Does expanding fiscal space lead to improved funding of the health sector?

Together with colleagues, I have just published an article that examines whether improved fiscal space in Kenya, Lagos State (Nigeria), and South Africa led to improved per capita spending on health.

Click here for the answer, together with an explanation of the trends.


NHI Snippets (4): Too many women die in South Africa from causes related to childbirth

In NHI Snippets (2) I made the point that health in South Africa is poor, especially when viewed in light of the country’s relative wealth.

I gave some figures on how many women die from causes related to childbirth.  I know these figures can seem very abstract so, as promised, I’ve found a graph (by Jack Langenbrunner) that helps to show how well South Africa does in preventing these deaths compared to other countries. 

Click “MMR relative to other countries” to see the graph and here to see the full presentation which includes additional graphs on other health indicators (the link takes you to the Health Systems Trust page with all the conference presentaitons – you will find Jack Langenbrunner’s presenation on Day 2).

As you can see, South Africa does badly when one considers both its average per capita income and its average per capita spending on health (in the graph, countries in the top right block manage to ‘buy’ much less health for the money they have at their disposal).  In this sense, South Africa is much less ‘efficient’ than some poorer countries that do much better.

NHI Snippets (2): Poor health in South Africa

Oops, an earlier version of this post had incorrect information! – I copied it from what I thought was a reliable source but didn’t check it.  This is what happens when writing late at night!  In future, if any readers notice mistakes, please let me know.  Here is the corrected version …

“In my previous post I made two points – one, that South Africa spends a large amount on private health care and, two, that the health of South Africans is poor in comparison to other countries of equivalent wealth.

I’m going to elaborate the second point here.

Set aside for a moment the question of why health is poor, and concentrate on grasping some simple health indicators.

One of the most shocking statistics is that, every year, 147 women die from causes linked to child birth for every 100,000 births.  This is known as ‘the maternal mortality rate’ and is around 4 times higher than the target of 38 set for the Millennium Development Goals (high-income countries usually have rates that are in the single digits as shown here). 

Of course, one could argue that South Africa’s high maternal mortality rate reflects the HIV/AIDS epidemic.  This is true to some extent:  it is estimated that just under half (around 44%) of maternal deaths can be attributed to HIV/AIDS.1  Yet this still leaves South Africa with a high non-HIV/AIDs-related maternal mortality rate and, in any case, a good health system should be able to reduce the impact of HIV/AIDS on maternal mortality.

Here are some indicators that reflect the poor health of children in South Africa:



(around 2008)

2015 Millennium Development Goal target

Number of children who die before they reach the age of 5 for every 1,000 who are born



Number of children who die before they reach the age of 1 for every 1,000 who are born



For a later post I’ll find you some graphs that show how this performance compares to other upper middle-income countries.

I’ll also see whether I can source some more up-to-date statistics for South Africa from the Medical Research Council’s Burden of Disease Unit.”


1.  Burden of Disease Unit.  2008.  Every death counts:  saving the lives of mothers, babies and children in South Africa – data supplement.  Cape Town:  Medical Research Council.  (Click on the link to read this easy-to-understand policy brief or click here to read the academic article that was published in The Lancet.)

2.  National Department of Health.  2011.  Human Resources For Health South Africa.  HRH Strategy for the Health Sector 2012/13-2016/17.  Pretoria:  National Department of Health.

Launching my blog, Health Policy South Africa

It’s February 2011:  I’ve just started setting up my blog, Health Policy South Africa.  I hope this site becomes a place to share and debate research relevant to South African health policy.  Read the pages on the right-hand-side of the page to find out more about me and this blog … and write a comment to let me know what you think!