Asia Pacifics health trendsObesity, NCDs

and
ADBs Operational Plan for Health 2015-2020
Dr. Susann Roth, Senior Social Development Specialist
Disclaimer: The views expressed in this paper/presentation are the views of the
author and do not necessarily reflect the views or policies of the Asian Development
Bank (ADB), or its Board of Governors, or the governments they represent. ADB does
not guarantee the accuracy of the data included in this paper and accepts no
responsibility for any consequence of their use. Terminology used may not necessarily
be consistent with ADB official terms.

December 2015

Outline
1.Obesity and NCDs in Asia Pacific
2. Asia Pacifics health systems
3. ADBs support to DMCs- The Operational Plan for Health 2015-2020
4. ADB-ADBI collaborations for better evidence based policy making

Outline
1.Obesity and NCDs in Asia Pacific
2. Asia Pacifics health systems
3. ADBs support to DMCs- The Operational Plan for Health 2015-2020
4. ADB-ADBI collaborations for better evidence based policy making

1. Obesity and NCDs in Asia Pacific

How do you define overweight and obesity?
Body Mass Index (WHO)
a BMI greater than or equal to 25 is overweight
a BMI greater than or equal to 30 is obesity.

What are non-communicable diseases risk associated

to overweight and obesity?
Cardiovascular diseases (mainly heart disease and
stroke)
Diabetes
Musculoskeletal disorders (especially osteoarthritis)
Some cancers (endometrial, breast, and colon)

Asia and the Pacific is getting

fatter and older

Asia Pacifics populations diet is

carbohydrate and fat rich

Source: The Blueprint for Chance Program Novo Nordisk. 2013

Expected economic output loss for

Indonesia: $4.47 trillion lost due to NCDs

Source: Background paper for World Economic Forum. Economics of non-communicable

diseases in Indonesia. 2015

Diabetes incidence is increasing faster in

developing countries

Source: The Blueprint for Chance Program Novo Nordisk. 2013

Economic burden from NCDs in increasing

Example: Singapore is investing in

healthy nutrition
Intervention

Situation

High consumption of saturated

fat and sugar

Training of cooks of foot stalls

and restaurant use health oil
and less sugar

Investment

SGD 8M in saturated fat intake reduction program through grants

To cover the average costs of price differences between
the healthier and regular ingredient

Return of
Investment
> 1,1%

Result

23%reduction in coronary heart disease incidence

averting 1,860 unhealthy life years in 2020
Economic benefits of SGD 102M2

NCDs Increase health care costs

Epidemiological transition in Viet Nam (hospital cases)
Communicable diseases

Non-Communicable diseases

80
70
60

50
40

71.6
62.4

59.2
50
39

37.6
24.9

30
20

10

Injuries, poisoning

12.4

12.7

1996

2006

19.8
8.6

1.8

0
1986

National Insurance Agency Viet Nam

2010

Fighting NCDs: Sooner rather than later

Cost of

inaction

in developing countries globally:

US$ 1.7 trillion (2015)

1,700,000,000,000
170,000,000,000

Cost of

action

in developing countries
US$ 170 billion (2015)

Source: Interim Report of the WHO Working Group of Financing for NCDs

12

Fighting against NCDs is not expensive

Cost of

Prevention

inaction

annual costs per person

in developing countries:
US$ 1.7 trillion (2011-2015)

Less than
$0.40 - $1

Population risk factors

Tobacco use

Alcohol use

Obesity/
Diet/inactivity

Primary care
CVD & diabetes
Cancer

Source: Interim Report of the WHO Working Group of Financing for NCDs

Cost of

action

in developing countries
US$ 170 billion (2011-2015)

13

Low availability of essential NCD medicines

in low & middle income countries
Mean availability

Public sector

Private sector

NCD medicines
Antidepressants

Antihypertensives
Antidiabetics

Acute medicines

28% 45%
35%

57%
50%
56%

65%

67%

Higher priority still given to acute medicines

From Cameron et al. Bull World Health Organ 2011;89:412421.

