The other crisis: the economics and financing of maternal, newborn and child health in Asia

Abstract

The Global Financial Crisis (GFC) of 2008/2009 was the largest economic slowdown since the Great Depression. It undermined the growth and development prospects of developing countries. Several recent studies estimate the impact of economic shocks on the poor and vulnerable, especially women and children. Infant and child mortality rates are still likely to continue to decline, but at lower rates than would have been the case in the absence of the GFC. Asia faces special challenges. Despite having been the fastest growing region in the world for decades, and even before the current crisis, this region accounted for nearly 34% of global deaths of children under 5, more than 40% of maternal deaths and 60% of newborn deaths. Global development goals cannot be achieved without much faster and deeper progress in Asia. Current health financing systems in much of Asia are not well placed to respond to the needs of women and their children, or the recent global financial and economic slowdown. Public expenditure is often already too low, and high levels of out-of-pocket health expenditure are an independent cause of inequity and impoverishment for women and their children. The GFC highlights the need for reforms that will improve health outcomes for the poor, protect the vulnerable from financial distress, improve public expenditure patterns and resource allocation decisions, and so strengthen health systems. This paper aims to highlight the most recent assessments of how economic shocks, including the GFC, affect the poor in developing countries, especially vulnerable women and children in Asia. It concludes that conditional cash transfers, increasing taxation on tobacco and increasing the level, and quality, of public expenditure through well-designed investment programmes are particularly relevant in the context of an economic shock. That is because these initiatives simultaneously improve health outcomes for the poor and vulnerable, protect them from further financial distress, improve public financing and/or provide a much-needed counter-cyclical stimulus at times of economic slowdown.

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“…Hal inilah menyebabkan ketidakmerataan pada masyarakat dan berdampak pada kesehatan kelompok rentan, salah satunya balita. 21 Terdapat lima faktor yang diperkirakan dapat menentukan prioritas dan kecukupan alokasi pembiayaan bidang kesehatan, yaitu jumlah penerimaan daerah yang berasal dari pemerintah pusat dan daerah yang tercantum dalam APBD, skala prioritas bidang kesehatan di mata para pimpinan daerah, 10,22 kemampuan dinas kesehatan dalam melakukan advocay, kemampuan dinas kesehatan untuk menyusun rencana anggaran yang baik, dan kemampuan dinas kesehatan menyajikan informasi alur pendanaan kesehatan daerah termasuk informasi sumber-sumber dana yang ada sampai bagaimana penggunaan dana tersebut terhadap pencapaian program-program kesehatan. 10,20,23 Sebuah studi yang menggunakan data 121 survei yang melibatkan 36 negara berpendapatan rendah dan berpendapatan menengah menyebutkan bahwa pertumbuhan makro-ekonomi memiliki hubungan yang lemah atau bahkan tidak ada dalam hal kaitannya dengan balita pendek (stunting), berat rendah (underweight) dan gizi buruk (wasting).…”

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“…2,9,10 Consequently the maternal health care needs of women are frequently unmet, and maternal mortality rates are amongst the highest globally. 9 In the following sections we provide a broad overview of each country's maternal health outlook and health care utilisation trends over the past decade.…”

“…3 If designed and implemented well, it is argued that cash transfers are affordable and cost-effective for funders and can be scaled up easily. 9 Both the major cash transfer schemes in Nepal and India are deployed nationwide.…”

Reproductive health financing in Kenya: an analysis of national commitments, donor assistance, and the resources tracking process

“…the poor, adolescents, older women and men). 30,31 Benefitincidence analyses have long been used in the public finance field, to determine who benefits from public spending on specific programmes. The socio-economic status and health status of beneficiaries are of particular importance in the analysis of reproductive health expenditures.…”