This review outlines the main organizational, financing, human resources and service delivery features of the health-care system. Although there has been implement in overall health outcomes since the 1990’s the current levels are still below average for the country’s Pacific neighbors. The remoteness of the many rural communities has hampered improvements in health services. This is one of the major challenges that the country faces in order to achieve SDG heath targets by 2030.
The health sector in Papua New Guinea is decentralized. Under decentralization, it is the local-level governments that have the primary responsibility for the majority of the funding and delivery of provincial- and lower-level health-care services. However, they are inadequately resourced to do so. Churches, through government subsidies, play an active role in the delivery of health care, particularly in rural locations. The government’s main policy priorities are tackling human resources for health and infrastructural needs of the country, particularly at the primary care level in rural and remote locations.
This Hits highlights steps taken to overcome these challenges especially in the face of epidemiological change in disease burden that is slowly taking place in the country.
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
The Kingdom of Bhutan has made great achievement in establishing and sustaining public financed and managed health system in the past five and a half decades. As enshrined in the Constitution, health services are free in the integrated traditional and allopathic medicines. The report also notes the epidemiological and health system challenges and the way forward to overcome in line with achieving SDGs.
The Indonesia HiT reports the significant improvement in the health status of the population over the last 25 years through transitional period in all fields. However, the country faces remaining and foreseeing challenges in communicable diseases and emerging NCDs. The HiT concludes with the future challenges of expanding coverage of National health insurance scheme (JKN), reducing regional disparities in health-care services, managing resources and engaging private sector.
The People’s Republic of China has made great achievements in improving health status over the past six decades, mainly due to the government’s commitment to health, provision of cost effective public health programmes, growing coverage of health financial protection mechanisms and investments in an extensive health-care delivery network.
The Kingdom of Tonga has had one of the best overall levels of health within the Pacific as a result of a dramatic reduction in communicable diseases and maternal and child mortality since the 1950s. It is also on target to achieve the Millennium Development Goals (MDG) around maternal and child mortality. Adapting its strong primary health-care system to deal with the large financial burden associated with chronic and noncommunicable diseases and ensuring quality primary health-care services in remote areas are the main health sector challenges facing Tonga.
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
The Republic of Korea HiT notes that economic development and universal health coverage through national health insurance has led to a rapid improvement in health outcomes. Overall, the health status of the Korean population is better than that of many other Asian countries. Reducing inequality in health coverage outcomes, strengthening primary health care and improving coordination between hospitals and long-term care facilities to meet the needs of the aged population are the challenges facing the Government.
The health system of Bangladesh has undergone a number of reforms and has established an extensive health service infrastructure in both the public and private sectors during the past four decades. Bangladesh has achieved impressive gains in population health, achieving the Millennium Development Goal 4 target of reducing under-five child mortality by two thirds between 1990 and 2015, and improving other key indicators such as maternal mortality, immunization coverage, and survival rates from malaria, tuberculosis, and diarrhoea diseases.
The Cambodia HiT reports that the national health sector reforms initiated two decades ago have had a positive impact on Cambodia’s health sector. The country’s health status has substantially improved since 1993 and is on track to achieve the Millennium Development Goal targets. Improving the quality of care is now the most pressing imperative in health-system strengthening.
The Solomon Islands HiT determines that the country’s health system has significant weaknesses but also considerable strengths. Despite the range and difficulty of issues facing policy-makers in the Solomon Islands, there have been significant achievements in health, including considerable progress in advancing population health status. The performance of the health system is positive, achieving high coverage, high satisfaction levels, and steady progress on health outcomes. Nonetheless, the country faces important health challenges that could undermine development gains made to date.
The Myanmar HiT reports of positive indications that, along with the changes in the country’s political system and administrative structures following the 2010 national elections, the new government is undertaking important reforms in the health sector. Along with the need to further improve health equity among its population, Myanmar has to overcome supply side limitations of the past, and effectively manage incoming challenges.
Lao PDR HiT: The Lao PDR HiT reports on impressive health gains over the past 3 decades due to strong political commitment to develop the health system. The results, however, have been mixed and gaps remain between policy intentions and effective implementation.
New Zealand HiT: New Zealand continues to have a predominantly tax-funded health system, providing universal coverage managed by the District Health Boards. The population enjoys high health status overall, but with significant inequalities in Māori and Pacific health.
Asia Pacific Observatory
WHO Regional Office for South-East Asia
World Health House
Mahatma Gandhi Marg
New Delhi, India 110 002
Telephone: +91-11-23370804, 23370809-11