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Education And Health Expenditure And Poverty Reduction In East Africa Oecd
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- 5. INTERNATIONAL DEVELOPMENT Edited by Christian Morrisson «Development Centre Studies Education and Health Expenditure and Poverty Reduction in East Africa MADAGASCAR AND TANZANIA
- 6. Development Centre Studies Education and Health Expenditure and Poverty Reduction in East Africa MADAGASCAR AND TANZANIA Edited by Christian Morrisson DEVELOPMENT CENTRE OF THE ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT
- 7. ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT Pursuant to Article 1 of the Convention signed in Paris on 14th December 1960, and which came into force on 30th September 1961, the Organisation for Economic Co-operation and Development (OECD) shall promote policies designed: – to achieve the highest sustainable economic growth and employment and a rising standard of living in Member countries, while maintaining financial stability, and thus to contribute to the development of the world economy; – to contribute to sound economic expansion in Member as well as non-member countries in the process of economic development; and – to contribute to the expansion of world trade on a multilateral, non-discriminatory basis in accordance with international obligations. The original Member countries of the OECD are Austria, Belgium, Canada, Denmark, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, Turkey, the United Kingdom and the United States. The following countries became Members subsequently through accession at the dates indicated hereafter: Japan (28th April 1964), Finland (28th January 1969), Australia (7th June 1971), New Zealand (29th May 1973), Mexico (18th May 1994), the Czech Republic (21st December 1995), Hungary (7th May 1996), Poland (22nd November 1996), Korea (12th December 1996) and the Slovak Republic (14th December 2000). The Commission of the European Communities takes part in the work of the OECD (Article 13 of the OECD Convention). The Development Centre of the Organisation for Economic Co-operation and Development was established by decision of the OECD Council on 23rd October 1962 and comprises twenty-two Member countries of the OECD: Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Korea, Luxembourg, Mexico, the Netherlands, Norway, Portugal, Slovak Republic, Spain, Sweden, Switzerland, as well as Argentina and Brazil from March 1994, Chile since November 1998 and India since February 2001. The Commission of the European Communities also takes part in the Centre’s Advisory Board. The purpose of the Centre is to bring together the knowledge and experience available in Member countries of both economic development and the formulation and execution of general economic policies; to adapt such knowledge and experience to the actual needs of countries or regions in the process of development and to put the results at the disposal of the countries by appropriate means. THE OPINIONS EXPRESSED AND ARGUMENTS EMPLOYED IN THIS PUBLICATION ARE THE SOLE RESPONSIBILITY OF THE AUTHORS AND DO NOT NECESSARILY REFLECT THOSE OF THE OECD, THE DEVELOPMENT CENTRE OR OF THE GOVERNMENTS OF THEIR MEMBER COUNTRIES. * * * Publié en français sous le titre : Dépenses d’éducation, de santé et réduction de la pauvreté en Afrique de l’Est MADAGASCAR ET TANZANIE © OECD 2002 Permission to reproduce a portion of this work for non-commercial purposes or classroom use should be obtained through the Centre français d’exploitation du droit de copie (CFC), 20, rue des Grands-Augustins, 75006 Paris, France, tel. (33-1) 44 07 47 70, fax (33-1) 46 34 67 19, for every country except the United States. In the United States permission should be obtained through the Copyright Clearance Center, Customer Service, (508)750-8400, 222 Rosewood Drive, Danvers, MA 01923 USA, or CCC Online: www.copyright.com. All other applications for permission to reproduce or translate all or part of this book should be made to OECD Publications, 2, rue André-Pascal, 75775 Paris Cedex 16, France.
- 8. 3 Foreword This volume on Madagascar and Tanzania was produced in the context of the research project “Empowering People to Meet the Challenges of Globalisation” which is part of the Development Centre’s 2001/2002 work programme.Acompanion volume looks at the case of health and education spending in developing countries, based on the experience of Indonesia and Peru. Both are part of the Development Centre’s research on poverty reduction.
- 9. 4 Acknowledgements The OECD Development Centre wishes to thank the Government of Switzerland for its financial support for the research project on “Human Resource Development and Poverty Reduction”.
