In response to the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) commitment, eight selected countries in the South East Asia region have made a remarkable reduction in infant and child mortality, while a few have achieved an SDG 3.2 target of 25 and 12 for child and neonatal mortality rate, respectively, well before 2030. Across these eight countries, there is a large variation in the achievement of the nine dimensions of maternal, neonatal, and child health service coverage. The poorest wealth quintiles who reside in rural areas are the most vulnerable and left behind from access to service. The rich rural residents are better off than the poor counterparts as they have financial means for travel and access to health services in urban town. The recent 2019 global Universal Health Coverage (UHC) monitoring produced a UHC service coverage index and an incidence of catastrophic health spending, which classified countries into four quadrants using global average. Countries belonging to a high coverage index and a low incidence of catastrophic spending are good performers. Countries having high coverage but also a high incidence of catastrophic spending need to improve their financial risk protection. Countries having low coverage and a high incidence of catastrophic spending need to boost service provision capacity, as well as expand financial protection. Countries having low coverage and a low incidence of catastrophic spending are the poor performers where both coverage and financial protection need significant improvement. In these countries, poor households who cannot afford to pay for health services may forego required care and instead choose to die at home. This paper recommended countries to spend adequately in the health sector, strengthen primary health care (PHC) and safeguard the poor, mothers and children as a priority in pathways towards UHC.
Background Asia is a region that is rapidly urbanising. While overall urban health is above rural health standards, there are also pockets of deep health and social disadvantage within urban slum and peri-urban areas that represent increased public health risk. With a focus on vaccine preventable disease and immunisation coverage, this commentary describes and analyses strengths and weaknesses of existing urban health and immunisation strategy, with a view to recommending strategic directions for improving access to immunisation and related maternal and child health services in urban areas across the region. The themes discussed in this commentary are based on the findings of country case studies published by the United Nations Childrens Fund (UNICEF) on the topic of immunisation and related health services for the urban poor in Cambodia, Indonesia, Mongolia, Myanmar, the Philippines, and Vietnam. Main body Although overall urban coverage is higher than rural coverage in selected countries of Asia, there are also wide disparities in coverage between socio economic groups within urban areas. Consistent with these coverage gaps, there is emerging evidence of outbreaks of vaccine preventable diseases in urban areas. In response to this elevated public health risk, there have been some promising innovations in operational strategy in urban settings, although most of these initiatives are project related and externally funded. Critical issues for attention for urban health services access include reaching consensus on accountability for management and resourcing of the strategy, and inclusion of an urban poor approach within the planning and budgeting procedures of Ministries of Health and local governments. Advancement of local partnership and community engagement strategies to inform operational approaches for socially marginalised populations are also urgently required. Such developments will be reliant on development of municipal models of primary health care that have clear delegations of authority, adequate resources and institutional capabilities to implement. Conclusions The development of urban health systems and immunisation strategy is required regionally and nationally, to respond to rapid demographic change, social transition, and increased epidemiological risk. Electronic supplementary material The online version of this article (10.1186/s40249-019-0538-4) contains supplementary material, which is available to authorized users.
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