Equity challenges in Indonesian health care

Progress towards health equity in Vietnam: evidence from nationwide official health statistics, 2010-2020

INTRODUCTION

One of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the 'fast-track countries' to achieve the health-related Millennium Development Goals, but research on its equity strategies remains inadequate.

METHODS

Using Vietnamese official health statistics, we investigated inequity in four dimensions including health resources, service delivery, service utilisation and residents' health status from the perspectives of income levels, poverty rates and subnational regions. The Slope Index of Inequality, concentration curve/Concentration Index, absolute difference and Theil Index were used.

RESULTS

Four indicators showed 'pro-poor' inequality in health resources, including the per capita health budget, per capita health personnel, per capita health personnel at the community level and per capita hospital beds at the community level, while provincial hospital beds showed 'pro-rich' inequality. Two health service delivery indicators (delivery of antenatal care ≥3 times and proportion of community health service centres with medical doctors) show 'pro-rich' inequality, although two health status indicators, mortality and malnutrition rates for children under five, showed 'pro-poor' inequality. The Northern Midlands and Mountain Areas, and the Central Highlands were disadvantaged regarding service delivery and health status. Intraregional differences were the main factors contributing to the inequalities in delivery of antenatal care ≥3 times, provincial hospital beds and percentage of community health centres with medical doctors, with the Red River Delta and the South East region experiencing the greatest inequalities.

CONCLUSION

The overall level of health equity in Vietnam has increased over the past decade, although inequality in health service delivery has hindered progress towards health equity based on income, poverty and subnational regions. Targeted policies need to be introduced to reduce inequities relating to the health workforce and service delivery capacity.

Quasi-experimental study on the impact of local smoke-free policies on smoking among Indonesian adults: Evidence from repeated national health surveys

BACKGROUND

Smoke-free policies (SFPs) have been effective in reducing smoking prevalence, but evidence remains limited for low- and middle-income countries. Due to decentralized governance in Indonesia, SFPs are adopted in different ways in different locations. This study aims to assess the impact of local smoke-free policies (SFPs) on current smoking among Indonesian adults.

METHODS

Data from national health surveys conducted in 515 districts and 34 provinces in 2007, 2013, and 2018, involving 1,599,517 adults, were analyzed. A multilevel logistic regression analysis was performed, considering variables such as survey year, SFP adoption in 2007, SFP between 2007 and 2013, SFP between 2013 and 2018, socio-demographic factors, and district characteristics.

RESULTS

Moderate (OR:0.94, 95%CI:0.91-0.97) and strong (OR:0.95, 95%CI:0.0.92-0.98) district-level SFPs between 2013 and 2018 were associated with decreased odds of current smoking, compared to no district-level SFP adoption. Similar results were observed for moderate (OR:0.91, 95%CI:0.86-0.96) and strong (OR:0.89, 95%CI:0.85-0.94) district-level SFPs between 2007 and 2013, compared to no district-level SFP. Compared to provinces without SFPs, individuals living in provinces with moderate SFPs between 2007 and 2013 had lower odds of current smoking (OR:0.67; 95% CI:0.63-0.71), while those in districts with moderate SFPs between 2013 and 2018 had higher odds (OR: 1.08, 95% CI: 1.05-1.11).

CONCLUSIONS

Local SFPs demonstrated a potential in reducing smoking persistence in Indonesia, particularly at the district level. However, the impact of province-level SFPs differed. Tailored SFPs and district-province strategies, focusing on synchronizing the top-down SFP implementation in the Indonesia's decentralized systems, are critical for lowering smoking rates.