This is the first Lancet series where health professionals from different disciplines in 10 member countries of the Association of Southeast Asian Nations (ASEAN) such as Brunei, Myanmar, Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam have collaborated to identify common and individual approaches to problems that challenge health systems in local and global settings.
The first Lancet series on Southeast Asia seeks to catalyze greater regional solidarity in health, the people, economy, and ecosystems of Southeast Asia by bringing together an outstanding group of Southeast Asian researchers and health leaders. The series also emphasizes the centrality of research in health-policy design and implementation, and the need for investment in regional research capacity and promotes more robust and sustainable mechanisms for bringing academics, professionals, and civil-society organizations together with governments into more effective health and public policy exchange for the advancement of health of all people in the region.
Dr. Jose Acuin, Chair of the PNHRS Research Utilization Committee and Director for Medical Quality Improvement of The Medical City is one of the experts who represented the Philippines to contribute in this Lancet series. 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.”
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, “Southeast Asia has achieved substantial reductions in child and mortality over the past decades, but these achievements are unevenly distributed among and within the countries of the region.”
Dr. Cecilia Acuin also discussed the causes of mortality in Southeast Asia. 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 the delays in attaining emergency obstetric care. Hypertensive disorders or indirect causes contributes 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 accounted for almost half of the deaths in children. “Although maternal and child mortality are on the decline in Southeast Asia, there are still major disparities and greater equity to achieve the Millennium Development Goals,” said Dr. Cecilia Acuin.
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, “Southeast Asia faces epidemic of chronic non-communicable diseases accounting to 60 percent of deaths in the region. The problem stems from the environmental factors that promote tobacco use, unhealthy diet and inadequate physical activity. Health care systems needed to be re-design to deliver chronic care. The ASEAN is in a unique position to make a united stand against chronic non-communicable diseases in the region.”
The topic on human resources for health in Southeast Asia, distributional challenges and international trade in health services 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 emphasized that there is no shortage of health workers in Southeast Asia. However, all ASEAN countries face problems of maldistribution of health workers and rural areas are often understaffed. “Despite a high capacity for medical and nursing training in both public and private facilities, there is a weak coordination between production of health workers and capacity for employment,” said Dr. Lorenzo.
“To ensure that vital human resources for health are available to meet the needs of the population, migration management and retention strategies 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,” Dr. Lorenzo concluded.
Health financing reforms and challenges in achieving universal health care was discussed by Dr. Eduardo Banzon, Senior Health Specialist of World Bank.
Universal coverage of health care is defined as securing access by all citizens to appropriate, preventive, curative and rehabilitation services at an affordable cost. However, according to Dr. Banzon, “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.”
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. “Though health financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened,” added Dr. Banzon.
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