Results: Ongoing Progress in Health, Nutrition and Population in East Asia and Pacific

Countries in the East Asia and Pacific region have achieved impressive progress on health, nutrition and population with the support from the World Bank. Recent examples include the following:

  Cambodia
  China
  Indonesia
  Lao PDR
  Papua New Guinea
  Philippines
  Timor-Leste
  Vietnam

Cambodia

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Establishing New Partnerships to Combat Tuberculosis (TB)  – The Tuberculosis Control Project, launched in 2002, is a joint effort by the United Kingdom Department for International Development, the World Bank, the World Health Organization, and the Government of China.  The project reached 50 percent of China’s population and provided free examination to over 9 million suspected cases, while diagnosing and treating over 2 million (including free treatment to 1.5 million infectious patients). There was a 35 percent reduction in prevalence in the project areas, as compared to a 3 percent reduction in other areas.  Furthermore, the average number of cases detected among the population was quadrupled and the cure rate more than doubled for an overall reduction in TB deaths of 50 percent.

Supporting Disease Prevention and Immunization Services – The Seventh Health Project has coordinated various programs to prevent and control vaccine-preventable diseases to reduce morbidity, disability and mortality, especially in the poorest provinces of China. During the project period, all ten provinces have significantly improved the quality and coverage of childhood immunization. All provinces reported over 95 percent coverage of the basic four vaccinations. Starting from a very insignificant base for hepatitis B vaccination, five programs have reported over 90 percent coverage and three others reported over 75 percent coverage.

Fighting HIV/AIDS – A crucial portion of the implementation activities of the Ninth Health Project is dedicated to the prevention and control of the HIV/AIDS epidemic as well as the promotion of safe blood practices. During the initial phase, the provinces have introduced pilot projects and demonstrated that it is possible to implement difficult prevention programs such as condom provision and counseling to sexworkers, needle and syringe exchange among injecting drug users. On the other hand, the Blood Management component of the project helped build a voluntary blood donation system in a short period of time. The percentage of voluntary donations has increased from 1997 to 2003, in Fujian from 10.7 to 86 percent; in Guangxi from 8.2 to 84 percent; and in Xinjiang from 14 to 71 percent. In all provinces, the rate of repeat donors has increased. Fujian is reporting 16 percent overall, but some of the project prefectures have reported much higher rates such as 30 percent for Longyan prefecture, Fuijian.

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Reducing Iodine Deficiency – Considering the country as a whole, the percentage of households using quality iodized salt at household level increased from 39.9 percent in 1995 to 88.9 percent in 1999. This was part of the World Bank financed Iodine Deficiency Disorders Control Project. Measures of goiter and low urinary iodine in school children also declined dramatically in the same period. The project helped enhance physical capacity building as well. At the end of the project in 2002, in fact, numerous capacities for salt production, iodization and packaging were successfully installed and significant technology transfers for production of retail packaging machines were effectively performed.

Improving Maternal and Child Health –   The goal of the Comprehensive Maternal and Child Health Project project was to reduce maternal and child mortality in the poorest regions of China. It covered 282 counties and benefited an estimated 100 million people.

On an institutional level, the project led to increasing collaboration between national and provincial research and training institutions, and the project’s establishment of norms and identification and support for clinical training bases will allow provinces and counties to address emerging development issues. The project has also strengthened the three-tiered maternal healthcare network as well as established standardized clinical protocols for care. The project has laid the foundation, provided the programmatic experience and accumulated the technical data essential in addressing the social and economic issues of poverty and maternal healthcare in China.

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Indonesia

Promoting Safe Motherhood Practices: A Partnership and Family Approach  – The Safe Motherhood Initiatives Project assisted the Government of Indonesia in improving maternal health status in selected districts. As a result, the percent of pregnant women in these districts who received antenatal care increased and so did the percent of complicated deliveries referred to hospitals. Related analytic work helped to illuminate the major causes of maternal mortality in Indonesia as well as to propose remediable action that can be implemented in a fairly cost-effective manner. For example, since many of the deaths occurred in the home under in the presence of a traditional birth attendant, the proper training of community-based providers in essential emergency obstetric care is a low cost intervention that should have a significant impact on lives saved.

