Health expenditures in Latin America and the Caribbean

This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average, per capita health expenditure of US$ 162. On average, the countries spent 6.2 percent of their GDP on health, with the expenditure divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.(AU)

Developing alternative approaches to urban wastewater disposal in Latin America and the Caribbean

The explosive rate of urbanization and industrialization in Latin America and the Caribbean has aggravated serious wastewater disposal problems. To address those problems, sound pollution control programs are needed - programs that are founded on a firm legal base and supported by an institutional infrastructure suitable for their effective operation. Such programs should make a point of employing technologies that are appropriate for the climatic and economic conditions prevailing in the areas they serve. Promising methods for dealing with such problems include use of submarine outfalls with minimal pretreatment for cities along coasts and estuaries, maximum use of receiving waters' assimilative capacity (as determined through application of system management and water quality models), reuse of treated sewage effluent for irrigation, and the application of unconventional technology for urban slum sanitation. This article reviews those various approches and describes the ongoing collaboration between national governments and PAHO's Pan American Center for Sanitary Engineering and Environmental Sciences (CEPIS) in the areas of research, information exchange, human resources development, and institutional development for the purpose of establishing a viable strategy and framework through which these major problems can be confronted and perhaps ultimately over come.(AU)