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The Case: Skolnikland Is in Eastern Africa. It Has 30 Million People

Question 11

Multiple Choice

The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.
The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its per capita income is $790. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihoods in agriculture but there is a growing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There are an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, to which the better off people do not go. The health system is not very effective or efficient and is largely of low quality. The TB and maternal healthservices are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.
-In which of these countries, ranked in order of income per capita, would you expect health expenditure per person in dollars (at purchasing power parity) to be the highest?


A) Skolnikland
B) Nigeria
C) Uruguay

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