Asia’s healthcare evolution

Investment in universal health coverage can boost  GDP by up to 4%, which means that in Asia, health expenditure is money well spent

By Woochong Um, director-general, Asian Development Bank’s Sustainable Development and Climate Change Departments

In the last 50 years, the Asia Pacific region has made tremendous strides in poverty reduction, economic growth and better health outcomes. Life expectancy is increasing and infant and maternal mortality is declining in many countries. The quality of health systems is improving, and health insurance coverage is gaining traction.

However, much work remains to be done to ensure everyone in the region has access to essential healthcare services. The increasing prevalence of non-communicable diseases such as diabetes, hypertension, cancer and mental illnesses – combined with increasingly open borders, rapid ageing, urbanisation, income inequality and climate change – is breeding a host of new health system threats that have not been fully addressed.

With many antibiotic and antiviral drugs becoming ineffective against infections due to anti-microbial resistance, and with other health security threats creeping up on Asia in recent years, the risk of new outbreaks similar to the severe acute respiratory syndrome and avian influenza outbreaks is increasing.

Moreover, adequate health care to safeguard against these threats remains expensive for many people in developing Asia. Out-of-pocket spending still accounts for nearly half of total health expenditures in lower-middle- and low-income countries in the region. Health financing and service delivery systems need further reform to withstand the strains placed  on them by ageing populations and the rising tide of NCDs.

Combating these vulnerabilities requires difficult political decisions implemented through joint actions by finance and health ministries. However, governments are not spending enough on health systems, with average domestic general public health expenditure as a percentage of gross domestic product at 2.7% for the Asian Development Bank’s developing member countries in East Asia, Southeast Asia and the Pacific, and 0.9% for member countries in South Asia. This compares to the average 10% share of the members of the Organisation for Economic Co-operation and Development.

Action on investment

Helping countries make and persevere with these difficult choices is an increasingly important part of ADB’s role. Under Strategy 2030: Achieving a Prosperous, Inclusive, Resilient Sustainable Asia and the Pacific, ADB’s first operational priority includes supporting countries to enhance their human capital and the health, education and social protection of their people. ADB commits to help countries invest in health, maximise the health benefits of transport, urban, energy and other non-health sector interventions, and pursue universal health coverage.

It is a lofty ambition: the aim of universal health coverage is to ensure that everyone has access to quality essential healthcare services without financial hardship.

ADB has a strong track record in promoting better health in the region. We support efforts to strengthen urban health service delivery in Bangladesh and India, the upgrading of hospitals and health facilities in Papua New Guinea, Tajikistan and Uzbekistan, and the introduction of new vaccines in Pacific countries. Other ADB operations support health financing reforms that are expanding health insurance coverage in Laos and Mongolia, and the coverage of essential medicines in Bhutan.

In China and Vietnam, we are helping improve the quality of elderly care and primary care health workers.
As funding universal health coverage is a major hurdle for many developing countries, ADB is focused on providing predictable and substantial long-term financing. Another priority is to help member countries build knowledge and capacities, mobilise partnerships and leverage health benefits from cross-sectoral projects.

Under its G20 presidency, Japan’s priority for universal health coverage is to help countries focus on sustainable health financing and highlight the importance of collaboration between the ministries of health and finance, exemplified by the G20 joint ministerial meeting on the sidelines of the G20 Summit in Osaka in June. It is creating a valuable opportunity to inform and expand region-wide and country-level policy dialogues on this important challenge.

It is a chance to highlight how G20 members have reaped socio-economic benefits from sustained government investment in health. Investments in better health outcomes contribute to improved productivity and educational performance and sustained inclusive economic growth. The World Health Organization estimates that low- and middle-income countries can achieve additional GDP growth of at least 2% to 4% when they invest in universal health coverage.

Clearly, investing in health is money well spent. But obtaining the required levels of investment will not be easy. Success requires strong political commitment, as well as collaboration among multiple stakeholders including governments, domestic agencies within countries, physicians and other healthcare providers, the private sector, civil society and international development organisations.

It is decision time on health for countries in Asia and the Pacific. By committing to universal health coverage, the region can ensure its tremendous economic progress is matched by the robust good health of its people and communities.