Abstract
BackgroundThere 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.MethodsWe 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.ResultsThree quarters of the Cambodian population and two thirds of the 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 Cambodian 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 higher levels of 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.ConclusionsThere 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.
Highlights
There is increasing perception that countries cannot work in isolation to militate against the threat of pandemic influenza
The Southeast Asia region plays a key role in the global circulation and long-term evolution of influenza viruses [1], and is considered likely to be at the epicentre for the emergence of a novel influenza strain with pandemic potential [2]
Data analysis For this comparative analysis we focus on four key health system resources: antiviral drugs, hospital beds, mechanical ventilators and healthcare workers
Summary
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. There is an increasing perception that countries cannot work in isolation to protect themselves from emerging pathogens and that international cooperation is essential [4,6,7,8,9,10,11]. At the forefront of cooperative activities, the Mekong Basin Disease Surveillance (MBDS) network has been facilitating cooperation in surveillance and control efforts across the land borders of countries in the Greater Mekong Subregion (GMS; Cambodia, Lao PDR, Myanmar, Thailand, Vietnam, and Yunnan and Guangxi provinces of China) for more than a decade [2,12]
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