Health care in Asia

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Health care in Asia

• Drs. Balram Bissumbhar
• Department of Biology and Society
• Free University Amsterdam

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Health care in Asia

• The role of
• Government
• Multinationals
• NGOs

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Introduction

• Short history of
• Bangladesh
• Mongolia
• Vietnam

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Current status of Bangladesh (1)

• Most populous and poorest country in the world
• 29 of the population lives on less than 1 US/
  day
• 48 are suffering from poverty, which influence
  the health status of these group
• very small proportion of poor women have access
  to health services
• child mortality is 7.6 per 1000 population
• 95 of children suffer from malnutrition

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• Poor are unable to pay the costs of their health
  care
• Less than 40 of the population has access to
  basic health services
• Use of private sector services is 4 times greater
  than the use of governmental services

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Source of financing health care sector in
Bangladesh
Source percentage Private household
63 MoHFW 31 Nonprofit organizations, NGOs,
donors 3 Other public revenue 3 Firms
and private insurance 0.04
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Health nutrition and population sector program
(HNPSP)

• Initiated in 2003 by the government
• Goal - sustainable improvement of health,
• nutrition and family welfare of countrys
• population
• Focused on - the poor, the women, the children
• and the elderly

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Priority objectives of HNPSP (1)

• Reducing maternal mortality ratio (MMR)
• Reducing total fertility ratio (TFR)
• Reducing malnutrition
• Reducing infant and under-five mortality
• Reducing the burden of TB
• Improving access to and quality of care of
  secondary and tertiary hospitals

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• Control of communicable diseases, including
  kala-azar, dengue, leprosy, STD and HIV/Aids
• Control of non-communicable disease, like cancer,
  cardiovascular diseases, diabetes, etc.
• Control and prevention of public health issues,
  like arsenicosis, environmental and occupation
  hazards and food safety
• Preventing injuries due to violence (especially
  against women and children) and accidents and
  injuries

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Improvement in child health

• By childrens immunization program (73)
  coverage for BCG, two doses DTP and polio 90
• Implementation of integrated management of
  childhood illness (IMCI)
• Goal IMCI - Reduction of morbidity and mortality
• associated with major childhood
• diseases
• - Access of poor to health , nutrition
  and
• population services through MoHFW or
  
• NGOs

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Government policy change has promoted inequity in
health

• Multilateral aid agencies such as USAID, World
  Bank and DFID have influence in shaping national
  health policy by defining priorities and
  provisioning of health care.
• The policy changes have not been based on the
  assessment of health needs of the population

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For instance

• Health services previously offered at the
  household level were decided to deliver at the
  community level
• User fees have been introduced at a government
  services
• User fees have marginalised access for the poorer
  sections

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Micro-credit borrowers hold up their passbooks.
Most micro-credit financers lend only to or give
priority to women, and women make up over 80
percent of the total borrowers in
Bangladesh.Studies have shown that when the
women have decision-making power over household
expenditures, they spend more on education and
health of the children. As such, whole families,
and society at large, benefit.
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Mongolia

• Capital Ulaanbatar
• total size 1.565.000 square kilometer almost
  90 of land area is pasture or desert, 1 arable
  and 9 forested.
• population 2.75 million
• climate continental, with little precipitation
  and sharp seasonal fluctuation.

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Mongolia

• Economy
• Activity is based on herding and agriculture (20
  of GDP in 2003)
• other sectors
• trade and services (28.8)
• transport and communication (15.1)
• manufacturing (6.0)
• mining (9.5)
• Mongolia has extensive mineral deposits (copper,
  coal, tin, gold, etc)

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Mongolia

• Environment
• Rapid urbanization and industrial growth under
  the communist regime Environment becomes a major
  concern
• Air pollution by using soft coal in factories
• Deforestation

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Mongolian health

• Since 1990 health system has been in transition
• Infant mortality rate is 40/1000
• Life expectancy 64 years (male/female)
• In 1991 introduction of a national immunization
  program
• In 2001, vaccination rate was 98 for six EPI
  vaccines and hepatitis B
• In 2002, rubella is added to the program

