyword(s):  
Older Adults ◽  
Care Home ◽  
Health Impact ◽  
Sub Saharan Africa ◽  
Care Homes ◽  
Family Structures ◽  
Content Type ◽  
Sub Saharan ◽  
Fear And Anxiety ◽  
The Impact

Purpose Institutionalized older adults in care homes and long-care facilities have been identified as being at greater risk of COVID-19 related morbidity and mortality. Thus, this paper aims to explore the impact of COVID-19 on care homes in south-east Nigeria given the recent increasing popularity of care homes in Nigeria. Design/methodology/approach The study adopted qualitative research method, and data was collected from 10 older residents and 5 caregivers using interviews from two care homes, while ensuring the safety of the researcher and participants. The collected data was analyzed using thematic analysis. Findings Findings revealed that the physical health impact of the COVID-19 pandemic is not a major problem in the homes. However, fear and anxiety, social disconnection and economic hardship were the major problems identified by the older residents and caregivers in the homes. Originality/value The popularity of care homes in Nigeria is growing as family structures continue to change. However, previous studies which have revealed devastating effect of COVID-19 on institutionalized older adults have been from the global north. This is the first study designed to bridge the gap in literature and contribute to knowledge on this topic from Nigeria and Sub-Saharan Africa.

scholarly journals Intestinal Schistosomiasis and Giardiasis Co-Infection in Sub-Saharan Africa: Can a One Health Approach Improve Control of Each Waterborne Parasite Simultaneously?

2020 ◽  
Vol 5 (3) ◽  
pp. 137 ◽  
Author(s):  
John Archer ◽  
Lisa O’Halloran ◽  
Hajri Al-Shehri ◽  
Shannan Summers ◽  
Tapan Bhattacharyya ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Large Scale ◽  
One Health ◽  
Control Strategies ◽  
Integrated Control ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Intestinal Schistosomiasis ◽  
Sanitation And Hygiene ◽  
Sub Saharan

Both intestinal schistosomiasis and giardiasis are co-endemic throughout many areas of sub-Saharan Africa, significantly impacting the health of millions of children in endemic areas. While giardiasis is not considered a neglected tropical disease (NTD), intestinal schistosomiasis is formally grouped under the NTD umbrella and receives significant advocacy and financial support for large-scale control. Although there are differences in the epidemiology between these two diseases, there are also key similarities that might be exploited within potential integrated control strategies permitting tandem interventions. In this review, we highlight these similarities and discuss opportunities for integrated control of giardiasis in low and middle-income countries where intestinal schistosomiasis is co-endemic. By applying new, advanced methods of disease surveillance, and by improving the provision of water, sanitation and hygiene (WASH) initiatives, (co)infection with intestinal schistosomiasis and/or giardiasis could not only be more effectively controlled but also better understood. In this light, we appraise the suitability of a One Health approach targeting both intestinal schistosomiasis and giardiasis, for if adopted more broadly, transmission of both diseases could be reduced to gain improvements in health and wellbeing.

scholarly journals Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa

2019 ◽  
Vol 220 (Supplement_4) ◽  
pp. S279-S285 ◽  
Author(s):  
Ryan T Novak ◽  
Olivier Ronveaux ◽  
André F Bita ◽  
Honoré Flavien Aké ◽  
Fernanda C Lessa ◽  
...  
Keyword(s):  
Conjugate Vaccine ◽  
Large Scale ◽  
Public Health Problem ◽  
Study Data ◽  
Sub Saharan Africa ◽  
Laboratory Diagnostics ◽  
Meningitis Belt ◽  
Significant Public Health ◽  
Sub Saharan ◽  
The Impact

Abstract In sub-Saharan Africa, bacterial meningitis remains a significant public health problem, especially in the countries of the meningitis belt, where Neisseria meningitidis serogroup A historically caused large-scale epidemics. In 2014, MenAfriNet was established as a consortium of partners supporting strategic implementation of case-based meningitis surveillance to monitor meningitis epidemiology and impact of meningococcal serogroup A conjugate vaccine (MACV). MenAfriNet improved data quality through use of standardized tools, procedures, and laboratory diagnostics. MenAfriNet surveillance and study data provided evidence of ongoing MACV impact, characterized the burden of non-serogroup A meningococcal disease (including the emergence of a new epidemic clone of serogroup C), and documented the impact of pneumococcal conjugate vaccine. New vaccines and schedules have been proposed for future implementation to address the remaining burden of meningitis. To support the goals of “Defeating Meningitis by 2030,” MenAfriNet will continue to strengthen surveillance and support research and modeling to monitor the impact of these programs on meningitis burden in sub-Saharan Africa.

scholarly journals Government Expenditure and Economic Growth in Sub-Saharan Africa

2021 ◽  
Vol 7 (4) ◽  
pp. p14
Author(s):  
Dickson Wandeda ◽  
Wafula Masai ◽  
Samuel M. Nyandemo
Keyword(s):  
Economic Growth ◽  
Panel Data ◽  
Low Income ◽  
Government Expenditure ◽  
Output Growth ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Sub Saharan ◽  
The Impact ◽  
Ssa Countries