- 10. 5 Table of Contents Preface Jorge Braga de Macedo ................................................................................ 7 Executive Summary ......................................................................................................... 9 Introduction...................................................................................................................... 13 Chapter 1 Poverty, Education and Health: The Case of Madagascar Denis Cogneau, Jean-Christophe Dumont, Peter Glick, Mireille Razafindrakoto, Jean Razafindravonona, Iarivony Randretsa and François Roubaud ................................................................................ 17 Comments Jean-Claude Berthélemy ............................................................................ 111 Chapter 2 Incidence of Public Spending in the Health and Education Sectors in Tanzania Sylvie Lambert and David Sahn ................................................................. 115 Comments Hans-Rimbert Hemmer................................................................................. 173 Chapter 3 Results and Recommendations Christian Morrisson .................................................................................... 177
- 11. 6
- 12. 7 Preface The reduction of poverty in all of its forms is central to the concerns of the international community interested in social and economic development. This community obviously includes governments, intergovernmental institutions such as the United Nations, the World Bank, the International Monetary Fund and the OECD. It also increasingly includes business associations, trades unions, parliaments and civil society, made up of NGOs, universities and the media. Traditional players, such as the member countries of the OECD Development Assistance Committee, have defined seven objectives for international development including four which concern this study in particular: reducing extreme poverty, providing universal primary education, lowering infant and maternal mortality, and transmitting health. One of these echoes a United Nations Millennium Summit commitment — halving the number of people living in extreme poverty by the year 2015. The programme of work at the OECD Development Centre dovetails with the international concern so clearly expressed by the DAC objectives. Its methodology of specific comparison makes it possible to improve dialogue on development policies in the most wide-ranging economic and social contexts. This is particularly true of the recently concluded Development Centre project Developing Human Resources and the Fight Against Poverty that studies four countries, including two poorer ones, Madagascar and Tanzania, and two less poor ones, Indonesia and Peru. The four DAC objectives are, unfortunately, entirely timely in Madagascar and Tanzania, the two countries looked at here. In Madagascar, more than two-thirds of the population live in extreme poverty on less than $1 per day, one-half of all children in Madagascar suffer from serious malnutrition, and nearly one-third of them have no access to primary school. The situation is no better in Tanzania. The thorough analyses presented are useful well beyond the borders of these two countries to all the poor countries of sub-Saharan Africa. Two conclusions merit particular attention, and these relate to policy coherence and good governance. Socialist and volontarist education and health policies aimed at overcoming poverty quickly failed in both countries because of lack of coherence
- 13. 8 (schools were built without teachers, health posts without medicines), and because of unsustainable macroeconomic policies. In addition, the administrative machinery was not up to the task of implementing such policies in health and education. Donors must help these countries to improve their governance. If they fail to do so, the health and education services essential for combating poverty will not reach the poorest people living in rural areas. It is much easier for a donor to finance the construction of a school than to increase administrative efficiency; this is nonetheless the condition if the international development community is to reach its objectives in the poorest countries, those precisely with the most serious governance difficulties. Jorge Braga de Macedo President OECD Development Centre July 2002
- 14. 9 Summary This volume is one of a group of works on health and education spending and on poverty and malnutrition, in the context of the report on Human Resource Development and the Fight Against Poverty. The introduction recalls the analyses of the 1990 and 2000 World Development Reports of the World Bank that focused on poverty, and presents the approach taken by the two studies on Madagascar and Tanzania. The traditional approach towards describing poverty, education and health services, and the incidence of spending in these sectors in terms of household revenues, has been used in this volume. In addition, however, the authors have analysed the demand for these services, and the benefits and the externalities that they procure as these are now recognised as being essential for refining effective policies to combat poverty. Chapters 1 and 2 on Madagascar and Tanzania are linked because they examine two similar experiences. The governments wanted to bring about a rapid end to poverty by providing universal education and health services. Indeed, they achieved virtually universal primary school enrolment in a few years. But the project was doomed by economic failure (per capita income dropped by one-quarter). Neither government had the means to run schools or health care centres. Quality deteriorated, attendance rates plummeted, the private sector had to be called in, and these countries are now classified among the last inAfrica in terms of per capita health and education spending. The study on Madagascar describes this deterioration and shows how the situation of poor people is even more unfavourable than national averages would suggest it to be. In health centres attended by the poorest people (first quintile), medication is half as available and satisfactory equipment is four times less available than in health centres attended by households in the fifth quintile. The children of the poorest people go to schools with half as many teachers per class as the schools attended by children in the fifth quintile. The poorest people, therefore, have access to health care centres where there is often neither a nurse nor medication, and to schools where there are not enough teachers. An analysis of the incidence of social spending compares the distribution of education spending from primary to higher education, and the distribution of health spending from basic health care centres to dispensaries and then to hospitals. It shows that in these two sectors, progressivity decreases just as it does in other countries. Moreover, the distribution of spending for high school and for higher education is