Reducing Iodine Deficiency – The percent of households consuming fully iodized salt increased from 58 percent to 73percent between 1996 and 2003. This was part of the Bank´s Intensified Iodine Deficiency Control Project. In this same period, Indonesia witnessed a 35 percent decline in the total goiter rate in severely and moderately endemic areas, as well as actively trained hundreds of small scale salt producers in salt iodization methods.

Building Human Resources – The Sister School Program, part of the Fifth Health Project in the provinces of Central Kalimantan, Central Java, and South Sulawesi, has improved the quality of teaching and enhanced student learning at health polytechnic schools, which train women in midwifery and nursing skills. These gains were accomplished through the skill enhancement of school staff, the reformation of school curriculum and teaching methods, and upgrades to laboratories and other school equipment.

Supporting Decentralization  – Bank financed projects in nine provinces throughout Indonesia have established an innovative framework for improving the capacity of district health sectors to manage the ongoing process of decentralization. These gains include the establishment of province-wide joint health councils, driven by the voluntary participation of districts, which coordinate and harmonize district health policies. In these councils, a forum of district leaders meets to discuss cross-district health issues. In order to support these discussions, province-wide technical review teams provide expert assistance to the joint health council in order to assist deliberations with necessary technical inputs.

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Lao PDR

Improving Health and Reducing Morbidity and Mortality Rates—The goal of the Health System Reform and Malaria Control Project was to improve the health of people in Lao PDR and to reduce morbidity and mortality rates in certain areas.  The projected targeted several key areas such as improving the quality of basic health care for children and women though health system reform; strengthening malaria control programs; improving health awareness and health behavior by strengthening the Ministry of Health (MOH) Institute of Health Education; and building the capacity of the MOH and other health systems to implement project activities. 

The project had significantly positive results. The Infant Mortality Rate fell from 106 per 1,000 live births in 1990 to 83 in 2000. In 2000, family planning usage was 32.2 percent, an increase over previously low levels. The Maternal Mortality Rate was 530 per 100,000 in 2000, as compared to 656 per 100,000 in 1995. The malaria mortality rate fell dramatically from 22.2 per 100,000 in 1996 to just 3.1 per 100,000 in 2003. Finally, overall knowledge about the causes of malaria increased and access to basic health care was improved in selected districts.

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Papua New Guinea

Population and Family Planning—The Population and Family Planning Project aimed to assist the government of Papua New Guinea implement their population policy, centered around balancing the rate of population growth with the country’s growth.

The government succeeded in implementing a population policy and increased its overall capacity to address family planning and emerging health issues. A total of 71 health facilities were constructed, 20 percent more than the original number envisaged. Community health and maternal health services were provided to 12 provinces—double the 6 provinces originally planned. The facilities showed good community utilization and staff knowledge of modern contraceptive methods rose from 23 percent in the beginning of the project (1993) to almost 100 percent by the end of the project (2002).

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Philippines

Promoting Women's Health and Safe Motherhood – The Women's Health and Safe MotherhooProject's main objective was to improve the health status of women, with particular focus on women of reproductive age, and thereby support the Government's long-term goals of reducing fertility, female morbidity and maternal mortality. Data from the Benefit Monitoring and Evaluation study show that awareness of delivery care services increased substantially (from 69 to 82 percent). Service data in project barangays showed increases in utilization between 1996 and 2001 for all key services - prenatal visits, postpartum care, iron, Vitamin A and iodine supplementation, use of family planning methods - except for voluntary female sterilization, which showed a disturbing decline during the period. Rates of increase ranged from 14 percent for postpartum visits to 302 percent for iodine supplementation.To address the high levels of cervical cancer, the project worked with the Department of Health to develop a more acceptable and less expensive alternative cervical cancer screening method.