The paper sought to investigate the effect government expenditure on economic growth in Sub-Saharan Africa using a panel data for 35 Sub-Saharan African countries for the period 2006-2018. The paper adopted dynamic panel data and estimates were achieved by using two-step system GMM while taking into account the problem of instrument proliferation. The paper provided evidence that education and health expenditure are key determinants of income growth for SSA. The impact of education spending on cross-country income variation is more effective in low income SSA countries than the middle income SSA countries. However, military expenditure on output growth is more effective in improving income level of middle income SSA countries than low income SSA countries. SSA countries should allocate more funding towards education sector and should also avail compulsory and free primary and secondary education. SSA should carry out health reforms which improve primary health and universal health insurance coverage.

scholarly journals The Nexus between Education and Economic Growth: Analyzing Empirically a Case of Middle-Income Countries

2020 ◽  
Vol 3 (2) ◽  
pp. 43-60
Author(s):  
Lamia Jamel ◽  
Monia Ben Ltaifa ◽  
Ahmed K Elnagar ◽  
Abdelkader Derbali ◽  
Ali Lamouchi
Keyword(s):  
Economic Growth ◽  
Labour Force ◽  
Sub Saharan Africa ◽  
Gdp Per Capita ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Pacific ◽  
Per Capita ◽  
Sub Saharan ◽  
The Impact

The purpose of this paper is to examine empirically the nexus between education accumulation and economic growth for a sample of middle-income countries through panel data regressions. The sample consists of 28 middle-income countries from various continents: North Africa and the Middle East (6 countries), sub-Saharan Africa (7 countries), Latin America and the Caribbean (8 countries), East Asia and the Pacific (3 countries), and Europe and Central Asia (4 countries). Education is measured by quantitative (average years of labour force study) and qualitative indicators (student scores on international assessments of educational achievements). To test the impact of education accumulation on GDP per capita growth, a static panel is used during the period of study from 1970 to 2014. A dynamic panel is also being developed to estimate the effect of the education stock on the growth rate of GDP per capita. The results confirm the positive and significant impact of the education quantity and quality on economic growth, both in level and variation. The stock of education and its increase are positively affecting the growth. Moreover, this paper’s original findings suggest that the quality of education is more significant than its quantity.

scholarly journals The impact of geographic targeting of oral cholera vaccination in sub-Saharan Africa: a modeling study

2019 ◽  
Author(s):  
Elizabeth C. Lee ◽  
Andrew S. Azman ◽  
Joshua Kaminsky ◽  
Sean M. Moore ◽  
Heather S. McKay ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Sub Saharan Africa ◽  
Population Projections ◽  
World Health ◽  
Water And Sanitation ◽  
Sub Saharan ◽  
Near Term ◽  
Cholera Vaccination ◽  
Vaccination Campaigns ◽  
The Impact

AbstractBackgroundIn May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize chances of success.Methods and FindingsWe compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, disability-adjusted life-years, and cost-effectiveness with models that account for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI: 803,370-859,980) cases (equivalent to 34.0% of projected cases; 95% CI: 33.2-34.8). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI: 599,150-643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI: 270,319-277,002) and 109,817 (95% CI: 103,735-114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs $1,843 (95% CI: 1,328-14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach did not project annual changes in baseline cholera risk or incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors.ConclusionsOur study suggests that geographic targeting is critical to the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near-term, without rapid progress in developing water and sanitation services, our results suggest that vaccine use alone are unlikely to allow us to achieve the 2030 goals.

Understanding the slum–health conundrum in sub-Saharan Africa: a proposal for a rights-based approach to health promotion in slums

2019 ◽  
Vol 27 (3) ◽  
pp. 65-72 ◽  
Author(s):  
Dominic A. Alaazi ◽  
Gamel A. M. Aganah
Keyword(s):  
Health Promotion ◽  
Affordable Housing ◽  
Health And Safety ◽  
Urban Slum ◽  
Health Impact ◽  
Sub Saharan Africa ◽  
Housing Provision ◽  
Slum Dwellers ◽  
Sub Saharan ◽  
The Impact

Sub-Saharan Africa is the world’s least urbanized region but is ironically also the region with the largest proportion of urban slum dwellers. However, there exists limited understanding of the impact of slums on health in the region. To address this knowledge gap, we conducted a systematic search in PubMed, Google, and Google Scholar to identify and review studies examining the slum–health relationship in sub-Saharan African cities. Subsequently, we performed thematic analysis of 40 studies to identify themes that explain the health impact of slums in the region. The majority of studies characterize slums as health-damaging settings, where poverty and unfavorable environmental conditions pose threats to public health and safety. Only a handful of studies suggest a beneficial relationship between slums and health, in such areas as affordable housing provision, employment generation, and community cohesion. We argue that the literature’s overwhelming emphasis on the environmental risks of slums feeds into a neoliberal urban agenda that seeks to clear slums at the expense of their beneficial contributions to health. Accordingly, we advocate a shift in policy discourse, from static characterization of slums as health risks to a health-promotion agenda that emphasizes the housing and service rights of slum populations.

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