Published: 14 December 2012
Abstract (provisional)
Background
There is increasing perception that countries cannot work in isolation to militate
against the threat of pandemic influenza. In the Greater Mekong Subregion (GMS) of
Asia, high socio-economic diversity and fertile conditions for the emergence and spread
of infectious diseases underscore the importance of transnational cooperation. Investigation
of healthcare resource distribution and inequalities can help determine the need for,
and inform decisions regarding, resource sharing and mobilisation.
Methods
We collected data on healthcare resources deemed important for responding to pandemic
influenza through surveys of hospitals and district health offices across four countries
of the GMS (Cambodia, Lao PDR, Thailand, Vietnam). Focusing on four key resource types
(oseltamivir, hospital beds, ventilators, and health workers), we mapped and analysed
resource distributions at province level to identify relative shortages, mismatches,
and clustering of resources. We analysed inequalities in resource distribution using
the Gini coefficient and Theil index.
Results
Three quarters of the Cambodian population and two thirds of Laotian population live
in relatively underserved provinces (those with resource densities in the lowest quintile
across the region) in relation to health workers, ventilators, and hospital beds.
More than a quarter of the Thai population is relatively underserved for health workers
and oseltamivir. Approximately one fifth of the Vietnamese population is underserved
for beds and ventilators. All Cambodia provinces are underserved for at least one
resource. In Lao PDR, 11 percent of the population is underserved by all four resource
items. Of the four resources, ventilators and oseltamivir were most unequally distributed.
Cambodia generally showed the higher inequalities in resource distribution compared
to other countries. Decomposition of the Theil index suggests that inequalities result
principally from differences within, rather than between, countries.
Conclusions
There is considerable heterogeneity in healthcare resource distribution within and
across countries of the GMS. Most inequalities result from within countries. Given
the inequalities, mismatches and clustering of resources observed here, resource sharing
and mobilization in a pandemic scenario could be crucial for more effective and equitable
use of the resources that are available in the GMS.
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