DEVELOPMENT-ASIA: Downturn Draining Health Budgets

By Suvendrini Kakuchi Reprint | | Print |

Suvendrini Kakuchi

TOKYO, Apr 29 1998 (IPS) - Asia’s economic downturn is sapping the region’s health resources, putting women and the poorest at greatest risk and threatening to reverse hard-fought gains made in improving health over the decades.

Health experts from Thailand, Indonesia, Malaysia and the Philippines shared similar stories at a conference here Monday: Health budgets are stretched to the limit and people cannot afford safe treatment, making them vulnerable to more illnesses.

The symposium was held among aid experts and health officials to give donors a clearer picture of the human costs of Asia’s crisis. It was organised by the Japanese foreign ministry, the United Nations Development Programme (UNDP), the Japan International Cooperation Agency and other institutions.

At the conference, UNDP special assistant Richard Jolly urged Asian governments to not compromise on a human-centered approach in dealing with effects of the region’s worst crisis in decades.

Allowing social and health programmes to lag behind now would hurt human development and quality of life well into in the future, said Jolly, who was principal coordinator of the UNDP’s Human Development Report 1997.

“It is important to learn from the lessons of the eighties, when Latin America and Africa faced a similar situation and followed IMF (International Monetary Fund) structural adjustment policies, but have yet to recover fully,” he said.

“It is only through heavy investment in poverty reduction that countries can emerge triumphant from the harsh problems faced in the crisis and the structural adjustment policies that are intended to steer Asia into more open market economies,” Jolly added.

Pregnant women and young children are “faring the worst”, said Dr Triono Soendoro, bureau chief for social welfare, health and nutrition of Indonesia.

Sharp declines in income are forcing pregnant women to deliver at home, and young children are vulnerable to diseases at a time when their families are hard pressed for money.

The devaluation of their currencies has hit the health networks of South-east Asian countries hard because they rely heavily on imports of pharmaceutical material, drug inputs and medical equipment.

In Indonesia, Soendoro said, import-dependent national health programs have been forced to reduce foreign drugs and medical equipment after the steep devaluation of the rupiah since late 1997.

Indonesia spends 70 percent of its health budgets on importing materials for drugs and equipment. Thailand forks out 45 percent for foreign drugs.

Data collected by Soendoro shows that out of Indonesia’s 200 million population, almost 18 million people, mostly in low income groups and living in rural areas, are facing increased health risks due to the economic slowdown.

To cut costs, the poor are avoiding out-patient facilities, not buying total prescription drugs, seeking out indigenous healers who sometimes worsen their problems, and have stopped family planning practices, he added.

Likewise, he said more mothers in rural areas are delivering at home with local midwives rather than going to hospitals, and patients with serious illnesses like cancer and AIDS cannot afford costly treatments.

Signs of the crisis’ effects on health are already evident. Soendoro presented statistics showing 50 new cases of tuberculosis documented in hospitals since the first three months of 1998 — an alarming trend because Indonesia had until recently been recording decreasing statistics.

Erlinda Capone, in charge of social development at the National Economic and Development Authority of the Philippines, said the devaluation of the peso has forced cuts of up to 23.3 percent in the coverage target of six vaccines in the country’s immunisation programme.

Confirming that children and women would bear the burden of poor health the most, Capone said fund cutbacks in the national nutrition programme would cut the number of child beneficiaries aged 12 to 15 months by as much as 436,090. This would also mean a 33 percent reduction in the number targeted pregnant women.

Jongkol Lertiendumrong of the Health Systems Research Institute in Thailand says some 1.8 million Thais had lost their social insurance, which included medical coverage, amid unemployment of 5.6 percent.

Many are moving back to their rural homes, in turn causing a severe burden on the health facilities in those areas as well as taxing local resources and the environment, she pointed out.

Suicides are rising among Thais, especially the poor and unemployed, and the government has had to start a special mental health department to deal with the problem.

Soendoro said it is clear that assistance funds are needed to help reduce the crisis’ effects on the poor and vulnerable. Last month, the World Bank (WB) said Indonesia would need 3 billion dollars for food and medicine to tide its people over in the coming months.

Japanese foreign ministry officials say Tokyo seeks to play a major role in reducing health risks in Asia, through emergency grants and drug donations to needy countries and hospitals.

Still, Asian experts say their governments are doing what they can to keep up social protection for the poor.

For instance, the Philippines has imposed 25 percent mandatory reserves for social protection, including health, in its 1998 budget with the help of a 250 million U.S. dollar WB loan. Malaysia has developed a social impact assessment for use as a mechanism to oversee and enforce laws on social development.

There are no signs that Asia’s ill economies will recover magically, so they need to turn back to the basics, analysts say.

Said Thailand’s Jongkol: “The economic crisis has proved to be a challenge to affected nations by forcing us to reduce the fat we accumulated during the bubble economy, and return to modest living standards that will in the long-run help us to develop in a more sustainable way”.