Oceania Health Profile

Health systems and services throughout
the Western PaciÞ c Region face a wide
variety of challenges. In some countries,
there is an urgent need to move towards
universal access through improved
Þ nancing and service delivery coverage.
In others, universal access is threatened
by cost inß ation. The quality and safety of
health services are far from ideal. Pressures
to widen coverage and improve quality
are offset by somewhat contradictory
pressures to increase efÞ ciency and
control costs. The private sector, in all
of its variations, is an important service
provider. Governments often lag behind
in fulÞ lling their stewardship role in
managing and regulating commercial
activities in the health sector.
The context in which health services
are delivered is changing rapidly.
Globalization, climate change, ageing
populations, epidemiological shifts
such as the increasing importance
of noncommunicable diseases,
decentralization and migration are just
a few examples of the forces impacting
the delivery of health services. Large
increases in overseas development
assistance for health have occurred,
mostly targeted at speciÞ c communicable diseases. This funding has not only
provided beneÞ ts to countries, but also
highlighted health system bottlenecks,
contributed to fragmentation, and made
overall coordination of the health sector
even more challenging.
Action and results
Resolution WPR/RC59.R4 adopted at
the Þ fty-ninth session of the WHO Regional
Committee for the Western PaciÞ c called
for the development, in consultation with
Members States, of a “regional strategy
on strengthening health systems based
on the guiding principles and core values
of primary health care”. A draft strategy
was prepared and related interviews were
conducted with over 220 key informants
from 28 Member States. The information
was analysed by a senior steering group
in February 2010. The results were used
to develop a second draft, which was
presented at a high-level meeting in
June 2010, and will be considered by
the Regional Committee at its sixty-Þ rst
session in October 2010.
Training-of-trainers workshops in
health services quality improvement
were conducted in cooperation with the
Institute of Health Systems Research,
Malaysia, for 36 participants from six
Asian countries and 20 others from 11
PaciÞ c island countries. Teams of trainers
from the countries represented were
provided start-up funds to implement
relevant small-scale quality improvement
activities to hone their skills. China also
conducted a comparative study on health
care quality regulation methods. The World Alliance for Patient Safety
has called on countries and institutions
to take up patient safety challenges.
Advocacy for improved hand hygiene has
continued with 407 hospitals from 16
countries in the Region having pledged
to improve their practices. A “safe surgery
checklist” has been launched or readied
for national roll-out in Australia, Malaysia,
the Philippines and Tonga, and has been
used by over 700 hospitals in China.
Support was provided to countries to
incorporate sustainable health systems
strengthening activities into proposals
for global health initiatives, namely, the
Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance.
Proposal development was supported
in eight countries, and nine of 11
applications submitted were provisionally
approved.
A workshop on “Maximizing Synergies
between Global Health Initiatives
and Health Systems” was held in
November 2009. Programme managers
from tuberculosis, malaria, immunization,
HIV/AIDS, maternal and child health,
and planning departments from eight
countries in the Western PaciÞ c Region
and three in the South-East Asia Region,
as well as WHO technical staff from both
the health systems and disease control
units, were brought together. Country
teams identiÞ ed health system bottlenecks
and synergistic interventions to improve
performance. This led to jointly agreed
upon recommendations and activities
to be considered for incorporation into
current implementation plans and future
applications for funding. Support was provided to review the
medical, dental and public health acts in
Fiji and Nauru, to advocate for passage
of the Law on Examination and Treatment
in Viet Nam, and to review the scope
of practice laws and regulations for
nurses and nurse practitioners in several
PaciÞ c island countries. Pilot studies on
developing standardized management
of health services in both rural and urban
settings were supported in China, as
well as a study on the mediation and
arbitration of medical disputes. A study on
private and public partnerships in health
was completed in Papua New Guinea,
where the majority of rural health services
are provided by the private sector.
Aid effectiveness activities of many
types, such as coordination meetings,
were supported in almost all countries
where aid is a signiÞ cant issue. SpeciÞ c
examples include annual health sector
reviews in Cambodia and Viet Nam;
a statement of intent for donors in
Viet Nam; reviews of sector-wide
approaches in Papua New Guinea,
Samoa and Solomon Islands; sector-wide
coordination with policy and guideline
development in the Lao People’s
Democratic Republic; and facilitation
of the International Health Partnership
process in Cambodia. WHO provided
technical support for a review of primary
health care in China to inform China’s
internal policy, as well as the overseas
development assistance it provides. In
addition, the Regional OfÞ ce for the
Western PaciÞ c published a four-country
case study on improving the compliance
of WHO processes with aid effectiveness
principles as outlined in the Paris
Declaration on Aid Effectiveness. National health planning has taken on
increasing signiÞ cance as both internal
and external partners recognize the
need to improve health sector coherence
through adherence to a nationally owned
health plan. The Regional Strategy on Health
Systems Strengthening Based on the
Values of Primary Health Care will be
presented to the Regional Committee
for the Western PaciÞ c for consideration.
The Strategy is part of a general move
to revitalize primary health care and
strengthen the cross-cutting and
intersectoral aspects of health systems.
Quality improvement activities will
continue with a focus on in-country work
with trainers. Where appropriate, work
on building frameworks and regulatory
structures for quality will be supported.
Management strengthening at the
operational level will be highlighted.
Cross-divisional work within the Regional
OfÞ ce on quality, antimicrobial resistance
and patient safety will continue.
Global health initiatives will continue
to be an important source of Þ nancing.
Technical support will be provided
to countries and disease-speciÞ c
programmes in designing, implementing
Health Sector Development
and monitoring cross-cutting action
aimed at strengthening health systems
and improving health outcomes using
these resources. Legal and regulatory
work will be supported when requested
by Member States.