- 15. 10 regressive in that it is more unequal than the distribution of consumption. Using unit costs, the authors aggregated health and education spending, both of which have a redistributive effect because their distribution is less unequal than that of consumption. This effect is overestimated, however, because it is based on constant unit costs whereas poor people often have access only to the poorest quality services that clearly cost less. An in-depth analysis of demand shows how sensitive parents are to the price and quality of primary education. Poor quality has a significant impact on demand. Price elasticity is high for poor people whereas it is almost nil for rich people. Any increase in school costs would therefore reduce poor people’s attendance in schools. Yet this effect could be avoided if quality were increased along with costs. The same is true for the demand for health care: price elasticity is far higher for poor people than it is for the rich. The chapter on Madagascar also shows the direct and indirect effects of education and health services. An additional year of schooling increases an hourly salary by 10 per cent; people who suffer from some form of handicap have a clearly lower rate of activity and when they do work, they are less well paid. Moreover, many indirect effects are also brought to light: a mother’s education very clearly influences her demand for prenatal health care. The same is true for the impact of parents’ education on their demand for their children’s health care. Finally, a mother’s level of education has a decisive influence on infantile and juvenile mortality rates and on their nutritional state, which influences school performance. This leads the authors to propose a model of transmission from one generation to another of the education and poverty variables. Chapter 2, on Tanzania, describes the same evolution in health and education services. In Tanzania, however, the changes in health services took place in a context that was aggravated by the AIDS pandemic: 1 million children have been orphaned by AIDS, and life expectancy has been reduced by five years in just one decade. The analysis of the incidence of health and education spending showed the same hierarchy as in other countries. Statistics on the quality of education (providing schoolbooks, uniforms, etc.) and on that of health services (i.e. medical care of pregnant women) reveal the same bias as in Madagascar: rich households have access to higher quality services. The progressivity of spending based on attendance rates is therefore overestimated. The analyses of demand confirm the analyses made in Madagascar: households react to variations costs (by going to the private sector if the public sector fees increase) and the quality of health care. For education, transportation was the only element that was available in terms of cost, and was estimated by distance: pupils living furthest from school go to school later and for shorter periods of time. Moreover, the demand for education proves to be particularly sensitive to the quality of teaching mathematics. Chapter 2 also considers the indirect effects of education and health services. Educated mothers enrol their children earlier in school, whereas the children of illiterate parents go to school less than other children. These choices have an impact, in turn,
- 16. 11 on the income of children since formal sector education returns reach 8 per cent. Demographic and health data confirm the effects observed in Madagascar: children are taller if their mothers had medical supervision during their pregnancy or if the parents went to secondary school. Chapter 3 draws the conclusions from these studies and makes recommendations so that education and health policy can more effectively combat poverty. The first conclusion is a warning: the wilful policies in Madagascar and Tanzania led to failure. Policy needs to be realistic and accept the fact that universal access for poor people to education and health care will take time. However, poor people have a right to services of a quality equal to those available to other people in order to escape once and for all from the cycle of poverty. The second conclusion concerns equity. The redistributive impact of social spending can be increased in several ways. Developing a private fee-based sector for rich families would liberate spaces for poor people in schools and in hospitals. Improving rural transportation networks would give many more poor people access to public services. Targeted spending like literacy and vaccination campaigns have a redistributive effect because of a self-selection process: intermediary and rich households know how to read and have already been vaccinated. Finally, providing access for the whole population to a service, i.e. a coverage rate of 100 per cent, is very efficient since experience shows that the prime beneficiaries of such a service are always non- poor households. Increasing coverage from 60 to 100 per cent will always benefit the poor above all. Decentralisation and local control can be recommended because they contribute to the efficiency and equity of education and health spending. Unfortunately, field studies reveal the real difficulties of this strategy. In Madagascar, rural districts are often unable to run primary schools or basic health centres. It is therefore essential to improve administrative capacity in these districts so that local management can target benefits for the poor. The last recommendation concerns the coherence of public interventions in a long-term perspective. A group of unco-ordinated spending programmes risks having little effect on poverty. A network of health centres with nurses, but without provision of free medication for the poor, will be of little help to them. There is no point in having these centres offer contraceptives to women if girls have not been educated or at least benefited from literacy campaigns. The result of a co-ordinated set of education and health services is higher than the sum of the effects of each service. Without a coherent strategy, the benefits of these increasing returns of social spending are lost and poverty is reduced less. This strategy must be conceived in a long-term perspective so as to stop the transmission of poverty from generation to generation. Indeed, children’s health and education and their school performance depend partly on the health and education of their parents. Therefore, education and health spending as a means to reduce the perpetuation of poverty should be a priority.
