An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion

International Journal of Health Geographics

Richard Coker⁶  Pratap Singhasivanon⁷  Bounlay Phommasack¹  Pham Ngoc Chau²  Weerasak Putthasri⁵  Sok Touch³  James W Rudge⁶  Irwin Chavez⁷  Piya Hanvoravongchai⁴ 

[1] National Emerging Infectious Diseases Coordination Office, Fa Ngoum Road, Vientiane, Laos;Vietnam Military Medical University, Hanoi, Vietnam;Cambodia Ministry of Health, Department of Communicable Disease Control, 151-153 Kampuchea Ground Avenue, Phnom Penh, Cambodia;Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand;International Health Policy Programme-Thailand, Ministry of Public Health, Nonthaburi, 11000, Thailand;Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, 9th Floor, Satharanasukwisit Building, Mahidol University, 420/1 Rajwithi Road, Ratchathewi, Bangkok, 10400, Thailand;Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand

关键词: Southeast Asia;    Antivirals;    Resource allocation;    Resource mapping;    Health equity;    Pandemic influenza;    Health system;   

Others  :  810353
DOI  :  10.1186/1476-072X-11-53

 received in 2012-10-05, accepted in 2012-12-11,  发布年份 2012

【 摘 要 】

Background

There is increasing perception that countries cannot work in isolation to militate against the threat of pandemic influenza. In the Greater Mekong Subregion (GMS) of Asia, high socio-economic diversity and fertile conditions for the emergence and spread of infectious diseases underscore the importance of transnational cooperation. Investigation of healthcare resource distribution and inequalities can help determine the need for, and inform decisions regarding, resource sharing and mobilisation.

Methods

We collected data on healthcare resources deemed important for responding to pandemic influenza through surveys of hospitals and district health offices across four countries of the GMS (Cambodia, Lao PDR, Thailand, Vietnam). Focusing on four key resource types (oseltamivir, hospital beds, ventilators, and health workers), we mapped and analysed resource distributions at province level to identify relative shortages, mismatches, and clustering of resources. We analysed inequalities in resource distribution using the Gini coefficient and Theil index.

Results

Three quarters of the Cambodian population and two thirds of the Laotian population live in relatively underserved provinces (those with resource densities in the lowest quintile across the region) in relation to health workers, ventilators, and hospital beds. More than a quarter of the Thai population is relatively underserved for health workers and oseltamivir. Approximately one fifth of the Vietnamese population is underserved for beds and ventilators. All Cambodian provinces are underserved for at least one resource. In Lao PDR, 11 percent of the population is underserved by all four resource items. Of the four resources, ventilators and oseltamivir were most unequally distributed. Cambodia generally showed higher levels of inequalities in resource distribution compared to other countries. Decomposition of the Theil index suggests that inequalities result principally from differences within, rather than between, countries.

Conclusions

There is considerable heterogeneity in healthcare resource distribution within and across countries of the GMS. Most inequalities result from within countries. Given the inequalities, mismatches, and clustering of resources observed here, resource sharing and mobilization in a pandemic scenario could be crucial for more effective and equitable use of the resources that are available in the GMS.

【 授权许可】

   
2012 Hanvoravongchai et al.; licensee BioMed Central Ltd.

【 图 表 】

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