The impact of the AIDS Pandemic on Health Services in Africa
Lester Picker
In the past twenty years, the AIDS crisis has had crippling effects
on the healthcare systems of many countries. The pandemic has
compromised the ability of health systems to deliver care, in part
because health professionals have fallen ill or have chosen to leave for
less risky assignments elsewhere.
The nature of care offered by clinics and hospitals has also changed,
with limited resources shifted toward those infected with HIV or
full-blown AIDS. A recent World Bank evaluation also reports changes in
its funding for health, nutrition, and population programs (HNP) over
the decade from 1997 to 2007, noting that “while the overall levels of
lending in HNP have not changed much over the past decade, the
composition of the portfolio has shifted rather dramatically toward
communicable disease projects, particularly AIDS...”
AIDS may also reduce the demand for non-AIDS related health services
in Africa: prime-aged adults who fall ill may need to leave the labour
force and other family members may find it necessary to change their
work patterns in order to care for the sick. These costs of lost work,
together with the financial costs of covering illnesses associated with
AIDS, can drive families into poverty, reducing their ability to fund
non-AIDS related care.
These strains on health systems and households have taken their toll,
according to a recent study by NBER researchers Anne Case and Christina
Paxson. In ‘The Impact of the AIDS Pandemic on Health Services in
Africa: Evidence from Demographic and Health Surveys’ (NBER Working
Paper No. 15000), they use data on fourteen sub-Saharan African
countries collected in Demographic and Health Surveys (DHS) to document
the impact of the AIDS crisis on non-AIDS related health services.
They find deterioration in a number of survey measures of healthcare,
including the presence of trained attendants at birth deliveries, tests
done as part of antenatal care, and rates of immunization for children
born between 1988 and 2005.
The most recent DHS survey for each country collected data on HIV
prevalence, so Case and Paxson are able to examine the association
between HIV burden and healthcare. They find that erosion of health
services is highly correlated with increases in AIDS prevalence. Regions
of countries that have light AIDS burdens have witnessed small or no
declines in healthcare, using the measures noted above.
Those regions currently shouldering the heaviest burdens have seen
the largest erosion in treatment for pregnant women and children. The
authors date the beginning of the divergence in health services between
high- and low-HIV regions to the mid-1990s.
The Demographic and Health Surveys are large, nationally
representative household-based surveys conducted at approximately four
to five year intervals in low- and middle-income countries. They focus
primarily on population, health, and nutrition. Women aged 15 to 49 are
asked about their fertility histories, including information on prenatal
care, delivery assistance, and children’s immunizations. In some of the
surveys, information on antenatal care is available for a woman’s most
recent birth; in others, it is collected for all births that occurred
within a particular time period.
The authors analyze data from 41 DHS surveys conducted between 1988
and 2006 in sub-Saharan Africa, including multiple surveys from eight
West African countries where HIV prevalence rates are relatively low -
Burkina Faso, Cameroon, Cote d’Ivoire, Ghana, Guinea, Mali, Niger, and
Senegal - and six countries in East and Southern Africa where rates are
higher - Ethiopia, Kenya, Malawi, Tanzania, Zambia, and Zimbabwe.
(NBER Digest) |