- 17. 12
- 18. 13 Introduction The 1990 World Development Report from the World Bank focuses on poverty. The chapter on “Social Services and the Poor” states that investment in human capital through education and health is “one of the keys to poverty reduction”. The authors justify their thesis by the effects of education on productivity, not only of salaried workers, but also of small agricultural workers and workers in the informal sector. At the same time, they showed all the favourable effects that better health has on productivity and, for children, on the acquisition of knowledge. Consequently, the report recommended that the government make these two social services accessible to all poor people. Certain remarks were made to temper this conclusion concerning the interest of having recourse to the private sector in certain cases and the need to decentralise basic health and primary school services. Moreover, the report already mentions a demand problem: poor people cannot use these services even if they are free of charge, either because they do not see their value or because they include a cost, such as the loss of household income when a child goes to school. The 2000 World Development Report also focuses on poverty and it addresses the same theme in Chapter 5, “Expanding Poor People’s Assets”. The basic idea is the same: the accumulation of human capital through health and education can reduce poverty. The approach, however, claims to be original. In the past, this accumulation was conceived of solely in terms of supply, and the state was either partly or entirely responsible for procuring services. Today, however, we know that demand counts as much as supply. Moreover, not everything depends on the state. In the absence of any supervision, teachers can be paid without worrying about teaching well. Medication can be provided to public health centres but can disappear and be resold on the black market. The report then gives several examples of ineffective health and education spending that correlates poorly with performance (knowledge acquired by pupils at the end of primary school, for example). Local management and monitoring were put forth as the most satisfying solutions for resolving the problem. This report also strongly emphasises the role of demand, by showing that it is essential to reduce costs so that all poor families can have access to these services. For example, in certain cases the parents must receive a subsidy to compensate them for
- 19. 14 the loss of revenue because their daughters go to school. Several case studies showed that the demand of poor people is sensitive to the quality of service, and is, at the same time, much more elastic with respect to cost than the demand of rich households. If the texts of the two reports are compared, the originality of these analyses on demand and local control requires some nuance. The authors of the 1990 Report were already aware of the problems. The change from one report to the next has more to do with the respective weight of the themes. Ten years ago, the different aspects of supply weighed more heavily and those of demand and the monitoring of services weighed far less. This change is linked to the experience of local policies targeted to poor people and to the literature that has been published since 1990. We now have far more documentation on the insufficiencies of supply policies and the 2000 Report uses this documentation to show that policies on the accumulation of human capital by poor people need to be revisited. Public Spending and the Poor (Van de Walle and Nead, 1995), an important publication from the mid-1990s, already indicated this shift with respect to the traditional analyses of the 1970s of the distribution of the benefits of social spending among households but that ignored their behaviour and reactions and the real impact of social spending on the human capital of poor people. The choice between traditional and new analyses is not academic. It is also important for donor countries. Indeed, if the recent analyses are pertinent, aid policy needs to change. If we agree that local authorities are better informed about poor people, should be accountable to their constituents and can better target interventions, then donor countries can replace government aid with direct aid to these organisations. If the price elasticity of demand is high for poor households, less aid should be spent on building schools and hospitals and more on financing programmes of the Food for Education type, like those created in Bangladesh that sent 2 million children to school in 1996 (food rations were distributed to households on the condition that their children attended class). This publication focuses on the relationship between education and health spending and poverty in Madagascar and in Tanzania, and is part of this literature. It is less ambitious than Van de Walle and Nead’s 1995 publication, because it focuses solely on health and education spending rather than examining all transfers made to poor people, including subsidies for food products, financial aid, public works programmes for the unemployed. Moreover, only two countries are addressed here whereas Van de Walle’s publication covers middle-income countries as well as Central and Eastern European countries in transition. By focusing on these countries, however, we were able to make broader case studies than those presented in the four chapters of “Public Spending and the Poor” concerning education and health in Peru, Pakistan, and Indonesia. Each case study takes the same approach. First, the basic data on poverty are presented. Poverty in this context is not relative or subjective poverty, but absolute poverty, and we use the poverty thresholds referring to the consumption of calories or to the traditional thresholds of $1 and $2/day. Information concerning access to
- 20. 15 education and to health services, particularly among poor people, complete the picture. Next, the authors summarise the provision of education and health services in financial terms and in terms of numbers of beneficiaries. When possible, information about the quality of services makes it possible to appreciate better the changes that statistical series describe only imperfectly. Even if the traditional analyses of the incidence of social spending have elicited considerable criticism, it seemed necessary to estimate the distribution of each service by households classified according to per capita income (or consumption). Even if unit costs of services are not known, the distribution of pupils (in primary school, junior high school or high school) and visits (to a basic health care centre or hospital) by income are sufficient for making an informative comparison of the concentration of a service and of income. In addition to a descriptive comparison using concentration curves, dominance tests allow us to make more rigorous