Children and Women's Health in South East Asia: Gap Analysis and Solutions

Abstract

In response to the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) commitment, eight selected countries in the South East Asia region have made a remarkable reduction in infant and child mortality, while a few have achieved an SDG 3.2 target of 25 and 12 for child and neonatal mortality rate, respectively, well before 2030. Across these eight countries, there is a large variation in the achievement of the nine dimensions of maternal, neonatal, and child health service coverage. The poorest wealth quintiles who reside in rural areas are the most vulnerable and left behind from access to service. The rich rural residents are better off than the poor counterparts as they have financial means for travel and access to health services in urban town. The recent 2019 global Universal Health Coverage (UHC) monitoring produced a UHC service coverage index and an incidence of catastrophic health spending, which classified countries into four quadrants using global average. Countries belonging to a high coverage index and a low incidence of catastrophic spending are good performers. Countries having high coverage but also a high incidence of catastrophic spending need to improve their financial risk protection. Countries having low coverage and a high incidence of catastrophic spending need to boost service provision capacity, as well as expand financial protection. Countries having low coverage and a low incidence of catastrophic spending are the poor performers where both coverage and financial protection need significant improvement. In these countries, poor households who cannot afford to pay for health services may forego required care and instead choose to die at home. This paper recommended countries to spend adequately in the health sector, strengthen primary health care (PHC) and safeguard the poor, mothers and children as a priority in pathways towards UHC.

Keywords: East-Asia Pacific; children health; maternal and child health; universal health coverage; women health.

Figure 1

Child and neonatal mortality per 1000 live births in 2018, selected countries in the South East Asia region. Data source: Levels and trends in child mortality 2019, UNICEF, WHO, World Bank Group and United Nations [11].

Figure 2

Under-5 mortality and infant mortality rate in 1990 and 2016 of selected countries in the South East Asia region. Data source: Levels and trends in child mortality 2019, UNICEF, WHO, World Bank Group and United Nations [11].

Figure 3

Achievement of women and children protection based on nine dimensions of maternal, newborn, and child health (MNCH) service coverage in eight selected countries. Data source: Thailand Multi-Indicator Cluster Survey (MICS) 2016, Viet Nam MICS 2014, Indonesia DHS 2017, Timor Leste DHS 2016, Philippines DHS 2017, Cambodia DHS 2014, Myanmar DHS 2016, and Lao PDR MICS 2017 (data from the reports of MICS and DHS in South East Asian countries [14]. (a) family planning (modern methods); (b) four quality antenatal care (ANC) visits; (c) skilled birth attendant rates; (d) the early initiation of breastfeeding; (e) third dose of Diphtheria-tetanus-pertussis (DTP3) immunization coverage; (f) care seeking for children with pneumonia; (g) the use of improved drinking water sources; (h) the use of improved sanitation; and coverage of birth registration.

Figure 4

Synergies of vulnerability: urban/rural and rich-poor quintiles, Lao PDR. Data source: Lao PDR MICS 2017 [14].

Figure 5

Synergies of vulnerability: urban/rural and rich-poor quintiles, Thailand. Data source: Thailand MICS 2016 [14].

Figure 6

Stage of country on service coverage and financial protection. Data source: Primary Health Care on the Road to Universal Health Coverage, 2019: Global Monitoring Report, Conference Edition [30].

Figure 7

Negative correlation between public health spending as % GDP and the proportion of out-of-pocket payment as % total health expenditure. Data source: New Perspective on Global Health Spending for Universal Health Coverage, Global report: Conference copy for consultation, WHO, 2018 [32].