Health care financing

Strategic issues
Universal coverage of health services is
the overarching goal of health Þ nancing
policies, ensuring that everyone has
access to appropriate health services
at affordable cost. Despite impressive
economic growth in recent decades in
the Western PaciÞ c Region, many people
suffer severe Þ nancial hardship due to
out-of-pocket payments for health care.
Many others simply go without treatment
because they cannot afford to pay.
There are a number of reasons for this
dilemma, including insufÞ cient spending
on health by many governments in
the Region, a reluctance to develop
prepayment mechanisms and, as a result,
an over-reliance on direct out-of-pocket
payments. This affects equity and access
by putting people, especially the poor
and vulnerable, at risk of not being able
to access health services or falling into
poverty when they pay their doctor and
hospital bills. Further, limited government
spending on health is not always utilized
in the most effective manner.
Action and results
In light of these concerns, a new Health
Financing Strategy for the Asia PaciÞ c
Region (2010–2015) was developed.
It highlights the main strategic areas
policy-makers should focus on to achieve
universal coverage. These include strategic
actions to improve the efÞ ciency of
health spending and measures to ensure
the dynamic use of scarce resources.
The Strategy encourages each country
to examine its own health Þ nancing
situation and to take steps to improve
health outcomes by improving coverage
and Þ nancial protection.
The Health Financing Strategy was
endorsed by the Regional Committee
at its sixtieth session in 2009. A novel
component of the Strategy is a group of
four interrelated target indicators that
enable governments to monitor and
evaluate progress in the transition to
universal coverage.

The global economic crisis that erupted
in 2008 has had a signiÞ cant impact on
many countries in the Region and has
put health Þ nancing issues into sharper
focus. Monitoring the health impact of
the crisis, such as ensuring low budgetary
allocations to health are not cut further,
has been an important area of work.
A study to assess the health impact of the
crisis was conducted in Þ ve developing
countries in Asia, in collaboration with
the Asian Development Bank. Although
the study found minimal adverse impact
to date, it warned that the effect of the
crisis on health would likely lag behind
the broader economic impacts.
Many households appear to have some
resources to buffer the negative impact of
the recent economic downturn. But some
are expected to struggle when these
resources are depleted, especially as higher unemployment makes more people
vulnerable. In contrast, the situation in
the PaciÞ c island countries has been
more severe, coming soon after a food
crisis and recent natural disasters. Lower
government revenues in a few PaciÞ c
island countries led to sharp reductions
in government budgets and a freeze on
staff recruitment, affecting the delivery of
health services.