Access to Insulin in Indonesia is low

Leading to expensive diabetes related complication

Source: The Blueprint for Chance Program Novo Nordisk. 2013

Population impoverished
purchasing essential NCD medicines
% of people living on less than $2 a day
BEFORE

AFTER

Pakistan

8%

12 - 21 %

4%

4%

13%

Indonesia

4%

6 - 20 %

2%

8%

5%

Philippines

21 %

28 - 32 %

8%

7%

11%

Uzbekistan

38 %

41 - 58 %
5%

3%

20%

From Niens et al. PLOS 2010; 7(8):e1000333

Preventing overweight and obesity is a

public health best buy

Outline
1.Obesity and NCDs in Asia Pacific
2. Asia Pacifics health systems
3. ADBs support to DMCs- The Operational Plan for Health 2015-2020
4. ADB-ADBI collaborations for better evidence based policy making

2. Asia Pacific Health Systems

Demand

Aging
Urbanization
NCDs

In-equitable
access to
quality health
care

Countries
commitment to
Universal Health
Coverage (SDG 3)
but reform process is
slow

Government commitment

Supply

Health spending grows faster than income

Source: HEALTH AT A GLANCE: ASIA/PACIFIC 2012 OECD 2012 (official WHO data)

Out-of pocket payments remains high

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%

Health expenditure,
public (% of total
health expenditure)
External resources for
health (% of total
expenditure on health)
Out-of-pocket health
expenditure (% of total
expenditure on health)

0%

21

LICs and MICs are aiming for UHC

Coverage and
quality low

Middle Income
Countries
Financial
Protection and
quality low
To do:
Purchase of
services from
private sector
Provide services
for poor and
vulnerable
Improve quality,
efficiency

To do:
Low Income Introduce essential packages for the poor and vulnerable
Countries Improve quality of essential care
Improve quality and quantity of health workforce

23

To ensure healthy lives and promote

wellbeing for all at all ages
Targets

3.1
3.2
3.3

Reduce maternal mortality

Reduce child and neonatal mortality
End epidemics of HIV, TB, malaria and NTD, and combat hepatitis, water-borne diseases and other
communicable diseases

3.4
3.5
3.6
3.7

Reduce mortality due to

and improve mental health
Strengthen prevention and treatment of substance abuse (narcotics, alcohol)
Reduce mortality due to road traffic injuries
Universal access to sexual and reproductive health-care services

3.8
3.9
3.a

Achieve
Reduce deaths and illness due to pollution and contamination
Strengthen implementation FCTC (tobacco)

3.b
3.c

Access to
and technologies
Increased health financing and health workforce in developing countries
Enhance capacity for early warning, risk reduction and management of national and global health
risks

NCD

universal health coverage

affordable essential medicines

Countries are implementing

Social Health Insurance
CHARACTERIZED BY

Quasi-Independent and
Protected (Pooled) Fund with
Autonomy
Split between Financing and
Provision
Funded by payroll taxes and
government revenues
Entitlements because of your
citizenship and not because of
your job (universality of
population coverage)

DRIVING

Strategic Health Purchasing for

Results, Outcomes and Outputs
Leveraging Payments to
ensure:

Enhanced Efficiency
Equity and Fairness
Quality of Care
Comprehensive Health Services
(primary care, medicines,
referral, hospital)

Harnessing the private sector

Empowerment of the insured
you do not owe the
provider a favor
25

Viet Nam

Latest amendment in Health Insurance

law in 2014 now calls for Universal Health
Insurance (UHI)

Poor (and other populations war

veterans, soldiers, widows) are subsidized
by the government

Under-six children ALL covered

Massive investments in supply side using

Health Bonds

(Explicit) premium subsidies for ALL

informal sector

Developing NCD insurance packages

26

Indonesia

In 2004, decided to have a single health

insurance fund
Survived legal challenges and finally
implemented of national health
insurance program (JKN) in 2014
All five health insurance funds pooled
into a single fund

Targets universal health insurance

coverage by 2019
Currently, 63% (151.5 million people)
are covered
Poor (individually determined by
provinces) are subsidized by the
government

Government and private providers are

contracted
ALL required NOT to charge copayments or to balance bill

27

Philippines

National Health Insurance enacted in

1995

PhilHealth (a government corporation)

was established to run the NHI with
policies set by its governing board

In 1997, two health funds were

consolidated into one fund. The third
fund (the overseas Filipino health
insurance fund) was incorporated in
2005

