Posts tagged under health systems
Mobile phones are increasingly being used to access health services, particularly in South Asia and parts of Africa. As the effects of mobile health initiatives on health outcomes have been positive, information sharing in the healthcare sector of developing countries can contribute toward more effective and sustainable healthcare systems and services.
The opportunities for mobile health initiatives are vast in Bangladesh for instance, where about 60 per cent of the population – approximately 85 million people – use the mobile phone. Patients can now get free advice from health workers and daily prenatal health alerts through the mobile phone. Should they be unsatisfied with the health services provided, patients can also file complaints through their phones. The complaints and suggestions from the public are received by a web-server which routes them by e-mail to the head of the hospital.
Urban poverty is an emerging trend in Asia. Millions of rural-urban migrants leave their traditional livelihoods to seek a new fortune in the city. Vietnam is a good example of this global trend recording some of the highest urbanisation rates in Southeast Asia. It has already 755 urban towns and cities which are home to approximately 30 million people. Estimates predict that by 2020, Vietnam’s cities will be populated by more than 46 million people.
The Asian Trends Monitoring team conducted a survey among Hanoi’s poor between May 18 and May 24. We collected a total of 351 responses from four different neighbourhoods with the help of 12 field interviewers from the Center for Studies and Applied Sciences in Gender in Hanoi.
The survey had a “perception of difficulties” section comprising ten categories, each to be rated on a 5-point scale (from “easy” to “impossible/unable to do”). In four out of ten categories more than 40% of respondents answered with very difficult or unable to do. ‘Accessing modern health treatments’ came up on top with more than 50% of respondents rating it as very difficult or unable to access health treatments.
Most countries in ASEAN have government programs to enable the poor to access health services. Whether in the form of subsidies, health insurance programs for the poor, or conditional cash transfers, these programs are designed to make health services more affordable to the poor.
However, is the price of healthcare the only access barrier? The visualization we made below illustrates the other factors that prevent the poor from having full access to health services. (click here to view it in full size)
Last month (in 2011! Came around quick didn’t it?) I was fortunate to catch a plethora of super-interesting presentations at the Elsevier Social Science & Medicine conference on Health System Reform in Asia – check out the copious oral program alone here. Rather upsettingly, no less than 6 parallel sessions meant I didn’t catch all of them. Here’s some of the highlights from the session on inequity:
Aditi Iyer and Gita Sen of IIM Bangalore on the intersections of gender and class inequalities in healthcare access over two decades of reforms in India, using 3 rounds of household survey data:
- Women generally ration treatment because they perceive their illness to not be “serious”, whereas men ration treatment due to “financial barriers”, indicating that women may not perceive that their health is important. Aditi linked women understating their need due to sheer lack of time that they have to visit healthcare facilities, due to work and family demands.
- ‘Perverse (gender) catch up’ is observed in non-treatment among the poorest during the mid-1990s and 2000s, whereby the poorest men were becoming as badly off as the women due to financial barriers. This was related mainly to increases in drug prices and possibly to user charges.
“More than 50% of our patients are from inside Burma – even the central provinces” explains Dr Cynthia Muang of the Mae Tao Clinic (MTC). These internally displaced persons (IDPs) often lack access to health services in Burma, with some travelling through dense jungle for up to seven days to receive treatment at the MTC.
Most Burmese migrants in Thailand come to escape the fighting between the Burmese government and minority groups, especially the Karen people, whilst others come to Thailand for greater employment opportunities in factories. The MTC estimates that there are over 550,000 IDPs within Burma, with the largest concentration along the Thailand-Burma border, in addition to over two million Burmese migrant workers in Thailand (most of them illegal). MTC treats most patients for free at the clinic as many cannot afford to pay for services, “they need at least 200 – 300 baht to come to the clinic” a great sum for IDPs. Knowing the challenges faced by migrants to reach the clinic, the MTC works with other NGOs like the Backpack Health Worker Team (BHWT) training Burmese mobile medics to provide preventive and maternal and child health services in the Karen villages bordering Thailand, often dangerous work in the presence of landmines and daily fighting between the Karen fighters and the army.
The Roundtable on “Rising Asia, Growing Inequality”, which was attended by a full house of about 220 guests, students and media, saw a lively debate on the nature of inequality witnessed today and the sense of injustice amplified by the social media, which is in turn facilitated by rapid technological change.
Watch the exciting debate among the six panelists moderated by Dean Kishore Mahbubani here. The first video features the only debate, further below you will find the Question & Answer Session.
- Professor Kishore Mahbubani, Dean of the Lee Kuan Yew School of Public Policy (Chair)
- Dr. Judith Rodin, President of the Rockefeller Foundation
- Dr. Anies Baswedan, President, Paramadina University and one of Indonesia’s leading public intellectuals
- Professor Fu Jun, Executive Dean, Peking University School of Government
- Mr. Gideon Rachman, Chief Foreign Affairs Columnist, The Financial Times
- Mr. Karim Raslan, writer and consultant based in Indonesia and Malaysia
Senator Ton Nu Thi Ninh, President, Founding Committee of Tri Viet University, Vietnam
We would like to express our gratitude to the Rockefeller Foundation, New York and the Centre for Strategic Futures, Singapore for their generosity in supporting this Roundtable event and the Asian Trends Monitoring Project.
Coming on Monday: Full-length video of the event and footage from the Q&A Session. We will post it here.
The session was moderated by Dean Kishore Mahbubani and featured Dr. Judith Rodin, President of the Rockefeller Foundation; Dr. Anies Baswedan, President, Paramadina University and one of Indonesia’s leading public intellectuals; Professor Fu Jun, Executive Dean, Peking University School of Government; Mr. Gideon Rachman, Chief Foreign Affairs Columnist, The Financial Times; Mr. Karim Raslan, writer and consultant based in Indonesia and Malaysia; and Senator Ton Nu Thi Ninh, President, Founding Committee of Tri Viet University, Vietnam.
Don’t want to wait for tomorrow? To find out what the panelists discussed during the 90 minute debate, read a feature article about the roundtable event on the LKY School’s homepage here.
Our final preview before the official release of ATM Bulletin #12. (click to see full size)
If you’re in Singapore, don’t forget to attend the “Rising Asia, Growing Inequality” roundtable event organized by the ATM team. This event looks into the question of why Southeast Asia’s economic growth has led to the creation of parallel economies with dramatic social inequalities. The Roundtable will be held on September 30, 2011, 1:30-3:00 pm at the Lee Kuan Yew School of Public Policy.
In ATM’s upcoming issue on “Rising Asia, Growing Inequality” we’ll be showcasing inequalities across basic infrastructure, health and financial services and ICTs with the aim to spark discussion about policy options to tackle them. In health, we’re zooming in on maternal and child health (MCH) and chronic diseases – aspects of population health that seem neglected amongst the hype about infectious disease (has anyone seen the movie contagion yet?) and focus on health innovations and financing models for secondary and tertiary care. Primary health systems don’t receive the same level of attention or investment. But for MCH and chronic disease, a solid primary health system that emphasizes prevention and early detection is vital for better health outcomes.
Health system responses to rising Non-Communicable Disease (NCD) rates in Southeast Asia and China vary. Most are built to deal with infectious diseases, endemic to this region, rather than chronic diseases. Whilst a crude measure, the table below gives some indication of which countries have operational strategy plans in place to tackle NCDs and selected risk factors (kudos to Dans et al, 2011 for compiling the first table I’d seen on this). Diabetes, alcohol intake and insufficient physical activity are three areas that stand out as neglected relative to other NCDs / risk factors.