As part of the broader need for
improving evidence for health Þ nancing
policy, national health accounts (NHA)
have been expanded, particularly in the
PaciÞ c. In partnership with the Asian
Development Bank, WHO has developed
NHA materials and estimation tools
consistent with PaciÞ c country needs,
established a PaciÞ c NHA sub-network
and conducted a series of in-country
capacity-building activities in Fiji, the
Federated States of Micronesia and
Vanuatu. Further, in decentralized health
systems such as the Philippines, a manual
for local health accounts estimation has
been developed and pilot tested.
Work on national health
accounts also progressed in China,
Mongolia, the Philippines and
Viet Nam. NHA development work also
aims to improve baseline data for the
health Þ nancing target indicators to
support the development of country-
speciÞ c target indicators and their
monitoring at country and regional levels.
Future directions
Universal coverage and access to good-
quality health services will remain the
guiding concept to improve population
health outcomes in the Western PaciÞ c
Region. The Health Financing Strategy
for the Asia PaciÞ c Region (2010–2015)
provides a medium-term perspective to
support universal coverage in different
socioeconomic settings.
Country-speciÞ c support will focus
primarily on those Member States with
low government spending on health, high
out-of-pocket expenditures and limited
safety nets for the poor and vulnerable.
In this regard, developing and Þ nancing
a basic package of essential health
services reß ecting a country’s public
health priorities would be an important
step to ensure access for the poor and
vulnerable. All these efforts are expected
to be carried out in collaboration with
other United Nations organizations and
development agencies.

Strategic issues
Despite economic growth and
expansion in the Western PaciÞ c Region
in recent decades, not all population
groups have beneÞ ted. As a result,
equity, gender and human rights issues
in health remain an area of continued
and increasing importance. Health gains
achieved over recent decades across the
Western PaciÞ c are unequally distributed
and have largely failed to reach the poor
and other marginalized groups. The
Region faces important challenges from
increasing inequalities in access to health
services and in health outcomes.
Weak or inefÞ cient health systems
continue to put the poor and other
socially excluded population groups at a
disadvantage.
Some progress has been made,
but more is needed. Health must be
recognized as central to development.
In addition, countries must ensure more
equitable access to health services for all
sections of the population and address
Þ nancial or social barriers to access,
including poverty, gender and ethnicity.
Action and results
The overall approach has been to build
awareness, skills and capacity through
WHO technical programmes in Member
States on poverty and equity, human
rights, and gender issues in health and
to develop, disseminate and promote the
use of tools and resources to support this
work.
SpeciÞ cally, support was extended
to China’s national TB programme on
poverty, equity and gender. In addition,
support was provided to the regional
malaria programme on ethnic minorities,
the Tobacco Free Initiative for gender
and tobacco, and the emerging disease
surveillance and response programme on
gender and emerging diseases. Further,
support for regional capacity-building
in equity, gender and human rights was
provided for health leaders.
Several publications and tools were
developed, disseminated and used
to support this work, including three
modules in the regional publication series
on integrating poverty and gender into
health programmes, nine country case
studies on promoting health equity in
the evidence-policy-action process, and
an assessment of compulsory treatment
of people who use drugs in four countries
through an application of selected human
rights principles. Web pages on equity,
social determinants, gender and human
rights have been created and are regularly
updated.
The evidence base for work in this area
was strengthened through initiation of
the development of country proÞ les on
gender, equity and human rights issues
in health, as a basis for subsequent
capacity-building and action planning.
In December 2009, China released
the report of its National Health Services
Survey (2008). The survey showed that
urban and low-income populations
underutilized health services and
concluded that there was a need to
improve health equity. It proposed several
policy recommendations to address these
equity-related Þ ndings.
An equity focus informs the Region’s
work in health systems strengthening
and primary health care, with a goal of
universal access to quality services for
improved health outcomes for all.