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Under-investment in health costs lives

Kim Hak-Su

Spending on health services is not expenditure but an investment. The time to act is now.

IN THE midst of the Asia-Pacific's robust economic growth, an unacceptable number of women — about 250,000 — still die every year during pregnancy or childbirth. Millions suffer and die from diseases that are entirely preventable and curable.

Many lives could be saved if governments commit higher levels of their budget to health services. More deaths could be prevented if health-care were made accessible to all. These are the key messages that emerged from a study by the U.N.'s regional arm, the Economic and Social Commission for Asia and the Pacific (UNESCAP).

Conventional wisdom dictates that the more money a nation spends on health care, the better heath it has. So what is new about the latest study? For one, the study makes it clear that spending on health services is not expenditure but an investment. In fact, it is one of the best investments a country can make — there is a strong correlation between investment in health systems and economic growth. Secondly, the study makes the point that it is not just how much, but how it is spent that matters.

The study, which will be presented to UNESCAP's 62 member governments during its annual session in Almaty, Kazakhstan, from May 17 to 23, has found that there is a clear and direct link between increased government investment in health systems and high life expectancy and low infant mortality. Perhaps not surprisingly, Asia-Pacific's richest countries spend higher percentages of their income on health. In 2003, Australia spent 9.5 per cent of its GDP on health, New Zealand 8.1 per cent, and Japan 7.9 per cent. In stark contrast, some of the Asia-Pacific's developing countries spend just 2-4 per cent of GDP on health.

However, there are exceptions, such as Mongolia, which spent 6.7 per cent of its GDP on health. This is clearly not a question of affordability, but one of getting the priorities right, as we are talking in relative, not absolute, terms.

When we come to absolute figures, the conclusion is the same — developing countries in Asia and the Pacific are spending too little on health. The World Health Organisation recommends spending at least $36 per person each year on health. Twenty-four governments in the region are falling behind this minimum requirement. The majority of them, 19, spend less than $20 per person — the bare minimum level to reduce maternal and infant mortality, and combat HIV/AIDS, malaria, and other diseases, three of the eight Millennium Development Goals (MDGs).

To achieve the goals by 2015, these countries would need to generate additional investment to the tune of $228 billion between now and then, or $25 billion annually.

Increasing spending, however, is just one part of the equation. A well-functioning health system needs to be equitable — affordable and accessible to all. Our study has shown that in many of the developing countries in Asia-Pacific, the vulnerable groups — women, rural populations, disabled people, and minorities — are often missing out on basic health services.

The result is disastrous. In South Asia, maternal mortality rose by almost 20 per cent during 1995-2000, bucking the global trend of overall improvement. The Central Asian sub-region also sees its prevalence rates of HIV and tuberculosis on the rise. Meanwhile, Central Asia's progress in reducing child mortality is limited; a failure linked may be to slow progress in providing rural communities with basic sanitation and clean water.

Success stories too

Fortunately, the picture is not all bleak. There are success stories in our region. Thailand's universal coverage health-care scheme has delivered basic medical services for free to millions, boosting its human development. Bangladesh has managed to slash maternal mortality rates by 55 per cent in the last ten years by increasing the number of emergency obstetric care centres, improving access to family planning services and training skilled health providers with the support of donors.

While three of eight MDGs are health-related — reducing maternal and child mortalities, and reversing the spread of HIV/AIDS, malaria, and other diseases — all the goals are inter-related. Without investing in health, progress in reducing poverty would be hampered. Staying sick means staying out of the workforce. The poverty cycle continues. With nearly two thirds of the world's poor in Asia-Pacific, we simply cannot afford to continue like this.

Experience has shown us that health services are not just for people who can afford private medical insurance. Real success requires real commitment from governments. It can be done. The time to act is now. — Courtesy: U.N. Information Centre, New Delhi.

(The writer is United Nations Under-Secretary-General and Executive Secretary of the Bangkok-based Economic and Social Commission for Asia and the Pacific [UNESCAP].)

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