conclusions. The following sections present the most stimulating developments, thanks to studies of demand and to the analyses of the benefits of health and education services and the externalities that they procure. It is useful to examine results because social services are only the means to an end. For poor people to be able to cross the poverty threshold, what counts is not how much money is spent but what results are obtained. For example, what has a child learned after six years of primary school, how much more salary can s/he hope for later compared to an illiterate worker? Finally, having considered education and health services, it would have been unfortunate to ignore the interactions between the two. Therefore, a child’s state of health proves more satisfying, all other things being equal, if the mother has gone to primary school. By showing these interactions, we can demonstrate that the results of joint efforts in the two sectors is greater than the sum of the benefits that can be expected from isolated investments in each sector. An overview of these is useful before turning to the case studies, because the authors occasionally use diverse sources and choose different years. Table I.1 refers to the same year and to figures from the same publications, which gives a set of coherent statistics. Madagascar and Tanzania are among the poorest countries, 160th and 156th respectively, of 174 countries for per capita PNB, with purchasing power parity, and 147th and 172nd on the PNUD human development index. Table I.1 shows that the incidence of poverty would be far smaller in Tanzania than in Madagascar, but these data, which depend on fragile estimates of income distribution, are to be considered with caution. The two countries are very close for all other data. As these countries have adopted the same policies and obtained the same results, are in the same region and have rather equivalent populations (the spread is from 1 to 2), a comparative analysis is of particular interest for evaluating poverty reduction policies in particularly difficult contexts.
- 22. 17 Chapter 1 Poverty, Education and Health: The Case of Madagascar Denis Cogneau, Jean-Christophe Dumont, Peter Glick, Mireille Razafindrakoto, Jean Razafindravonona, Iarivony Randretsa and François Roubaud Introduction Like Tanzania, the other country studied in this volume, Madagascar is one of the poorest countries in the world (see the Introduction, Table I.1). The two countries went through similar socialist experiments during which special efforts were made in the field of public social spending. During the 1970s and until the mid-1980s, these policies brought substantial progress in education and health care. In Madagascar, however, per capita income has fallen almost continually since the mid-1970s, and health and education conditions have greatly worsened over the last 20 years. In 1997, Madagascar ranked 160th of 174 countries in the UNDP ranking of GDP per capita in purchasing power parity terms, and 147th in the Human Development Index (HDI)1 (UNDP, 1999). This chapter seeks to clarify the links among three dimensions — income, education, and health — of poverty in Madagascar. It also reviews the government’s efforts to improve education and health. In the context of a revival of such efforts since 1997, the chapter aims to contribute to the development of new poverty reduction strategies. The first section presents past trends and the current situation of Malagasy households in terms of income, education and health dimensions of poverty. The second assesses the public provision of health and education services. The third studies the distribution of public health and education spending among households. The fourth undertakes to model household behaviour in connection with school enrolment and access to health care, as well as presenting simulations of various alternative policies. The fifth explores the inter-relationships among the three forms of poverty. The sixth and last section summarises the results and offers policy recommendations.
- 23. 18 Current Situation and Evolution of the Various Forms of Poverty since 1960 Macroeconomic Developments and Monetary Poverty Nearly 15 years ago, Madagascar embarked on a process of economic adjustment. A first adjustment phase emphasised financial stabilisation, but the limitations of such a policy quickly became apparent. Since then, the country has been focusing on liberalisation and opening up to the world economy. Despiteaninitialreluctance,theauthoritieshaveundertakenabroadrangeofreforms to accomplish this. Among the measures taken, the following are the most important: — elimination of export taxes; — sharp cuts in import duties and taxes; — liberalisation of marketing channels and prices; — introduction of a duty-exempt regime for export enterprises; — establishment of a floating exchange rate system; — withdrawal of the central government from the banking sector and other public enterprises (air transport, oil, etc.). Although there are some remaining obstacles to the continuation of sectoral reforms in certain areas (privatisation of public enterprises, reform of the civil service, etc.), the steps that have already been taken reflect a high degree of commitment to the introduction of market mechanisms and trade liberalisation. In fact, since the early 1990s Madagascar has simultaneously been pursuing two transition processes: economic, of course, but also a political transition. The country has succeeded in terminating a socialist experiment which had lasted two decades, in favour of a democratic system (free elections, freedom of the press, emergence of civil society, etc.). On the strength of this progress, Madagascar in 1996 was restored to the good graces of the international financial community, which allowed it to obtain many loans and remissions of debt (SAL, ESAF, Paris Club, etc.). Despite the scale of the reform programme, Madagascar’s economy stagnated during the first half of the 1990s. The chronic political instability that reigned during this period was largely responsible for the absence of growth in this period of adjustment (Razafindrakoto and Roubaud, 1998). A pickup in growth has been observed only since 1997, when GDP per capita rose slightly (increasing by 1 per cent for the first time in many years). Since then, the process has been picking up speed, and GDP growth should be nearly 5 per cent in 1999. Viewed against the background of Madagascar’s economic history, this is an exceptional upturn. Conditions have not been this good since the late 1960s. Inflation is under control, after the episode of 1994-96 brought on by exchange rate liberalisation. Real remuneration of urban labour saw an unprecedented rise (increasing 33 per cent from 1995 to 1998), and at the same time per capita consumption by urban households increased by 30 per cent in real terms (Razafindrakoto and Roubaud, 1999).
