Regional: Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity

Sovereign Project | 41252-012

Summary

Health is a development issue. Health is central to development. For individuals, poor health undermines education and income opportunities. Ill health means loss of income and higher costs, further impoverishing poor people and increasing inequity. Indeed, after illiteracy and unemployment, health costs are the most important precursor to poverty. Health is a critical development issue at the national level too. Thirty to fifty per cent of Asia's economic growth between 1965 and 1990 can be attributed to favourable demographic and health changes. USAID estimates that maternal and newborn morality accounts for $15 billion in lost potential production globally every year. Not surprisingly, three of the seven MDGs explicitly target health , and those three interact with MDG 1 (poverty reduction). The high level of Out Of Pocket Expenditure (OOPE) adversely affects poverty, inequity and access. Several studies have found that health shocks and especially the high level of OOPE, increases poverty.

Latest Project Documents


Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.

The Public Communications Policy (PCP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.

The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.

In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

Project Name Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity
Project Number 41252-012
Country Regional
Project Status Closed
Project Type / Modality of Assistance Technical Assistance
Source of Funding / Amount
TA 6515-REG: Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity
Technical Assistance Special Fund US$ 300,000.00
Strategic Agendas Inclusive economic growth
Drivers of Change Governance and capacity development
Partnerships
Sector / Subsector Health - Health insurance and subsidized health programs
Gender Equity and Mainstreaming Gender equity
Description Health is a development issue. Health is central to development. For individuals, poor health undermines education and income opportunities. Ill health means loss of income and higher costs, further impoverishing poor people and increasing inequity. Indeed, after illiteracy and unemployment, health costs are the most important precursor to poverty. Health is a critical development issue at the national level too. Thirty to fifty per cent of Asia's economic growth between 1965 and 1990 can be attributed to favourable demographic and health changes. USAID estimates that maternal and newborn morality accounts for $15 billion in lost potential production globally every year. Not surprisingly, three of the seven MDGs explicitly target health , and those three interact with MDG 1 (poverty reduction). The high level of Out Of Pocket Expenditure (OOPE) adversely affects poverty, inequity and access. Several studies have found that health shocks and especially the high level of OOPE, increases poverty. EQUITAP studied 11 countries in Asia and found that 78 million people fell below the $1.08 poverty line as a result of health payments. ADB analysis finds that nearly 40 million people in India were below the poverty line as a result of health payments. Others estimate that nearly one quarter of people admitted to hospitals in India were above the poverty line when they were admitted but were below it by the end of their stay because of health expenditures they incurred. Studies also show that high OOPE is also associated with catastrophic expenditures that clearly impoverish people. In sum, high rates of OOPE so common in this region are regressive, can increase poverty, exacerbate inequity, increase household debt, and discourage access to essential health care. This is especially true for MNCH. The adverse effects of OOPE are particularly significant when it comes to maternal, newborn and child care (MNCH) because such medical expenses can be large, sudden and unexpected. Borghi shows that in Bangladesh the total cost of health care during pregnancy, delivery and postpartum period amounted to an average 15% of annual income for those women delivering at home rising to 35% in a basic obstetric facility, and to 452% of annual income for delivery in a public comprehensive obstetric facility. Even a relatively small payment can mean financial catastrophe to a poor person or household, forcing them to reduce other basic expenses such as food, shelter, or their children's education. Most recent analysis by ADB finds that maternal health care expenditure was catastrophic (exceeding more than 40% of capacity to pay) for virtually all households from the poorest decile in India. More broadly, it is becoming increasingly apparent that MDG outcomes for MNCH can be achieved at the national level for several DMCs in Asia such as Vietnam and the Philippines, but with little or no progress for the poorest quintile, thereby exacerbating inequity. It is also increasingly being recognized that reducing maternal mortality is likely to have This is especially true for MNCH. The adverse effects of OOPE are particularly significant when it comes to maternal, newborn and child care (MNCH) because such medical expenses can be large, sudden and unexpected. Borghi shows that in Bangladesh the total cost of health care during pregnancy, delivery and postpartum period amounted to an average 15% of annual income for those women delivering at home rising to 35% in a basic obstetric facility, and to 452% of annual income for delivery in a public comprehensive obstetric facility. Even a relatively small payment can mean financial catastrophe to a poor person or household, forcing them to reduce other basic expenses such as food, shelter, or their children's education. Most recent analysis by ADB finds that maternal health care expenditure was catastrophic (exceeding more than 40% of c
Project Rationale and Linkage to Country/Regional Strategy Virtually all Country, and Regional, Strategies refer to the importance of social inclusion, gender, and the Millennium Development Goals (MDGs) including MDG 4 and 5 aimed at reducing child and maternal mortality. This RETA will provide new knowledge and insights to those issues.
Impact A better and more reliable basis for policy making and resource allocation decisions, including measures to protect the poor, of both DMCs and their development partners when considering OOPE and MNCH
Project Outcome
Description of Outcome Increased recognition and evidence-based understanding by DMCs and development partners of the interactions between OOPE, MNCH, and impoverishment
Progress Toward Outcome
Implementation Progress
Description of Project Outputs

Report on the extent and quality of existing data sets as a basis for understanding how OOPE on MNCH interacts with inequity and impoverishment

Workshop to determine which countries are then priorities for more detailed analysis in phase 2

Detailed, more focused study based on workshop cited in output 2, analyzing in more depth the policy implications for a smaller number of highpriority countries

Status of Implementation Progress (Outputs, Activities, and Issues)
Geographical Location Regional, involving countries in both Asia and the Pacific
Summary of Environmental and Social Aspects
Environmental Aspects
Involuntary Resettlement
Indigenous Peoples
Stakeholder Communication, Participation, and Consultation
During Project Design
During Project Implementation
Business Opportunities
Consulting Services Consulting Services yet to be determined.
Responsible ADB Officer Patricia Moser
Responsible ADB Department SDCC
Responsible ADB Division Poverty Reduction, Gender and Social Development Div., RSDD
Executing Agencies
Asian Development Bank Ian Andersonianderson@adb.orgADB PLCO OFFICE, 1 Margaret St Sydney Australia
Timetable
Concept Clearance 09 Mar 2008
Fact Finding 10 Mar 2008 to 24 Mar 2008
MRM -
Approval 18 Dec 2008
Last Review Mission -
PDS Creation Date 30 Jan 2009
Last PDS Update 16 Oct 2009

TA 6515-REG

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
18 Dec 2008 - 18 Dec 2008 31 Mar 2010 31 Aug 2013 -
Financing Plan/TA Utilization Cumulative Disbursements
ADB Cofinancing Counterpart Total Date Amount
Gov Beneficiaries Project Sponsor Others
300,000.00 0.00 0.00 0.00 0.00 0.00 300,000.00 18 Dec 2008 562,357.07

Safeguard Documents

See also: Safeguards

No documents found.

Evaluation Documents

See also: Independent Evaluation

No documents found.


The Public Communications Policy (PCP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.

Requests for information may also be directed to the InfoUnit.