Written by Patricia Moser, Lead Health Specialist 

The ADB Health Community of Practice had an opportunity to contribute to the regional post-2015 social development agenda last week.  Susann Roth, a Senior Social Development Specialist colleague in the Regional Sustainable Development Department, presented the initial outcomes from the ADB-UNDP-UNESCAP-sponsored Asia and the Pacific consultations. The subsequent discussion highlighted the unfinished Millennium Development Goals (MDGs) agenda and region specific issues. Five points regarding the context for health in Asia and the Pacific particularly stood out:

Rapidly aging populations: Reductions in fertility mean that most countries in Asia are rapidly aging, with the percent of population and numbers of people over 60, as well as deaths and disability from non-communicable diseases, expected to rise dramatically in the next decades.  Women’s greater longevity means health and social protection for the aging is a growing gender issue. 

Poverty and phenomenal economic growth: The region is becoming largely a domain of middle income countries while, at the same time, containing more than 70% of the world’s absolute poor (<$1.25/day). External development assistance for health goes overwhelmingly toward the lowest income countries and toward Africa. MICs will have to shoulder an increasing fiscal burden for meeting the unfinished MDG agenda as large global transfers for health go elsewhere.

Universal health coverage: Most regional countries have committed to health coverage for all citizens. Many are addressing this through demand-side financing schemes and health insurance programs. Information technology advances make this affordable and possible. This is game-changing in that it provides levers to change health system incentives to improve quality and access to services for the poor. However, it also carries fiscal contingent liabilities and risks given aging and rising MIC expectations. 

Private health sector: Rising demand for health and growing national and household incomes are resulting in growth of private health services and goods. Regional economies are gaining from production and sales of pharmaceuticals, medical devices and services; and households are gaining from related employment opportunities and more options for care. However, engaging the private health sector, both as an engine of economic growth and to meet national health goals, will require oversight, quality assurance and financing mechanisms that prevent impoverishment. Governments need tools that can support them in these tasks. 

Expanding risks of disaster from communicable diseases: Emerging and re-emerging communicable diseases, including pandemic influenza, SARS-like viruses, dengue and drug-resistant malaria, tuberculosis and other microbes pose increasing threats for countries in Asia and the Pacific, and globally. These diseases prove they respect no country or geographic boundaries. Increased interconnectivity and migration compound the risks, providing new opportunities for virus evolution and reassembly, as well as opportunities for existing diseases to move into new populations. Risks are increased by climate change, disasters, increasing livestock and poultry production to meet new demands in MICs, trade in fake and low quality pharmaceuticals, and slow achievement of the 2005 International Health Regulations (IHR) by the majority of countries in the region.

The list of ways that the health sector is different in the region, as well as how it has changed since the initial MDGs were developed, was much longer, including the ICT revolution, urbanization, high rates of tobacco use, interregional labor migration and frequent disasters!  How might these concerns be reflected in the post-2015 goals? That’s a longer blog and requires longer thought.  I plan to remain engaged in the process with Susann at ADB, and in the global process of the World We Want health thematic group. 

In the meantime, here are three recommendations that I believe fit nicely within ADB’s Agenda 2020:

• Expand ADB operations and knowledge work on health financing system innovations that improve equity, efficiency and value for money in health services; 
• Work with countries and regionally to improve the environment for private health sector, including regulation and oversight, new models for health infrastructure investments, public-private partnerships, and ensuring bottom-of-the-pyramid approaches to health goods; and 
• Increase support for regional public goods for communicable disease control, including country level operations for meeting the IHR and regional knowledge products and capacity building.

Do you have suggestions on how Asia-Pacific issues might be translated into ADB operations given our comparative advantages and the need to strengthen our value-added in providing investments and knowledge?