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Public sector priorities impact reproductive health outcomes.

Public or government spending on health is very important especially for people who can barely meet their survival needs. Public spending on health is one indicator of the priority that it gives to the health needs of the people. The best performer in the group (see table) in terms of female life expectancy and maternal mortality rates is Malaysia (74.7 per 100,000 and 41 per cent). Yet public spending on health as a percentage of total government budget is only 6.5 per cent.

Compare this to the Philippines whose maternal mortality rate is high (200 per 100,000), yet its public spending on health as a percentage of the total government budget is nearly the same as Malaysia. Public spending on health as a percentage of total government expenditure annually in Malaysia (6.5 per cent) is lower than that of Thailand (11.6 per cent), yet the former has better maternal mortality and female life expectancy rates. The maternal mortality rate in Sri Lanka is the third lowest in the group at 92 per 100,000. Yet, Sri Lanka and the Philippines are comparable in relation to social and health indicators of government priority for health and poverty rates,

To understand these intriguing statistics, a holistic analysis of the overall policies, especially of social policies is needed. Malaysia, in prioritising education and income inequity-reducing strategies, has seen poverty levels drop from a high of almost 50 per cent in the 1970s to 15 per cent (1997). In the past, China, Vietnam and Sri Lanka used to follow strong welfare-oriented social policies. Priority was given to primary healthcare and service delivery. Health services were almost totally subsidised by the State and education for women was accorded high priority. Since the 1980s, China and Vietnam have shifted to more market-oriented policies. Even Sri Lanka which was held as a beacon for developing countries to follow, is seeing evidence of deterioration in women's health status. (Partly driven by an economic crunch, since the mid-90s, the Sri Lankan government reduced government subsidies to health, especially in the area of mobile service delivery. User fees too have been introduced.) In order to explain the current moderate to low rates of maternal mortality, it is important to acknowledge that some of the gains of the welfare-oriented period could still be seen up to now in these three countries.

This analysis does not suggest that there are no problems for women's reproductive health in good performing countries for indeed there are. What the analysis suggests is that government health expenditures alone, while crucial, should not be examined in isolation from any government's overall social agenda. More importantly, in advocating for women's reproductive health, attention should also be given to non-health policies because these can either lead to improvement or deterioration in women's overall health status.
Selected Social and Health Indicators in Asian Countries

 Health spending
 Female life Maternal mortality as % of total
 expectancy (per 100,000 Public
 at birth live births, expenditure
Countries (year 2000) year 2000) *** (year 2001)

China 72.7 43.2 10.2
India 62.0 440 3.1
Indonesia 67.9 307 3.0
Malaysia 74.7 30 6.5
Philippines 71.7 172 6.2
Sri Lanka 74.3 92 6.1
Thailand 72.1 44 11.6
Vietnam 72.2 130 6.1

 Public health
 spending % of
 as % of population
 overall health living below
 expenditure poverty line
Countries (year 2001) (1987-97) **

China 37.2 17
India 17.9 35
Indonesia 25.1 15.1
Malaysia 53.7 15.5
Philippines 45.2 37.5
Sri Lanka 48.9 35.3
Thailand 57.1 13.1
Vietnam 28.5 50.9

Source: wHO. 2004. World Health Report Geneva: WHO

** Available at
presskit/hpi-/.pdf (accessed July 13, 2004)

*** ARROW. 2004. Monitoring ICPD Ten Years On. [unpublished]

* By Fatima Alvarez-Castillo, a Member of the Coordinating Team of the Initiative for Sexual and Reproductive Rights in Health Reforms. Bioethics-Programme, Benton Hall, University of the Philippines, Diliman, Quezon City, Philippines. Tel: 63 24269590 Email:
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Title Annotation:Factfile
Author:Alvarez-Castillo, Fatima
Publication:Arrows For Change
Geographic Code:90ASI
Date:May 1, 2004
Previous Article:Private health insurance.
Next Article:Understanding men's responsibilities in addressing gender inequality.

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