Than Sein. Challenges in Public Health Development. in Developing Countries

Transcription

1 Challenges in Public Health Development in Developing Countries Than Sein Challenges in Public Health Development in Developing Countries 1

2 An Overview Demographic and epidemiological transition Double Burden communicable diseases as well as noncommunicable diseases (new, emerging and reemerging) Health Inequity; Health Insecurity Rapid development of technology, trade expansion and liberalization, fastest transportation and communication (New Globalization) Many players in international health Governments, Philanthropists, INGOs, NNGOs, Partnerships Challenges in Public Health Development in Developing Countries 2

3 Brunei Singapore Trends in Human Development 1.0 HDI value Year Challenges in Public Health Development in Developing Countries 3 Timor-Leste Nepal Bangladesh Laos Bhutan Myanmar Cambodia India Vietnam Indonesia Sri Lanka China Maldives Philippines Thailand Malaysia Source: UNDP, Human Development Report 2004

4 Three Sub-index values of HDI in SEAR Countries, LEB EDU GDP HDI Index value Timor-Leste Nepal Bangladesh Bhutan Myanmar India Indonesia Sri Lanka Maldives Thailand Challenges in Public Health Development in Developing Countries 4

5 60 Prevalence of Under 5 Under weight children among SEAR Countries Prevalence (%) Bangladesh India Nepal Timor-Leste Bhutan Sri Lanka Indonesia Myanmar Maldives Thailand DPR Korea Baseline data for 1990 for Timor-Leste and Maldives are estimates and 2015 is target set as MDG Source : WHO/SEARO, Routine and ad hoc reports from countries to the EHI Unit as of June 2004

6 Low Birth Weight Prevalence by Districts, Sri Lanka, 2002 Nuwara Eliya 29.4 Mannar 22.8 Badulla Batticaloa Moneragala Jaffna 13.7 Kilinochchi 11.6 Mullaitivu 16.2 Legend LBW per 100 live births Kandy 19.1 Mannar 22.8 Vavuniya Anuradhapura 18.5 Gampaha 18.0 Anuradhapura 18.5 Trincomalee 11.8 Ratnapura Matale Puttalam 15.2 Kurunegala 15.6 Polonnaruwa 14.6 Batticaloa 19.4 Matale 17.9 Hambantota Sri Lanka Colombo Kandy 19.1 Gampaha Kegalle Nuwara Eliya Colombo Kalutara Ratnapura Ampara 13.7 Badulla 21.7 Moneragala 19.2 Kegalle Kalutara Galle 13.4 Matara 15.5 Hambantota 17.7 Mullaitivu 16.2 Kurunegala 15.6 Matara 15.5 Puttalam 15.2 Vavuniya 15.0 Polonnaruwa 14.6 Jaffna 13.7 Ampara 13.7 Galle 13.4 Trincomalee 11.8 Kilinochchi Low Birth Weight per 100 live births Source : Family Health Bureau

7 175 Under-5 Mortality Rate (Reduced by two thirds b/w ) (UN MDG Goal G4, T5, I13) U5MR (per 1,000 live births) HFA 2000 target of U5MR < Nepal Timor-Leste Bangladesh Myanmar India Bhutan Indonesia Maldives Thailand DPR Korea Sri Lanka Source : WHO/SEARO, June 2004 (based on National Data)

8 Infant Mortality Rate, Sri Lanka, 2001 Anuradhapura Badulla Nuwara Eliya Kandy Colombo Batticaloa Mullaitivu Galle Kurunegala Polonnaruwa Ratnapura Sri Lanka Vavuniya Kegalle Matale Matara Mannar Kilinochchi Puttalam Ampara Hambantota Gampaha Jaffna Kalutara Moneragala Trincomalee Infant M ortality Rate per 1,000 Live Births Jaffna 5.1 Legend Infant Mortality Rate per 1,000 Live Births Kilinochchi Mullaitivu Vavuniya Mannar Anuradhapura Trincomalee Puttalam 6.8 Polonnaruwa 13.1 Batticaloa 14.6 Kurunegala 13.1 Matale 7.9 Kandy 17.3 Ampara Gampaha Kegalle Nuwara Badulla Eliya Colombo 15.9 Moneragala 3.2 Kalutara Ratnapura Galle Hambantota 13.5 Matara Source : Sri Lanka Health Atlas 2003

9 Measles coverage in SEAR countries, Percentage Timor-Leste India SEAR Nepal Myanmar Indonesia Bangladesh Bhutan Thailand Maldives Sri Lanka Source : WHO/SEARO, IVD Unit Note : Data for DPR Korea not available

10 Trend and distribution of polio cases in the SEA Region, 1988 and 2003 Total cases > 25, Source: IVD Unit, WHO-SEARO

11 Estimated maternal mortality ratio, 2000 & Reported MMRatio, 2002 in countries of SEA Region 1400 Figures in boxes are national reported data as of Maternal deaths per 100,000 LB Nepal Timor- Leste India Bhutan Bangladesh Myanmar Indonesia Maldives Sri Lanka DPR Korea Thailand 160 Source: Joint WHO-UNICEF-UNFPA estimates of MMR, 2000

12 Coverage of births by skilled attendants in India by States, Kerala 94.0 Goa 90.8 Tamil Nadu 83.8 Mizoram Delhi Andhra Pradesh Punjab 62.6 Maharashtra Karnataka Manipur Gujarat West Bengal Jammu & Kashmir India Haryana Himachal Pradesh Rajasthan Sikkim Orissa Nagaland Arunachal Pradesh Madhya Pradesh 29.7 Bihar Uttar Pradesh Assam Meghalaya Source: India, National Family Health Survey (NFHS-II), Percentage

13 Challenges in Public Health Development in Developing Countries 13

14 Challenges in Public Health Development in Developing Countries 14

15 1,000,000 ARV Treatment Needs of countries in the SEA Region (as of December 2003) 343, ,000 31,500 50,250 Number of HIV/AIDS patients 10,000 1, ,500 9, Bhutan Maldives Sri Lanka Source : WHO/SEARO, HIV/AIDs Unit Bangladesh Nepal Indonesia Myanmar Thailand India

16 Trends in malaria in the SEA Region, ,000, ,000,000 5,000,000 Total malaria cases Cases 4,000,000 3,000, Pf percentage 2,000,000 Pf % ,000, * 0 Source : WHO/SEARO, Malaria Unit Year * provisional

17 Trends in TB case detection in the SEA, Target 70% SEAR effort: 40 Global average rate of progress

18 Challenges in Public Health Development in Developing Countries 18

19 Trends in coverage by health insurance schemes in Thailand Total Medical care for the poor and the socially supported (underprivileged) groups Medical services for civil servants and state enterprise employees Voluntary health insurance Compulsory health insurance Source: Thailand Health Profile

20 Challenges Socio economic and political changes Demographic and Epidemiological Transitions Double Burden of diseases Increasing role of private health care providers Increasing responsibility by individuals Globalization rapid advancement in ideas and technology, ease of communication, spread of mass media, trade liberalization Changing role in health governance (local, national, international) Challenges in Public Health Development in Developing Countries 20

21 Challenge for Health Systems Improving performance Improving balance and relevance of human resources; Improving financing of health systems; Reducing physical and social barriers; safe and predictable supplies of affordable drugs and vaccines; Choosing effective interventions; and strengthening stewardship, including working with other sectors. Challenges in Public Health Development in Developing Countries 21