SHAPING THE FUTURE HOW CHANGING DEMOGRAPHICS CAN POWER HUMAN DEVELOPMENT

some cases, a bump in public spending has
begun to mitigate these costs. Out-of-pocket
payments in India are still high at 58 percent,
for instance, but declined 10 percentage points
in the last decade, helped by measures such as
the free provision of drugs, which account for
nearly half of out-of-pocket spending.
The region also needs to rectify the still
limited supply of doctors and nurses. 96 Revising
national intellectual property legislation could
take advantage of flexibilities in trade rules
that allow enhanced access to medicines. Public-private
partnerships to deliver expanded and/
or improved health services could be explored,
with due consideration for balancing public and
private risks and gains.
Accurate and relevant health information is
critical for services to improve their efficiency,
cost-effectiveness, quality and safety. Reviewing
government policies relevant to health disparities
and bringing together data from disparate
sources can shed light on effective means to
uproot the causes of unequal access to health care.
As appropriate, the decentralization of health
services and community participation can help
push forward the provision of universal primary
health care. For example, decentralization of
services to provide immunization, prenatal care
and rehydration against diarrhoea have saved
many children in developing countries.
Increase spending on health care: As recommended
by the World Health Organization,
in moving towards universal health care, all
countries should aim for a minimum health care
spending floor of at least 5 percent of GDP. 97 The
region on average is above that share, but lags
other regions. Health expenditures in Asia-Pacific
increased by 17 percent from 1995 to 2012
to an average of 6.7 percent of GDP in 2012, yet
the average was 7.7 percent for Latin American
countries and 10.1 percent for European ones.
Some subregions and countries have yet to hit
the 5 percent mark. Among all Asia-Pacific
subregions, South-east Asian countries invested
the smallest share, about 3.9 percent, while the
Pacific countries had the highest share at 9.2
percent. Myanmar at 1.5 percent, Timor-Leste
at 2.6 percent and Pakistan at 4.7 percent are
among the countries with the lowest shares. 98
Promote health equity: Efforts to improve health
care affordability and access and to scale-up
investment need to be backed by a reorientation
of public policy to explicitly tackle inequities in
health outcomes. This should be grounded in
health policy itself, with explicit and practical
strategies to achieve equity. In New Zealand, for
example, guidance has been developed to assist
staff working in health planning and funding
to incorporate equity considerations during
BOX 3.9:
Low-cost care and quality medical services improve health outcomes in some Pacific island
and other countries
Accurate and relevant
health information is
critical for efficiency,
quality and safety
Several Pacific island countries have set excellent
examples of providing state-sponsored health care
systems. Out-of-pocket health costs in Kiribati,
Tuvalu, Samoa, and Solomon Islands account for
less than 10 percent of total health expenditures.
At 17 percent of GDP, the share of public expenditure
on health care in Tuvalu is among the highest in
the region. From 2007 to 2012, 93 percent of births
were attended by qualified medical personnel,
and 98 percent of one-year-olds received immunizations.
Indicators on child and maternal health
are very good, with the proportion of underweight
children under the age of five only 1.7 percent, and
child mortality at only 30 per 1,000 births.
Brunei Darussalam has high-quality, comprehensive
health care that is universal and equitable.
An early achiever of the Millennium Development
Goal health targets, it has attained commendable
progress in child and maternal health care, with
99 percent of deliveries attended by trained staff.
Average life expectancy at birth stands at 75 years.
High-quality hospitals and clinics are at hand, along
with flying medical services for airlifting any citizen
in need of emergency care.
Source: UNESCAP 2015c, Commonwealth health online 2015.
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