Distribution of selected healthcare resources for influenza pandemic response in Cambodia

International Journal for Equity in Health

Research

Khieu Borin¹  Richard Coker²  James W Rudge²  Sara U Schwanke Khilji²  Tom Drake²  Sok Touch³  Irwin Chavez⁴ 

[1] Centre for Livestock & Agriculture Development (CelAgrid), Phnom Penh, Cambodia;Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, 10400, 9th Floor, Satharanasukwisit Building, Mahidol University, 420/1 Rajavithi Road, Bangkok, Thailand;Department of Communicable Disease Control, Cambodia Ministry of Health, 151-153 Kampuchea Ground Avenue, Phnom Penh, Cambodia;Faculty of Tropical Medicine, Mahidol University, 10400, Bangkok, Thailand;

关键词: Health system;    Pandemic influenza;    Resource mapping;    Resource;    Allocation;    Antivirals;    Cambodia;    Southeast Asia;   

DOI  :  10.1186/1475-9276-12-82

 received in 2013-05-22, accepted in 2013-09-30,  发布年份 2013

来源: Springer

【 摘 要 】

IntroductionHuman influenza infection poses a serious public health threat in Cambodia, a country at risk for the emergence and spread of novel influenza viruses with pandemic potential. Prior pandemics demonstrated the adverse impact of influenza on poor communities in developing countries. Investigation of healthcare resource distribution can inform decisions regarding resource mobilization and investment for pandemic mitigation.MethodsA health facility survey performed across Cambodia obtained data on availability of healthcare resources important for pandemic influenza response. Focusing on five key resources considered most necessary for treating severe influenza (inpatient beds, doctors, nurses, oseltamivir, and ventilators), resource distributions were analyzed at the Operational District (OD) and Province levels, refining data analysis from earlier studies. Resources were stratified by respondent type (hospital vs. District Health Office [DHO]). A summary index of distribution inequality was calculated using the Gini coefficient. Indices for local spatial autocorrelation were measured at the OD level using geographical information system (GIS) analysis. Finally, a potential link between socioeconomic status and resource distribution was explored by mapping resource densities against poverty rates.ResultsGini coefficient calculation revealed variable inequality in distribution of the five key resources at the Province and OD levels. A greater percentage of the population resides in areas of relative under-supply (28.5%) than over-supply (21.3%). Areas with more resources per capita showed significant clustering in central Cambodia while areas with fewer resources clustered in the northern and western provinces. Hospital-based inpatient beds, doctors, and nurses were most heavily concentrated in areas of the country with the lowest poverty rates; however, beds and nurses in Non-Hospital Medical Facilities (NHMF) showed increasing concentrations at higher levels of poverty.ConclusionsThere is considerable heterogeneity in healthcare resource distribution across Cambodia. Distribution mapping at the local level can inform policy decisions on where to stockpile resources in advance of and for reallocation in the event of a pandemic. These findings will be useful in determining future health resource investment, both for pandemic preparedness and for general health system strengthening, and provide a foundation for future analyses of equity in health services provision for pandemic mitigation planning in Cambodia.

【 授权许可】

Unknown   
© Schwanke Khilji et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.