WEAK, INEQUITABLE
WHO decries inadequacy, failure of health services in Asia and the Pacific to provide even the most basic care
Weak and inequitable health systems are preventing many Asia-Pacific nations from meeting international goals set on health and poverty.
The health-care systems of many countries are failing to deliver services of adequate quality, often using resources inefficiently or inappropriately, the World Health Organization said. Some countries do not fully provide the most essential and cost-effective services such as childhood immunization.
"We have the tools. Technical solutions are available and affordable. But we don't always have systems to deliver them," said Dr. Shigeru Omi, WHO director for Western Pacific.
Inequalities have widened in recent decades, with the poor increasingly unable to access or pay for health care. Of the 700 million people in Asia and the Pacific living on US$1 or less a day, many lack access to basic services. Ethnic minorities, poor women and rural communities are especially likely to suffer inequalities in health.
"The rich-poor health divide is growing. Good health should be a universal right, not a privilege," Omi told regional ministers of finance, development, and health, as well as representatives from donor and United Nations agencies, who gathered in Tokyo on June 21 to address challenges in reaching the Millennium Development Goals (MDG) on health.
Endorsed by all UN members in 2000, the MDG offers a comprehensive road map to ending poverty, with targets for the year 2015. Health is central to poverty reduction. Appropriately, three goals focus specifically on health and the rest indirectly relate to health.
WHO says that at current rates of progress, the region will be challenged to meet many MDG, including the goal to eradicate extreme poverty. One "hunger hot spot" is south Asia, which has a higher prevalence of underweight young children than Africa. Less than 30 percent of Asia-Pacific nations are on track to meet the target of reducing deaths of children under five.
The target for sanitation will also be a challenge to meet--current coverage rates are just 34 percent in South Asia and 48 percent in East Asia and the Pacific. Most countries are also not on track to reverse the spread of HIV and to reduce the number of women dying in childbirth. In Nepal and the Lao People's Democratic Republic, where a high proportion of women die in childbirth, less than 50 percent of pregnant women receive antenatal check-ups.
If Asia-Pacific nations are to reach the MDG and uplift millions from extreme poverty, then steps must be taken to strengthen health systems, promote equity, secure and better manage resources, and promote partnerships with nonhealth sectors.
Significant health gains are unlikely without improving health systems, WHO says. There needs to be better management, with greater accountability and responsiveness.
Securing sustainable financing is also a key priority. Many health systems require urgent investment. An estimated US$30 to $40 per capita is needed annually to finance a minimum health-service package, but many countries invest far less and some spend less than US$10 per capita.
There is also a critical shortage of trained health workers and other staff imbalances. Bangladesh, China, Mongolia, and Pakistan have more doctors than nurses. Human resources need to be strengthened and retained with adequate salaries, incentives, and training. With adequate training and supervision, community health workers can support some services.
While funding is inadequate, there is also a need to better allocate and utilize resources. Many governments direct the bulk of funding to urban areas--often to costly curative services--at the expense of essential services in rural areas, where most people live.
Typically, the rural poor have to travel a considerable distance for services. Pakistan addressed this problem with a Lady Health Worker Program that provided primary health care to one fifth of the population through home visits.
"Governments should prioritize investments toward the poor and those most in need," said Dr. Samlee Plianbangchang, WHO director for Southeast Asia. "We need to use resources efficiently."
Illness drives the poor further into poverty. Families may go into debt or sell land to pay for treatment. One study in Cambodia found that 40 percent of new landlessness was due to illness.
Often, the poor pay from their own pockets at the time of sickness, rather than from prepaid schemes or tax-funded care. In Cambodia and India, "out-of-pocket" payments account for 80 percent of all health spending. WHO recommends prepaid financial protection schemes, whether in the form of insurance, taxes, or social security.
Improving health will also require more investments and action in diverse nonhealth areas, such as water supply, education, infrastructure, and gender equality. For example, a study of several countries found that child mortality declines by three percent if access to drinking water is improved by 10 percent. Studies have shown that education of women can reduce child malnutrition by 40 percent.
Besides national governments, international donors need to play a key role. Some US$135 billion is needed in aid to meet the MDG in 2006. Donor nations have committed to increasing aid.
WHO Press Office
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