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

Abstract

BackgroundThere 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.MethodsWe 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.ResultsThree 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.ConclusionsThere 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.

Distribution of selected healthcare resources for influenza pandemic response in Cambodia

“…Data were collected as part of the AsiaFluCap Project, using survey tools as described in Hanvoravongchai et al . [ 17 ]. In brief, itemized healthcare resources were captured and quantified via questionnaires administered to all government-supported hospitals (n=185) and District Health Offices (DHOs) throughout all ODs (n=77) in Cambodia during March 2009 to September 2009.…”

“…The results of these analyses, carried out at the Province level in all study countries, revealed high variability in resource capacities both between and within countries, with substantial avoidable mortality attributed to severe shortages in mechanical ventilators [ 12 ]. A follow-up analysis, focusing only on study countries in the Greater Mekong Subregion (Cambodia, Lao PDR, Thailand and Vietnam) mapped and analyzed key health care resource distributions at the Province level in order to identify relative resource shortages, mismatches, clustering, and inequalities in distribution [ 17 ]. Again, a high degree of heterogeneity in resource distribution was noted.…”

Evolution of research in health geographics through the International Journal of Health Geographics (2002–2015)

“…These articles also deal with the development of pertinent cartographic approaches to represent, for example, the risk linked to natural-focal diseases [ 38 ], or for better distributing healthcare resources in developing countries [ 39 ]. The scale of work seems to be different, the areas being bigger at a regional scale [ 40 ] or national [ 41 ], it is more about assessing or comparing health systems [ 42 ], access to healthcare [ 43 ] or health situations [ 44 ], transposing methods from a country to another rather than within a limited space where one tries to evaluate one’s ability to act on its inhabitants. The foregoing can partly explain the appearance of the terms countries , facilities and services in these articles.…”

A Review of the Relationships among the Key Determinants Affecting the Mental Health Disorders of the People in Greater Mekong Subregion Countries

“…The ASEAN Free Trade Area (AFTA) [ 4 ] and the ASEAN Economic Community were also formed to enhance ASEAN economic growth, to open a single market, and to achieve further expansion in international markets [ 2 ]. Moreover, these issues have repeatedly occurred in some countries for over decades because the same actions and measures have been employed and have failed to resolve the situation [ 5 ]. Previous studies have stated that there are many economic, environmental, and healthcare problems found in the GMS countries [ 5 ].…”

“…Moreover, these issues have repeatedly occurred in some countries for over decades because the same actions and measures have been employed and have failed to resolve the situation [ 5 ]. Previous studies have stated that there are many economic, environmental, and healthcare problems found in the GMS countries [ 5 ].…”