- 24. 19 Several factors suggest, however, that this recovery should be put in perspective. First, the current growth process is not robust, and it is accompanied by structural disequilibria that are likely to compromise its viability. The supply-side response to the pickup in demand has been much too small on both the domestic and the export markets, leading to a slide in the trade balance. Fiscal performance remains unconvincing, despite the various reform programmes, at a time when spending policy is easing and the foreign debt problem is completely unresolved. Lastly, the countryside, where the pockets of poverty are concentrated, is not benefiting from the recent return to growth, which heightens the inequalities between urban and rural areas. From a long-term perspective, Madagascar is characterised by an inexorable fall in household living standards, which in 1996 reached its lowest level since independence (Figure 1.1). The majority of the population alive today has never known a lasting period of income growth. From 1960 to 1996, GDP per capita fell by 37.3 per cent and household consumption by 47.6 per cent — an annual average decrease of 1.8 per cent. If we consider the sub-period 1971-96, in which 1971 was the best year, per capita consumption fell by half. Two points are worth noting: — First, despite the uncertainties surrounding official statistics, detailed analysis of household consumption survey data confirms that this downward trend was quite real, and not the result of measurement errors such as failure to factor in the informal sector, multiple job-holding, subsistence farming or transfers (Ravelosoa and Roubaud, 1996). — Second, cross-country comparison shows that Madagascar’s economic decline was exceptional in both scale and duration. Although many countries in sub- Saharan Africa seem to have experienced the same recessionary climate as from the 1980s, Madagascar stands out because its recession began much earlier, in the early 1970s. From 1960 to 1996, Madagascar’s GDP per capita fell by 37 per cent, whereas in Côte d’Ivoire and Senegal the decrease over the same period was only 10 per cent, and Cameroon and Mauritius posted increases of 20 per cent and 210 per cent respectively. It is more difficult to reconstruct past trends in the level of poverty. For 1962 and 1980, we relied on the work of Essama-Nsah (1997) and on the data reconstructed by Pryor (1990). The poverty line used by Pryor, which is defined in terms of the total consumption of a household, has been extrapolated for 1993 and 1997 (see Appendix III). It can be seen that at the household level2 , all indicators show a dramatic increase in poverty from 1980 to 1993, regardless of whether the households lived in urban or rural areas (Table 1.1). Poverty at the end of the period was also much greater than in 1962.
- 25. Exploring the Variety of Random Documents with Different Content
- 26. especially enjoyed the Divine oracles in their respective languages. That the blood actually possesses a living principle, and that the life of the whole body is derived from it, is a doctrine of Divine revelation, and which the observations and experiments of the most accurate anatomists have served strongly to confirm. The proper circulation of this important fluid through the whole human system, was taught by Solomon in figurative language, Eccles. xii, 6; and discovered, as it is called, and demonstrated by Dr. Harvey in 1628; though some Italian philosophers had the same notion a little before. This distinguished anatomist was the first who fully revived the Mosaic notion of the vitality of the blood; and which correct view was afterwards adopted by the justly celebrated Mr. John Hunter, whose strong reasoning and accurate experiments have served to sanction and give publicity to a fact so long unknown to mankind. The doctrine of Moses and St. Paul proves the truth of the doctrine of Harvey and Hunter: and the reasonings and experiments of the latter, illustrate and confirm the doctrine of the former.—See Dr. A. Clarke on Lev. xvii, 11. 190 — As an instance of this I may mention the case of a gentleman who was subject to frequent attacks of asthma, to such a degree, that if he were not relieved immediately by bleeding, he was in danger of suffocation: by being so frequently bled in that state, his blood at length became so pale as scarcely to stain a linen cloth, in consequence of the particles of the blood being so slowly renewed. 191 — Two of these causes are peculiarly important and interesting. When an animal has lost a considerable quantity of blood, and faints in consequence, the power of the blood to coagulate quickly is greatly increased.—When, for example, a sheep is bled to death, if you receive a cupful of the blood which first issues from the throat, and a cupful of the last, you will find that the latter will coagulate sooner, and become much more solid than the first portion. By way of experiment, the large artery of the thigh of a dog has been divided and laid open; the animal bled till he fainted, and on recovering had no return of the bleeding. On examining the artery, its divided end was found plugged up by coagulated blood, and much contracted in its diameter; this natural means, however, of checking hæmorrhage, we shall afterwards find, is assisted by the contractile power possessed by the vessel from whence it is effused. Hence it appears that