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Source of financing health care sector in Mongolia

• Source percentage
• State budget 64.1
• Health insurance fund (since 1994) 28.5
• Out-of-pocket payments and other sources 7.4
• Donor aid 15-20

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Populations are affected by four major infections

• Hepatitis B and C
• Brucellosis
• Tuberculosis
• Sexual transmitted diseases (STD)
• In 2001 two HIV infections have been detected

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Effort of the Mongolian government to improve the
health

• Clinical diagnosis of TB
• Optimizing individual treatment (DOT strategy)
• National program to reduce excessive alcohol
  consumption
• Program to reduce the prevalence of Brucellosis
  infection in livestock

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Current health situation

• Infant and under-five mortality rate shows a
  downward trend.
• Decreased deaths from communicable diseases and
  respiratory diseases.
• Increased deaths from cardiovascular diseases,
  cancer, injuries and poisoning.
• High costs of travel for the rural population
  (poor) is a real barrier to their basic
  diagnostic and more advanced health care services
  

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Health services in Mongolia

• In 2003 the World Bank launched a master plan
  for - hospital restructuring and
• privatization, but implementation
• has not started
• Health system problem include
• thin population spread
• growing expectation by patients
• cost-effectiveness
• quality of services

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Vietnam status

• Population about 82.377.000
• GDP per capita in 2002 was 2.847 US
• Life expectancy (M/F) 68/74
• Total health expenditure as of GDP5.2
• Per capita total expenditure on health was 234
  US (2001)

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Structure of economy 1994 versus 2004 ( of
GDP) 1994 2004 Agriculture 27.4 21.8 Indus
try 28.9 40.1 Manufacturing 14.9 20.3 Servic
es 43.9 38.2 GDP (US billions)
45.2 Average annual growth GDP 7.5
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Waste threatens public health and environment

• By 2010
• Municipal waste increase by 60
• Industrial waste by 50
• Hazardous waste by 300
• The reason is fastest economic growth

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Health issues

• The basic health indicators are better than other
  developing countries
• The reasons are
• wide spread practices of promoting social
  solidarity
• a relative egalitarian distribution of wealth and
  income
• many modern and cost-effective disease control
  interventions and primary health services
  delivered through services network
• public investment and recurrent budget support

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Health care transition in Vietnam

• All communes in Vietnam have commune health
  centers
• Community health care facilities undergo
  improvement (family based health care
  management).
• gt 95 of children under one year of age are
  immunized (six common deadly diseases).
• Infant mortality rate has decreased to 19/1000
• A number of the Vietnam Development Targets are
  managed at communal level

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Regional Blood Transfusion Centers

• The aim is to secure the health benefits of safe
  blood transfusion in Vietnam
• promote voluntary donation recruitment program
• organizing blood collection sessions
• promoting of efficient screening and testing of
  blood

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Non governmental organization

• The Netherlands Vietnam Medical committee (MCNV)
  based in both Amsterdam en Hanoi helping the
  people of Vietnam since 1968.
• There role has shifted from providing medicine to
  giving training and advice so communities can
  help themselves
• Mosquito born-diseases (dengue and malaria)
  control through MCNV.
• Micro-shrimp eats mosquito larvae
• Bednets (impregnated)

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The director of a 2 1/2 year secondary nursing
school in Saigon, shows a typical nursing
classroom. Nursing education is primarily
lecture/demonstration
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Most hospitals in Vietnam date back to the French
colonial period. Wards are large and offer no
privacy.
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Patient wards are overcrowded, making infection
control more difficult to manage.
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Hospital corridors function as living space for
patient families.
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It is not unusual to see 2 patients assigned to
the same bed.
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The family is responsible for all physical care,
hygiene, and meals. Nursing care, as we know it
does not exist.
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Equipment is limited and outdated by western
standards.Notice the rusty metal.
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Thank you!