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Essential health coverage low in South Asian region

Among several South Asian countries, rates of health care coverage and financial risk protection were low and inequality in access to health care was common, according to a study published in JAMA Internal Medicine.

These findings indicate that greater progress is needed for these countries to achieve universal coverage that provides essential treatment and preventive services and financial security, according to the researchers.

“In the United Nations’ newly adopted Sustainable Development Goals, universal health coverage is promoted as an essential precondition for health and human security, particularly in low- and lower middle-income countries,” Md. Mizanur Rahman, PhD, from the University of Tokyo, and colleagues wrote. “The main goal of universal health coverage is to ensure that everyone who needs health care services is able to gain access to them without incurring financial hardship.”

Rahman and colleagues conducted a population-based study between June 2012 and February 2016 to determine the progress and challenges towards universal health coverage in five South Asian countries: Afghanistan, Bangladesh, India, Nepal and Pakistan. They calculated relative indices of health coverage, financial risk protection and inequality in coverage among wealth quintiles using nationally representative survey data from 335,373 households. They assessed access to basic services, financial risk protection and equity and then estimated composite and indicator-specific coverage rates, stratifying by wealth quintiles. Inequalities in service and financial indicators were assessed through slope and relative index of inequality.

Results showed a substantial variation in access to basic care among all South Asian countries. The mean rates of overall prevention coverage and treatment coverage were 53% (95% CI, 42.2-63.6) and 51.2% (95% CI, 45.2-57.1) in Afghanistan; 76.5% (95% CI, 61-89) and 44.8% (95% CI, 37.1-52.5) in Bangladesh; 74.2% (95% CI, 57-88.1) and 83.5% (95% CI, 54.4-99.1) in India; 76.8% (95% CI, 66.5-85.7) and 57.8% (95% CI, 50.1-65.4) in Nepal; and 69.8% (95% CI, 58.3-80.2) and 50.4% (95% CI, 37.1-63.6) in Pakistan. The rates of financial risk protection were generally low. Catastrophic payments due to health care costs was reported by 15.3% (95% CI, 14.7-16) of respondents in Afghanistan; 15.8% (95% CI, 14.9-16.8) in Bangladesh; 17.9% (95% CI, 17.7-18.2) in India; 11.8% (95% CI, 11.8-11.9) in Nepal; and 4.4% (95% CI, 4.0-4.9) in Pakistan. The wealthiest mothers in Afghanistan, Bangladesh, Nepal and Pakistan were at least three times more likely than poor mothers to have access to at least four antenatal care visits, institutional delivery and presence of skilled attendant during delivery. Furthermore, wealthy mothers in these countries had access to institutional delivery 60 to 65 percentage points higher than poor mothers and wealthy mothers in India had 21 percentage points higher. For adequate sanitation, institutional delivery and the presence of skilled birth attendants, coverage was least equitable.

“Universal health coverage is a crucial step forward for South Asian countries seeking to ensure access to essential health services without imposing financial risk upon citizens,” Rahman and colleagues concluded. “Recent improved service provision in certain key areas is encouraging and highlights the increasing enthusiasm and momentum behind the universal health coverage movement. However, the ultimate challenge for policymakers is not merely to improve clinical services but also to ensure equity in service and treatment coverage and protection against health care–related financial hardship. The journey toward universal health coverage is far from complete, but with proper attention to access and equity in health, even the poorest nations in South Asia can make steady progress toward achieving health care for all.” – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.