This blog post originally appeared on the Agrilink website. Click here to read it there.
Woman getting vaccinated in Ghana. Photo: Curt Carnemark/World Bank
Health intersects with resilience and sustained poverty escapes in at least three ways. Poor health reduces wellbeing and can be a shock or stressor at the individual, household, community or systems level. It can also act as an important form of human capital, a resilience capacity that protects outcomes over time in the face of adversity. Moreover, health is an outcome in and of itself that needs to be protected.
Chronic Poverty Advisory Network (CPAN) mixed-methods studies supported by USAID provided evidence on the first two of these three channels. They analyzed the interrelationships among resilience, health and sustainable poverty escapes in Africa (Tanzania, Rwanda, Niger, Malawi, Ethiopia, Uganda and rural Kenya) and Asia (Philippines, Nepal, rural Cambodia and rural Bangladesh) and offered policy and programming implications. In this blog we discuss ill health as a shock or stressor and its policy implications.
Ill health as a shock/stressor leading to transitory poverty escapes and impoverishment
The results across countries point to the negative effects of ill health. Often, while a small health shock may be managed, a series of health shocks as well as chronic illnesses can impoverish. In the rural Ethiopa National Synthesis Report, Redo recalls: “When the doctor referred my mentally ill daughter to a big hospital in Addis Ababa, I had to spend Birr 11,000. Then my son got sick and I had to spend Birr 7,000 for medication. I had to sell my only ox to cover these expenses.”
Barriers to healthcare in terms of quality and coverage also reinforce this impoverishment. In the Resilience and Sustainable Poverty Escapes in Tanzania report, individuals in some cases would need to drive ten hours to a hospital to treat more complicated conditions, sometimes incurring lodging fees in a less familiar city. This led some qualitative respondents to measure cost by "how many hours away" the hospital was.
Most countries also had low health insurance coverage in the fieldwork, even where policies claimed to reach a larger share of the population. As a result, households without health insurance engaged in various coping strategies for health shocks, such as relying on savings, selling assets, receiving support from family members or taking out loans from informal moneylenders. These all have potentially negative impacts on household poverty trajectories.
What policies can help mitigate the negative effects of ill health?
Universal health insurance is a key policy to help prevent impoverishment due to health shocks. This may require developing new health insurance or expanding existing systems to more effectively provide safety nets for the poor and vulnerable near-poor alongside sustainable financing mechanisms.
For universal health insurance to succeed in preventing impoverishment and sustaining poverty escapes, public health systems across contexts need to be up to the task. Increasing their effectiveness requires improving the coverage and quality of health services, in terms of facilities, number of doctors and technical and managerial support.
The research also pointed to a wide range of conditions which require expansion or upgrading of existing health services, including better coverage of reproductive health, and improved responses to chronic medical issues, mental health problems and alcohol abuse/alcoholism, such that these do not contribute to impoverishment or only permit transitory escapes from poverty. A way forward here is to develop a model — such as the model developed by Kopinak for Uganda — that focuses on people’s beliefs and values, as well as resiliency, health promotion and recovery.
Finally, critical links need to be developed with health access improvements tied to investments in other areas, including in pro-poor education, improved access to financial services and cash transfers.
Authors: Andrew Shepherd and Vidya Diwakar