Challenges in Public Health Development in Developing Countries Than Sein Challenges in Public Health Development in Developing Countries 1
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
Brunei Singapore Trends in Human Development 1.0 HDI value Year 1975 1980 1985 1990 1995 2000 2002 0.8 0.6 0.4 0.2 0.0 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
Three Sub-index values of HDI in SEAR Countries, 2002 1.000 0.900 LEB EDU GDP HDI 0.800 0.700 0.600 Index value 0.500 0.400 0.300 0.200 0.100 0.000 Timor-Leste Nepal Bangladesh Bhutan Myanmar India Indonesia Sri Lanka Maldives Thailand Challenges in Public Health Development in Developing Countries 4
60 Prevalence of Under 5 Under weight children among SEAR Countries 1990 2002 2015 50 40 Prevalence (%) 30 20 10 0 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
Low Birth Weight Prevalence by Districts, Sri Lanka, 2002 Nuwara Eliya 29.4 Mannar 22.8 Badulla Batticaloa Moneragala 19.4 19.2 21.7 Jaffna 13.7 Kilinochchi 11.6 Mullaitivu 16.2 Legend LBW per 100 live births 10-15 15-20 20-25 Kandy 19.1 Mannar 22.8 Vavuniya 15.0 25-30 Anuradhapura 18.5 Gampaha 18.0 Anuradhapura 18.5 Trincomalee 11.8 Ratnapura Matale 17.9 17.9 Puttalam 15.2 Kurunegala 15.6 Polonnaruwa 14.6 Batticaloa 19.4 Matale 17.9 Hambantota Sri Lanka Colombo 17.7 17.1 16.8 Kandy 19.1 Gampaha Kegalle 18.0 16.6 Nuwara Eliya Colombo 29.4 16.8 Kalutara Ratnapura 16.3 17.9 Ampara 13.7 Badulla 21.7 Moneragala 19.2 Kegalle Kalutara 16.6 16.3 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 11.6 0 5 10 15 20 25 30 35 Low Birth Weight per 100 live births Source : Family Health Bureau
175 Under-5 Mortality Rate (Reduced by two thirds b/w 1990 2015) (UN MDG Goal G4, T5, I13) 150 1990 2002 2015 125 U5MR (per 1,000 live births) 100 75 HFA 2000 target of U5MR < 70 50 25 0 Nepal Timor-Leste Bangladesh Myanmar India Bhutan Indonesia Maldives Thailand DPR Korea Sri Lanka Source : WHO/SEARO, June 2004 (based on National Data)
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 22.5 20.9 20.7 17.3 15.9 14.6 14.4 13.5 13.1 13.1 12.4 12.2 10.0 10.0 7.9 7.6 7.5 7.3 6.8 5.9 5.6 5.2 5.1 4.3 3.2 2.0 0 5 10 15 20 25 Infant M ortality Rate per 1,000 Live Births Jaffna 5.1 Legend Infant Mortality Rate per 1,000 Live Births Kilinochchi 2-5 7.3 5-10 Mullaitivu 10-15 14.4 15-20 20-25 Vavuniya Mannar 7.5 10.0 Anuradhapura Trincomalee 22.5 2.0 Puttalam 6.8 Polonnaruwa 13.1 Batticaloa 14.6 Kurunegala 13.1 Matale 7.9 Kandy 17.3 Ampara Gampaha Kegalle 5.9 5.2 10.0 Nuwara Badulla Eliya 20.9 20.7 Colombo 15.9 Moneragala 3.2 Kalutara Ratnapura 4.3 12.4 Galle Hambantota 13.5 Matara 5.6 7.6 Source : Sri Lanka Health Atlas 2003
Measles coverage in SEAR countries, 2002 100 Percentage 94 99 99 90 80 70 67 70 71 75 76 77 78 60 50 47 40 30 20 10 0 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
Trend and distribution of polio cases in the SEA Region, 1988 and 2003 Total cases > 25,000 1988 2003 Source: IVD Unit, WHO-SEARO
Estimated maternal mortality ratio, 2000 & Reported MMRatio, 2002 in countries of SEA Region 1400 Figures in boxes are national reported data as of 2002. 1200 1200 1100 Maternal deaths per 100,000 LB 1000 800 600 400 415 740 440 660 800 650 540 430 407 780 420 450 380 320 660 360 440 307 200 0 170 255 255 230 110 91 230 58 220 110 28 180 60 92 105 46 130 88 67 13 44 17 22 Nepal Timor- Leste India Bhutan Bangladesh Myanmar Indonesia Maldives Sri Lanka DPR Korea Thailand 160 Source: Joint WHO-UNICEF-UNFPA estimates of MMR, 2000
Coverage of births by skilled attendants in India by States, 1998-99 Kerala 94.0 Goa 90.8 Tamil Nadu 83.8 Mizoram Delhi Andhra Pradesh 65.9 65.2 67.5 Punjab 62.6 Maharashtra Karnataka 59.4 59.1 Manipur Gujarat 53.9 53.5 West Bengal Jammu & Kashmir India Haryana Himachal Pradesh 44.2 42.4 42.3 42.0 40.2 Rajasthan Sikkim Orissa Nagaland Arunachal Pradesh 35.8 35.1 33.4 32.8 31.9 Madhya Pradesh 29.7 Bihar Uttar Pradesh Assam Meghalaya 23.4 22.4 21.4 20.6 0 10 20 30 40 50 60 70 80 90 100 Source: India, National Family Health Survey (NFHS-II), 1998-99 Percentage
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1,000,000 ARV Treatment Needs of countries in the SEA Region (as of December 2003) 343,500 100,000 31,500 50,250 Number of HIV/AIDS patients 10,000 1,000 100 360 975 4,500 9,750 10 8 8 1 Bhutan Maldives Sri Lanka Source : WHO/SEARO, HIV/AIDs Unit Bangladesh Nepal Indonesia Myanmar Thailand India
Trends in malaria in the SEA Region, 1976-2000 7,000,000 100 90 6,000,000 5,000,000 Total malaria cases 80 70 60 Cases 4,000,000 3,000,000 50 40 Pf percentage 2,000,000 Pf % 30 20 1,000,000 10 0 1976 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000* 0 Source : WHO/SEARO, Malaria Unit Year * provisional
Trends in TB case detection in the SEA, 1990-20020 80 70 Target 70% 60 50 SEAR 2000--2003 effort: 40 Global average rate of progress 30 20 10 0 1990 1995 2000 2005 2010 2015 2020
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Trends in coverage by health insurance schemes in Thailand 1991-2000 90 80 Total 70 60 Medical care for the poor and the socially supported (underprivileged) groups 50 40 30 20 10 Medical services for civil servants and state enterprise employees Voluntary health insurance Compulsory health insurance 0 1991 1992 1995 1997 1998 1999 2000 Source: Thailand Health Profile 1997-1998
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
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