- 27. fainting is favorable to checking hæmorrhages, as far as it puts a temporary check on the circulation, and should always be encouraged to a certain degree. Another cause which influences the coagulation of the blood, is inflammatory diseases. Under such circumstances it remains much longer in a fluid state, but coagulates at length more firmly. This coagulation of the lymph is the first step towards its conversion into various parts of the body, or the union of divided parts. When, for example, the coagulating lymph is thrown out upon inflamed internal parts of the body which lie in contact, as the intestines or lungs, it becomes solid, and connects them loosely together. Blood vessels shoot into it, and convert it at length into cellular membrane, forming what are called adhesions, and in a similar way it is converted into the nature of various parts of the body. We may therefore say, that the coagulating lymph is the most important part of the blood, inasmuch as it is subservient to the formation of various organs in the body. Many parts, particularly the muscles, very nearly resemble it in their nature. 192 — Substances may even be introduced into the blood directly. By way of experiment, Ipecacuanha, or a small portion of Emetic Tartar, or Jalap, have been infused into the veins: the result of this has been found to be, that they have produced the same effect as if introduced by the stomach; the former produced vomiting, the latter purging. 193 — Mr. Hunter, however, found that this natural inclination might be changed by education, for he taught an Eagle, which is a carnivorous animal, to subsist on farinaceous food alone. The plan he adopted was this: he began by abstracting the flesh meat, and substituting bread and butter, till at length the meat was entirely taken away; he then by degrees diminished the quantity of butter, till at length the animal fed on bread alone. It appears, however, from experiment, that this transition cannot be made suddenly, as the gastric juice of the animal is not adapted to act upon an opposite kind of food. It has been found that a quantity of pear or apple introduced into the stomach of a Buzzard Hawk was not digested, but remained unacted upon when the fowl was killed for inspection many hours afterwards; yet the stomach of this animal habitually digested bone. 194 — Dr. A. Hunter says, “When we consider the delicacy of the internal structure of the stomach, and the high and essential consequence of its office, we may truly say, it is treated with too
- 28. little tenderness and respect on our parts. The stomach is the chief organ of the human system, upon the state of which all the powers and feelings of the individual depend. “The stomach is the kitchen that prepares our discordant food, and which, after due maceration, it delivers over by a certain undulatory motion, to the intestines, where it receives a further concoction. Being now reduced into a white balmy fluid, it is sucked up by a set of small vessels, called lacteals, and carried to the thoracic duct. This duct runs up the back-bone, and is in length about sixteen inches, but in diameter it hardly exceeds a crow quill. Through this small tube, the greatest part of what is taken in at the mouth passes, and when it has arrived at its greatest height, it is discharged into the left subclavian vein; when mixing with the general mass of blood, it becomes, very soon, blood itself.” 195 — Dr. O. Gregory observes, “Animal heat is preserved entirely by the inspiration of atmospheric air! The lungs which imbibe the oxygen gas from the air, impart it to the blood; and the blood, in its circulation, gives out the caloric to every part of the body. Nothing can afford a more striking proof of creative wisdom, than this provision for the preservation of an equable animal temperature. By the decomposition of atmospheric air, caloric is evolved, and this caloric is taken up by the arterial blood, without its temperature being at all raised by the addition. When it passes to the veins, its capacity for caloric is diminished, as much as it had been before increased in the lungs: the caloric, therefore, which had been absorbed, is again given out; and this slow and constant evolution of the caloric in the extreme vessels over the whole body, is the source of that uniform temperature which we have so much occasion to admire. Dr. Crawford ascertained, that whenever an animal is placed in a medium the temperature of which is considerably high, the usual change of arterial venous blood does not go on; consequently, no evolution of caloric will take place, and the animal heat will not rise much above the natural standard. How pleasing it is to contemplate the arrangements which the Deity has made for the preservation and felicity of his creatures, and to observe that he has provided for every possible exigency!”—Lessons, Astronomical and Philosophical, 4th edit. p. 87.
