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.
| Project Name | Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity | ||||||||||
| Project Number | 41252-012 | ||||||||||
| Country | Regional |
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| Project Status | Closed | ||||||||||
| Project Type / Modality of Assistance | Technical Assistance |
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| Source of Funding / Amount |
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| Strategic Agendas | Regional integration |
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| Drivers of Change | Gender Equity and Mainstreaming Governance and capacity development Partnerships |
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| Sector / Subsector | Health / Health insurance and subsidized health programs |
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| 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 |
| 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 | Regional and Sustainable Development Department |
| Responsible ADB Division | Poverty Reduction, Social Development, & Governance Division, RSDD |
| Executing Agencies |
Asian Development Bank Ian Anderson [email protected] ADB PLCO OFFICE, 1 Margaret St Sydney Australia Asian Development Bank 6 ADB Avenue, Mandaluyong City 1550, Philippines |
| 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 | |||||
| 926,000.00 | 326,000.00 | 0.00 | 0.00 | 0.00 | 0.00 | 1,252,000.00 | 18 Dec 2008 | 562,357.07 |
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| Title | Document Type | Document Date |
|---|---|---|
| Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity | TA Completion Reports | Aug 2014 |
| Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity (Cofinanced by the Government of Australia) | Technical Assistance Reports | Nov 2008 |
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