Aiding Early Childhood Development – The Early Childhood Development Project aims to build on and improve essential services for children 0-6 years. 105 municipalities and cities are included and the project involves the Department of Health, Department of Social Welfare and Development, and the Department of Education.

The project’s most significant achievement is the impact it has had in learning associated with the delivery of early childhood development programs. A number of new interventions tested under the program, including the 8-week early childhood education curriculum, improving parent effectiveness, and micro-nutrient food fortification have already been mainstreamed by the implementing agencies. In addition, lessons from several research studies have already been incorporated into the Government’s ECCD program.  These include: weekly iron supplementation of school children, adoption of the school readiness tool, use of revised ECCD Checklist as a developmental assessment tool for 0-6 year old children, revised guidelines on Food Supplementation and a resource book on establishing and localizing the ECCD System based on the experiences and lessons learned.

A study conducted points to significant positive impacts of the Early Childhood Development project in several dimensions, especially with respect to indicators related to the feeding programs, PES, and availability of day-care mothers.  These positive impacts can be largely attributed to greater service availability. The project has also greatly helped to increase awareness on early childhood development issues and programs. It has heightened recognition of the rights of the child both at the national and local levels, as seen in the 2005 launch of the Bright Child campaign by the President. 

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Timor-Leste

Assisting the Reconstruction of the Healthcare System   – The Health Sector Rehabilitation and Development Project was financed by the multi-donor Trust Fund for East Timor with the International Development Association as Trustee. The project focused on facilitating access to basic healthcare services after the conflict; and building the foundations for the development of health policies and systems for the medium term.

The project succeeded in meeting immediate health needs, as evidenced by the increase of vaccination coverage rates to 85 percent of children under 5, increased health facility utilization to 2.13 outpatient visits per capita in 2004 from .75 in 2000, and improved access to health facilities (90 percent of the population has a facility within a two-hour walking distance). The project also strengthened the government’s capacity to support a health system and fostered a strong Timorese ownership of a health policy framework. A total of 28 health centers were built and 36 health posts renovated and communication between health centers improved through the distribution of additional radios and vehicles. To aid in the future of Timor-Leste’s health administration and education, fourteen Timorese medical students were given scholarships for health study and seminars held on such issues as reproductive health.

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Vietnam

Facilitating Population and Family Health Initiatives  – The Population and Family Health Project sought to assist the Government facilitate economic growth and poverty alleviation, by reducing the rate of population growth and improving the health of women and children.  Between 1997 and 2002 (during the life of the project), key demographic indicators improved. The total fertility Rate fell from 2.67 to 1.87 and the infant mortality rate fell as well. The proportion of children fully immunized during their first year of life rose from 50.4 to 58.1 percent. Care at delivery improved significantly: the proportion of births taking place in a health facility rose from 62 percent to nearly 79 percent. Antenatal care improved significantly, with the percentage of women reporting receiving antenatal services rising from 71 to 87 percent. The source of service improved substantially, with the percentage of women reporting seeing a doctor for antenatal care rising from 25 to 46 percent.

Improving the Health of the Rural Population – The National Health Support Project aims to provide high quality primary health care to 15 of the poorest provinces; reduce the rates of mortality and morbidity, as well as the socio-economic impact of malaria, tuberculosis and acute respiratory infections; strengthen the capacity of the ministry of health in health systems management, policy-formulation and planning. The project is ongoing, but has already made significant strides in achieving its goals. So far, the project has built and upgraded 15 health and family planning centers, 137 obstetric and operating rooms, 2,606 communal health centers, and 60 mountainous health posts. Training courses for more than 22,000 medical workers have also been organized and support for the malarial control program has resulted in significant reductions in infection levels.

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