- 29. 196 — A London Alderman, who had accidentally heard of the thoracic duct, was so struck with the importance and delicacy of the vessel, that he became very apprehensive lest it should be in the least obstructed; and, being one day caught in a crowd, from whence he could not extricate himself, he most earnestly entreated those who pressed on him, to take care of his thoracic duct. 197 — This is a good example of muscles, which, under ordinary circumstances, are directed by the will, becoming involuntary from an altered excitement. 198 — Dr. A. Hunter remarks, “Were it possible for us to view through the skin and integuments, the mechanism of our bodies, after the manner of a watch-maker when he examines a watch, we should be struck with an awful astonishment! Were we to see the stomach and intestines busily employed in the concoction of our food by a certain undulatory motion; the heart working, day and night, like a forcing pump; the lungs blowing alternate blasts; the humors filtrating through innumerable strainers; together with an incomprehensible assemblage of tubes, valves, and currents, all actively and unceasingly employed in support of our existence, we could hardly be induced to stir from our places!” 199 — Mr. Cruikshank, late Professor of Chemistry at Woolwich, judiciously observes, says Dr. Olinthus Gregory, that the size of the body, the quantity of food taken in, the vigor with which the system is acting, the passions of the mind, and external heat or cold, are circumstances which will ever occasion considerable variety in the quantity of the insensible perspiration. This gentleman, assuming that the surface of the hand is to that of the rest of the body as one to sixty (an assumption which Mr. Abernethy thinks much too small for the body,) and that every part of that surface perspired equally with his hand, concluded that he lost during an hour, by insensible perspiration from the skin, 3 ounces, 6 drams; and in 24 hours, at that rate, would have lost 7 pounds, 6 ounces. Also, that he lost 124 grains of vapor by respiration, in an hour; or 6 ounces, 1 dram, and 36 grains, in 24 hours; which, added to the former cutaneous exhalation, would make the whole insensible perspiration, in 24 hours, equal to 8 pounds, 1 dram, and 36 grains: the evaporation from the lungs will be little more than one-fifteenth of the whole.
- 30. Mr. Cruikshank has not the smallest doubt, but that electric fluid is also perspired from the pores of the skin: it appearing to him impossible that an enraged Lion, or Cat, should erect the hairs of the tail on any other principle: indeed he strongly suspects that, as electric fire is now known to be the prime conductor of the variation in the atmosphere, so it is also the grand conductor of insensible perspiration. He likewise states it as a matter beyond doubt, that, independent of aqueous vapor (of fixed air and phlogiston,) emitted from the skin in insensible perspiration, there is an odorous effluvia, which, though generally insensible to ourselves and the by standers, is perceptible to other animals. —Hence it happens, that a Dog follows the footsteps of his master by the smell; and, in like manner, with regard to other animals: the Fox-Hound knows afar the smell of the Fox; the Pointer that of the Partridge, the Snipe, or the Pheasant; and every carnivorous animal that of its prey.—Haüy’s Natural Philosophy, vol. i, p. 27. 200 — Dr. Priestley has positively asserted, that the doctrine of the soul has no foundation in reason or the Scriptures. But Dr. Jortin, in his sermon on John xi, 25, vol. vi, and Dean Sherlock, in his discourse on the immortality of the soul, completely refute the Doctor’s arguments. In the fourth volume of the Memoirs of the Literary and Philosophical Society of Manchester, there is a very valuable paper, by Dr. Ferriar, proving, by evidence apparently complete, that every part of the brain has been injured without affecting the act of thought; the reasoning of which memoir, being built on matters of fact and experience, appears to have shaken the modern theory of the materialists from its very foundation. 201 — See Wesley’s Sermon on Heb. xi, 1. 202 — Dr. Scott’s Christian Life, vol. v, p. 14. 203 — Practical Treaties on the Holy Spirit, pp. 7, 8. 204 — See Dr. Beattie’s Theory of Language, chap. ii. 205 — It is very singular, says Nicholas, in his very interesting history of New-Zealand, that the natives believe that the first woman was made of one of man’s ribs; and, what adds still more to this strange coincidence, their general term for bone is hevee, which, for ought we know, may be a corruption of the name of our first
- 31. parent, communicated to them, perhaps, originally, by some means or other, and preserved, without being much disfigured, among the records of ignorance. 206 — See Townsend’s Character of Moses, pp. 66-68.
- 32. Transcriber's Notes: Punctuation has been standardised. Non-printable symbols have been presented in square brackets with a description [triangle] This book was written in a period when many words had not become standarized in their spelling. Numerous words have multiple spelling variations or inconsistent hyphenation in the text. These have been left unchanged while obvious spelling mistakes have been repaired.
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