The Philippine National Health Research System (PNHRS) week celebration became the launch pad of the Lancet Southeast Asia series. The event was held last 11 August 2011 at L’Fisher Hotel in Bacolod City.
Lancet is the world’s leading independent medical journal based in the United Kingdom. The journal’s coverage is international in focus and extends to all aspects of human health.
The Lancet Southeast Asia series being the first lancet series to focus on a region, aimed to seek greater regional solidarity in health, the people, economy, and the ecosystems of Southeast Asia. By bringing together an outstanding group of researchers and health leaders from the 10 member countries of the Association of Southeast Asian Nations (ASEAN), the series emphasizes the centrality of research in health-policy design and implementation, and the need for investment in regional research capacity.
Dr. Jose Acuin, Chair of the PNHRS Research Utilization Committee and one of the contributing authors in this Lancet series discussed the history, processes and overview of the papers. In his presentation, Dr. Acuin said that, “Southeast Asia presents daunting health challenges. The region has borne the brunt of several emerging and re-emerging infections, testing the responsiveness of local health authorities and the ability of the regional and global communities to cooperate to control diseases that cross national boundaries.”
Among the topics included in the series were Southeast Asia’s maternal, neonatal and child health situations; rise of chronic non-communicable diseases; distributional challenges and international trade for human resources in health and challenges in achieving universal health coverage through health financing reforms.
Maternal, Neonatal and Child health situations in Southeast Asia
According to Dr. Cecilia Acuin, Assistant Professor of the Institute of Epidemiology, University of the Philippines Manila – National Institutes of Health (UPM-NIH) and member of the PNHRS Research Utilization Committee presented the maternal, neonatal and child health in Southeast Asia. She cited that, “Although maternal and child mortality are on the decline in Southeast Asia, there are still major disparities and greater equity is key to achieve Millennium Development Goals (MDGs).”
Comparable cross-national data sources were used to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child death. For maternal death – causes are indicative of the substantial variations in health status and health system development in the region. Hemorrhage is the leading cause of death because of possible delays in attaining emergency obstetric care. Hypertensive disorders or indirect causes contribute to about one in every six maternal deaths and unsafe abortion as another factor contributing to 10 percent of the maternal deaths. On the other hand, about 40 percent of child’s death is attributed to neonatal problems. Infectious diseases including pneumonia and diarrhea also accounted for almost half of the deaths in children.
A Live Saved Tool was developed to estimate deaths averted by cause and intervention. The study also identified three major patterns of maternal and child mortality reductions: early rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with downward trend (Laos, Cambodia and Myanmar).
“Economic development seems to provide an important context that should be coupled with broader health system interventions. The increasing coverage and consideration of the health-system context is also needed, and regional support from the ASEAN can provide increase policy support to achieve maternal, neonatal and child health goals,” concluded Dr. Acuin.
The rise of non-communicable diseases in Southeast Asia
Dr. Antonio L. Dans, Assistant Professor at the College of Medicine, University of the Philippines Manila reported the rise of chronic non-communicable diseases in Southeast Asia. According to Dr. Dans, “Sixty percent of deaths in Southeast Asia is due to an epidemic of chronic non-communicable diseases. The problem stems from the environmental factors that promote tobacco use, unhealthy diet and inadequate physical activity. The disadvantaged communities are mostly affected, with death rates inversely proportional to a country’s gross national income.
Families shoulder the financial burden, but the entire economy suffers as well. Although attempts to control non-communicable diseases are increasing, more interventions still need to be done. Health care systems need to be re-designed to deliver chronic health care. “The ASEAN is in a unique position to make a united stand against chronic non-communicable diseases in the region,” stressed Dr. Dans.
Distributional challenges and international trade for human resources in health in Southeast Asia
The topic on human resources for health in Southeast Asia was presented by Dr. Fely Marilyn E. Lorenzo, Research Professor at the University of the Philippines Manila – National Institutes of Health (UPM-NIH).
Dr. Lorenzo raised the issue of maldistribution of health personnel in Southeast Asia in the context of international trade in health services. Though she emphasized that there is no shortage of health workers, unequal distribution of health workers has resulted to inadequate health personnel in some areas especially in far-flung communities. “This is due to weak coordination between production of health workers and the capacity for empowerment despite the high capabilities of public and private medical training facilities,” said Dr. Lorenzo.
Based on experiences, Southeast Asia has a distinctive feature in terms of international trade in health services engagement. Thailand attracts foreign patients for health services. For other countries like the Philippines and Indonesia, exporting nurses and doctors has resulted to brain-drain of highly specialized health staff from public schools to the private hospitals. An understanding about mutual recognition of professional qualifications of health workers under the ASEAN Framework Agreement of Services could be helpful to address this problem in the future.
Dr. Lorenzo further stated that, “To ensure that vital human resources for health are available to meet the needs of the population, migration management and retention strategies are needed to be integrated into ongoing efforts to strengthen health system in Southeast Asia. There is also a need to improve dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with the domestic needs and equity issues.”
Challenges in achieving universal health coverage through health financing reforms
According to Dr. Eduardo Banzon, Senior Health Specialist of World Bank, “Health financing reforms for Southeast Asia seeks to reduce dependence on out-of-pocket payments, increase pooled health finance and expand services use as steps toward universal health care coverage.” Universal health care coverage is defined as securing access by all citizens to appropriate, preventive, curative and rehabilitation services at an affordable cost.
However, “Prospect of progress toward this aspiration seem poor, particularly for countries whose government fiscal capacity is low and whose social health insurance for the employed sector is absent or very small, thus, restricting the mobilization of additional resources from payroll contributions,” revealed Dr. Banzon.
Laos and Cambodia, both resource poor countries, have mostly relied on donor-supported health equity funds to reach the poor. Thailand, Indonesia, Vietnam and the Philippines use social health insurance tax for formal sector employees.
Financing health care in most developing countries greatly relies on out-of-the-pocket payments, with most donors and global health initiatives such as the Global Fund focusing on specific diseases or interventions rather than the broader health system. Expanding coverage of good quality services and ensuring adequate human resources are important to achieve universal coverage. “Though health financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened,” added Dr. Banzon.(Edmon B. Agron)
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