Financing Health Promotion in South East Asia - Does it Match with Current and Future Challenges?

Abstract

Objectives: There is an increasing policy concern over the growing trend of burden of diseases from non-communicable diseases (NCD) around the globe. In response to a call for increase investment in and explore potential role of innovative financing mechanism for health promotion and disease prevention, this multi-country study in South-East Asia Region reviews trend of burden of disease (BOD), expenditure on health promotion, innovative financing experiences, and views of policy stakeholders on innovative financing through a self-administrative questionnaire survey. Methods: Literature review on burden of disease (BOD), financing health care in general and financing health promotion in particular, and expereinces in innovative health care finance, in five selected countreis (India, Indonesia, Nepal, Sri Lanka, and Thailand). A self administered questionnaire survey on policy maker's and key stakeholder's views on health care financing, innovative financing for health promotion were conducted in five selected countries. In-depth interviews with key stakeholders were carried out in some countries. Results: The profile of burden of disease (BOD) indicates advanced stage of epidemiological transition in Sri Lanka, Thailand, and Indonesia towards NCD, whereas Nepal and India are facing dual burden from infectious disease and NCD. National Health Account (NHA) is not well established and maintained in South East Asia Region to reflect level and profile of health expenditure. Limited data indicate very small amount spent on health promotion, mostly on conventional clinical based preventive and health promotion services, rather than social mobilization and reduction of primary risk factors, notably tobacco and alcohol consumption, fatty diets, and sedentary life styles. It is questionable whether the current level and effectiveness of public spending on health promotion can effectively halt the trend of BOD from NCD. Among five selected countries, only Nepal and Thailand have innovative financing from sin tax and from tobacco and alcohol earmarked tax to health. Nepal Health Tax Fund is orientated toward treatment of cancers, while Thai Health Promotion Foundation focuses more on social mobilization and strong campaign against tobacco and alcohol consumption, and healthy lifestyles. Results from the questionnaire survey of policy makers and key stakeholders indicate serious under-funding for health and especially health promotion. In view of current burden from chronic NCD, the government should spend more than double or triple of the current spending level on health promotion. A consensus view emerged in favour of the potential role of earmarked tax from alcohol and tobacco, as most desirable and most feasible sources, across four countries lay a foundation for innovative financing health promotion in these countries. Conclusions: Current level and effectiveness of spending on health promotion in these countries are far from the reality to halt the trend of chronic NCD. Innovative financing for health promotion is one of several policy choices to mobilize additional resources. Policy maker's views consistently confirm the under funding of health and health promotion which requires a significant increase in the current level of spending. A consensus view from policy makers and key stakeholders emerges that earmark tax from alcohol and tobacco is highly desirable and feasible source for health promotion. Policy recommendations: In view of resource constraints, it is recommended to increase value for money of the current health promotion program by addressing primary reduction of risk factors. Mobilize more resources from hazardous products such as tobacco and alcohol is recommended. This movement towards additional resource and efficient spending requires strong political leadership and commitments by countries in this region.