Health, Economic Status, and Poverty
Global health is dynamic, varying from country to country. The health disparities can be attributed to differences in the social determinants of health, environmental factors, health systems and policies, and political goodwill in financing health care. This article explores the impact of the economic status of Sierra Leone on health, productivity, health systems, and access to healthcare services.
Economy Indicators and Poverty
Sierra Leone is classified as a low-income country (LIC) with an estimated gross domestic product (GDP) of $3.12 billion as of 2018. The government has realized economic growth since the end of civil wars in 2002, with GDP doubling over the period from 650 PPP dollars in 2002 to approximately 1490 PPP dollar as of 2018(The World Bank, n.d.). The gains can be attributed to relative political stability allowing the country to refocus and utilize its natural resources in economic development and growth. However, the Ebola epidemic 2014-2016 resulted in a significant drop in the country's GDP, with reduced buying at a global scale.
The country has a favourable tropical climate to promote agricultural activities. Agriculture is the major contributor to the GDP (over 60%) as the country exports coffee, cocoa, rice, among other crops(Central Intelligence Agency, n.d.). Moreover, the sector employs approximately two-thirds of the population; hence significantly reducing the unemployment rates. Furthermore, Sierra Leone remains a top exporter for diamonds and iron ore- major foreign exchange-earners. However, the neglect of the agricultural sector in favour of industry and service income earners may be contributing to the low income per capita of approximately $557(Central Intelligence Agency, n.d.). An estimated 70% of the Sierra Leone population lies below the poverty line despite low unemployment levels at 16%, which may affect health financing and access to healthcare.
Despite the economic growth realized, the most critical areas for improvement are fiscal health, financial freedom, government integrity and labour freedom to enable the government to achieve better health outcomes, improve educational standards, and better incomes for employees. Recent data shows that the country allocates 11% of the GDP to health despite the challenges of infectious disease burden (Malaria and viral epidemics) which is lower compared to other countries such as the United States( table below).
Health is not only a state of complete physical well-being but also mental and social well-being and not merely the absence of disease or infirmity. Productivity refers to the ability of an individual to achieve maximal potential in their daily activities. Health and productivity are correlated in that low health status is associated with minimal productivity(Arora, 2001). For a person to achieve maximal potential, good health is a vital form of human capital. It improves individuals' productivity by increasing both their mental (cognitive functioning) and physical (strength and endurance) capacities. According to a journal article published by Cambridge University, changes in health can spur economic growth by 30-40%(Arora, 2001). As such, the government of any country should ensure that its country people are given access to adequate health care services so that they can work, be productive, and in the long run, contribute to the macroeconomic level of the country.
Health Expenditure
Health expenditure is essential in determining the health status and economic development of a country. It is noted that countries that assign more recognition and resources to health status have much more productive human capital amounting to an increase in the nation's GDP(Arora, 2001). Sierra Leone allocates 11% of its GDP to health, which has not been sufficient. The country relies on foreign aid and loans. The government has established international collaboration with key organizations including; the World Bank, World Health Organization(WHO), Department for International Development(DFID), the local U.U. Agency for International Development(USAID) in Sierra Leone, Global Fund and United Nations Population Fund(UNFPA).
Health Outcomes
Health outcomes refer to changes in health that are due to specific measures and health care investments or interventions. There are seven healthcare outcome measures, and they include mortality rate, the safety of care, readmissions, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. Health outcomes highlight the performance of health systems and population health status, basis for monitoring and evaluations, and identifying countries that need assistance in achieving the Sustainable Development Goals (SDGs). For example, Sierra Leone has among lowest life expectancy at birth (51 years), high maternal mortality ratios (~1100 per 100000 live births) and high the under-five mortality rate is at 122 per 1,000 live birth(SLDHS, 2019). Better health outcomes are tied to the quadruple aim of the health care system which also involves; improving the patient experience of care (quality and satisfaction), improving the health outcomes of the nations' citizens and reducing the per capita cost of health care. An increase in health care expenditure is associated with a considerable improvement in the positive health outcomes of a nation, increased productivity and positive economic growth.
Reference
2019 SLDHS. (2019). Sierra Leone Demographic and Health Survey 2019 Key Indicators Report. www.statistics.sl
Arora, S. (2001). HEALTH, HUMAN PRODUCTIVITY, AND LONG-TERM ECONOMIC GROWTH. The Journal of Economic History, 61(3), 699–749. https://doi.org/10.1017/S0022050701030054
Central Intelligence Agency. (n.d.). Africa :: Sierra Leone — The World Factbook . Retrieved October 4, 2020, from https://www.cia.gov/library/publications/the-world-factbook/geos/sl.html
The World Bank. (n.d.). World Development Indicators . Retrieved October 4, 2020, from http://wdi.worldbank.org/table/2.5