Poor are subsidized by the government

(increased subsidies by 2012/13 with sin
taxes earmarked to increase/sustain
the subsidies)

Government and private providers are

contracted

28

UHC Coverage is still very low in the region

Outline
1.Obesity and NCDs in Asia Pacific
2. Asia Pacifics health systems
3. ADBs support to DMCs- The Operational Plan for Health 2015-2020
4. ADB-ADBI collaborations for better evidence based policy making

3. ADBs Operational Plan for Health

Focusing and model building

Strengthen health systems for Universal Health

Coverage
1.Health infrastructure
2.Health governance
3.Health financing

Focus on 812 ADB DMCs

Build best practices, share knowledge,

evaluate impact

Innovative feature
Infrastructure investment to develop model
hospitals backed by strong ICT systems
Hospital and primary care network with
referral system
Financial autonomy of hospitals
Project link
MON - Fourth Health Sector Development
Project
Fourth Health Sector Development Project
(Additional Financing)
Fifth Health Sector Development Project
Impact
Improved quality of health services
Partnerships
WHO
The next big thing
Pooling of State and health insurance funds
Improving quality of care for disadvantaged
groups, introducing evidence based care and
standards

Innovative feature
Regional cooperation on public goods
Infrastructure projects integrate preventive
health activities (HIV)
Neighboring provinces establish cross-border
diseases surveillance, response to epidemics,
patients referrals.
Project/program link
GMS Communicable Diseases Control
Projects 1 + 2 (existing) in CAM, LAO and VIE
GMS Health Security Loan (in preparation for
2016) (MYA included)
Impact
Control of communicable diseases with epidemic
potential, malaria elimination.
Partnerships
WHO, Global Funds, IOM, International NGOs
The next big thing
Interconnected network of sentinel
laboratories for early warning
Health insurance portability between GMS
countries

Innovative feature
Innovation creation for service delivery
models and knowledge generation in urban
health integrated as Disbursement Linked
Indicators
First Result Based Loan in health
Project/program link

IND-Support for National Urban Health

Mission
(learning from BAN-Urban Primary Health
Care Services Delivery Project)
Impact
Better health for urban poor
Partnerships
The next big thing
Intersectoral convergence of urban health
Patient centric Health Information System
Management
Service delivery through performance based
PPP models

Innovative feature
Innovation creation for service delivery
models and knowledge generation in urban
health integrated as Disbursement Linked
Indicators
First Result Based Loan in health
Project/program link

PAK- Benazir Income Support Program

MON- Fourth Health Sector Development
Project (Additional Financing)
Impact
Improved health outcomes,
Sustainable financing
Partnerships
University of Seoul

The next big thing

ICT in health, big data analysis
Benchmarking of prices for services
Harnessing the private sector
Service delivery through performance based
PPP models

ADB is collaborating with

Centers of Excellence

Outline
1.Obesity and NCDs in Asia Pacific
2. Asia Pacifics health systems
3. ADBs support to DMCs- The Operational Plan for Health 2015-2020
4. ADB-ADBI collaborations for better evidence based policy making

4. ADB-ADBI collaboration
Urban Health
Analyzing the impact of
housing on health

?
NCDs
Economic impact of
NCD risk factors such as
Obesity

NCD prevention
Developing the economic
argument for investing in disease
prevention

38

For more information

Dr. Susann Roth sroth@adb.org

LinkedIn: https://ph.linkedin.com/pub/susann-dr-roth/15/29a/940
Twitter: https://twitter.com/adb_susannr
Blog: http://blogs.adb.org/author/health-team
Health Sector Website: http://www.adb.org/sectors/health/main

Knowledge Product pipeline

Opportunities for knowledge collaboration

ADBs working paper series 2015-2016

Pharmaceutical policy/regulatory convergence for better access
to malaria and other communicable diseases treatments
Unique identifiers for malaria elimination, links to civil registration
and vital statistics and UHC, with reference to in-country landscape
analyses
From malaria surveillance to sustainable e-health architecture
Interoperability lab for better HMIS
Malaria surveillance in the GMS
Urban Health in Asia and the Pacific
Social Health Insurance- From Design to Implementation
The Business Case of investing in NCD Prevention
Health Public Private Partnership in Asia and the Pacific
The UHC Dashboard- Why measuring UHC matters