Health in Asia and the Pacific: Your Questions Answered
Patrick Osewe, Chief of ADB’s Health Sector Group, discusses health challenges and how ADB is helping through financing and knowledge sharing.
Contents
What lessons can be learnt from ADB’s response to the COVID-19 pandemic in Asia and the Pacific?
The pandemic exposed critical shortcomings in public health and care systems related to historic underinvestment in many DMCs. An important lesson is that ADB has the capability and resources to respond swiftly and at scale to public health emergencies. ADB’s COVID-19 pandemic response and its Asia Pacific Vaccine Access Facility (APVAX) were critical in saving lives, restoring economies, and boosting confidence in health systems.
A second key lesson is the effectiveness of combining extensive technical assistance with financing operations. This allowed DMCs to rapidly access critical goods and knowledge to help them invest immediately in key public health, even as substantial loan and grant resources were mobilized. In addition, ADB was able to capitalize on partnerships with World Health Organization, UNICEF, and others. These enhanced the effectiveness of APVAX, such as through Gavi and the COVAX initiative.
Important here also, is that ADB was also able to fully leverage private sector, NGO, and consultant expertise to respond effectively to the crisis. A related lesson is the need for stronger regional health institutions, something ADB continues to make progress on, given its existing links with regional networks.
COVID-19 has stunted growth and returned millions to poverty, so what’s ADB’s strategy in the Philippines for reducing the region’s vulnerability to future pandemics?
The Philippines was one of several DMCs to access substantial financing under ADB’s APVAX projects, mobilizing a total of $1,225 million, including $550 million in cofinancing from the Asian Infrastructure Investment Bank, towards the procurement of life saving COVID-19 vaccines. The Philippines government mobilized financing of $113 million for the vaccination program in conjunction with the APVAX projects. By end of June 2022, the Philippines had hit its target of 71% of the population aged 5 or over fully vaccinated, a critical milestone for safe reopening of the economy.
ADB and the government continue to strengthen the health system. In 2021 ADB signed a $600 million loan to improve essential health services. A sustained recovery from the pandemic will be multisectoral. As such, ADB’s other projects, including a $500 million loan for disaster resilience, and a grant for a new public health laboratory capacity ($3 million in San Fernando), are also relevant. ADB will continue to focus on infrastructure, local economic development, and social investment to enhance economic and social resilience.
The region’s health needs are so great and ADB’s resources so limited, how do you prioritize your health-related project work across Asia and the Pacific?
The response to the COVID-19 pandemic shows that ADB can mobilize significant resources. ADB’s resources are not limited at source – usage is demand driven. Of the $9 billion allocated for APVAX from ADB’s own financing, 47% has been accessed as of November 2022, and the rest still remains available. ADB is aware the needs of its DMCs keep evolving due to demographic and epidemiological shifts, climate change, and other factors.
ADB works to align its resources, including concessional financing and technical assistance, with emerging trends and priorities. In addition, the bank is engaged in knowledge creation to better respond to the changing needs of its DMCs. As such, ADB will remain responsive to the demands of its DMCs as they strive to improve their health systems to become more resilient, adaptive, and efficient.
What role can the private sector be playing in extending quality healthcare, particularly to the poorest, in ADB’s developing member countries?
Much of the healthcare in Asia and the Pacific, especially in urban areas, is delivered by the private sector. The private sector is also an important investor in pharmaceuticals, supply chains, and administrative and information systems. The challenges are to encourage the private sector to build capacity in underserved areas where profitability is less certain, and to ensure the affordability of services. ADB is working with the private sector to invest in hospital services and increase delivery in rural and underserved areas. As a significant investor, ADB works with private actors to adopt gender and socioeconomic equity when investing.
ADB is also promoting public-private partnerships that can help investments in new hospitals, specialized care, and healthcare training. In addition, ADB supports healthcare reform, so as governments adopt new healthcare financing arrangements, affordable health services provided by the private are constantly emerging. ADB supports some pharmaceutical manufacturing to increase the availability and affordability of life-saving medicines.
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Affordable, high-quality health services need to be widely available to ensure no one is impoverished by paying for medical care.
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Government health spending across the lifecycle is a good investment with major social and economic returns.
How is Asia and the Pacific's changing age demographic impacting on ADB’s health related project work?
Some of ADB’s DMCs face rapid population aging, while in others, there is a “youth bulge”, which requires investment to capitalize on this demographic dividend. Where societies are aging, there may be a reduction in ADB investment in primary care and maternal health, and more resources allocated for specialized care and healthy aging. Aging societies may move towards more integrated approaches to welfare, including unifying health provision with social protection and urban development.
In relatively young societies in the Pacific, South Asia and Central Asia, ADB will work with governments to ensure the health system provides quality, affordable primary care and maternity services to all citizens, while offering excellent referral for specialized care. Across all demographic shifts, there is a need for enhanced investment in health promotion and prevention to reduce risk factors throughout the course of people’s lives.
Is Asia and the Pacific on track to reach its health-related Sustainable Development Goals by 2030?
The COVID-19 pandemic slowed progress in meeting health-related Sustainable Development Goal (SDG) 3 targets. The pandemic severely disrupted health systems and essential health services and derailed progress in raising service coverage for HIV, tuberculosis, and malaria. Millions of children missed their basic vaccinations in 2020-2021. In some DMCs, progress in reducing maternal, under-5 and neo-natal mortality (all SDG 3 target indicators) and controlling neglected tropical diseases has slowed.
The pandemic also took a heavy toll on health and care workers. As a result, technologies which offered labor-saving and efficiency gains, such as telehealth and telemedicine, rapidly spread. With resumed progress, technological change, and renewed fiscal commitment toward universal health coverage in the region, it is possible that substantial progress towards SDG 3 targets will still be made in the region.
How has digitalization and big data impacted on the provision of healthcare in Asia and the Pacific?
Digital solutions help improve manage patient care, the collection of data for decision making, and track progress toward universal health coverage. The trend towards digitalization was already present before the pandemic. Due to necessity during the pandemic though, there was a substantial increase in telehealth and telemedicine delivered via digital platforms. There was also a boost in healthcare payments via mobile apps.
The pandemic saw digital innovation in the rollout of national vaccination programs, such as India’s CoWIN platform. Government agencies also introduced new tools such as digital COVID war rooms, dashboards, and mobile public health apps.
Alongside this rapid adoption of digital technology, new analytical approaches were needed to manage the increased flow of data, and to create information useful for policymaking. ADB supports these changes, as they help deliver health services more efficiently and effectively. ADB is working in India supporting the National Urban Health Mission and in Tonga with the Introducing eGovernment through Digital Health project, as well as others.
What are the three most cost-effective ways of improving primary healthcare in developing Asia?
Primary healthcare is the foundation of universal health coverage. A key cost-effective way of improving primary healthcare is to recruit and retain a workforce with the right skills and in sufficient numbers, through appraisal, incentives, and training. Another important way is to promote community engagement and outreach with health promotion, in particular surveillance for infectious diseases and reduce risk factors for non-communicable diseases.
Thirdly, primary health care benefits enormously from the deployment of scalable, innovative and affordable digital technology in primary care facilities. This includes simplified electronic medical records built on existing health information systems, telehealth, telemedicine and digital diagnostic assistance.
