Child Poverty in East Asia and the Pacific: Shared Vision, Different Strategies: a Study of Seven Countries in the EAP Region

Poverty reduction begins with children. A child's experience of poverty is very different from that of an adult. Income is but one dimension among many that should be assessed when analyzing child poverty and disparity. Non-monetary deprivation in dimensions such as shelter, food, water, sanitation, education, health, and information is equally, if not more, revealing. Since deprivation along these dimensions can have significant negative consequences on a child's development and future, an examination of multidimensional child poverty and associated disparities is clearly warranted. As part of UNICEF's Global Study on Child Poverty and Disparity, several countries in East Asia and the Pacific have undertaken national child poverty and disparity studies. In this paper, results from seven of those countries, Cambodia, Lao PDR, Mongolia, the Philippines, Thailand, Vanuatu and Viet Nam, are reviewed. The objective is to identify trends and lessons, generate strategies for UNICEF EAPRO, and to contribute toward a richer conceptualization of the situation of children in the region. Data from the aforementioned countries indicates substantial reductions in the percentage of children who are severely deprived, with rates falling by one third from 56% in 2000 to 36% in 2006. The percentage of children who suffer from multiple severe deprivations nearly halved, from 27% in 2000 to 14% in 2006. While improvements can be observed in most dimensions of child wellbeing, the multidimensional deprivation analysis reveals that the most statistically significant improvements were found in the water and sanitation dimensions. However, the analysis also reveals that despite these gains, over 30 million children in the seven countries suffer from at least one severe deprivation. This is more acute in certain segments of the population, representing critical equity challenges. The most notable dimensions of inequity include disparities between rural and urban areas, between provinces or sub-national regions, between different ethnic groups, between small and large households, and between households headed by well-educated and poorly educated adults. Although severe deprivation is visible across all wealth quintiles, children from the poorest and second poorest wealth quintiles are much more likely to be severely deprived compared to children from the richest quintile. Much more can and must be done in each of the seven countries to reduce inequities that block opportunities for children

Using relative and absolute measures for monitoring health inequalities: experiences from cross-national analyses on maternal and child health

Background. As reducing socio-economic inequalities in health is an important public health objective, monitoring of these inequalities is an important public health task. The specific inequality measure used can influence the conclusions drawn, and there is no consensus on which measure is most meaningful. The key issue raising most debate is whether to use relative or absolute inequality measures. Our paper aims to inform this debate and develop recommendations for monitoring health inequalities on the basis of empirical analyses for a broad range of developing countries. Methods. Wealth-group specific data on under-5 mortality, immunisation coverage, antenatal and delivery care for 43 countries were obtained from the Demographic and Health Surveys. These data were used to describe the association between the overall level of these outcomes on the one hand, and relative and absolute poor-rich inequalities in these outcomes on the other. Results. We demonstrate that the values that the absolute and relative inequality measures can take are bound by mathematical ceilings. Yet, even where these ceilings do not play a role, the magnitude of inequality is correlated with the overall level of the outcome. The observed tendencies are, however, not necessities. There are countries with low mortality levels and low relative inequalities. Also absolute inequalities showed variation at most overall levels. Conclusion. Our study shows that both absolute and relative inequality measures can be meaningful for monitoring inequalities, provided that the overall level of the outcome is taken into account. Suggestions are given on how to do this. In addition, our paper presents data that can be used for benchmarking of inequalities in the field of maternal and child health in low and middle-income countries

Equity in health and healthcare in Malawi: analysis of trends

<p>Abstract</p> <p>Background</p> <p>Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the <it>inverse care law</it>, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.</p> <p>Objective</p> <p>This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004.</p> <p>Methods</p> <p>Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.</p> <p>Results</p> <p>Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.</p> <p>Conclusion</p> <p>The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.</p

Malaria prevention in north-eastern Tanzania: patterns of expenditure and determinants of demand at the household level

OBJECTIVE: This study aims to provide a better understanding of the amounts spent on different malaria prevention products and the determinants of these expenditures. METHODS: 1,601 households were interviewed about their expenditure on malaria mosquito nets in the past five years, net re-treatments in the past six months and other expenditures prevention in the past two weeks. Simple random sampling was used to select villages and streets while convenience sampling was used to select households. Expenditure was compared across bed nets, aerosols, coils, indoor spraying, using smoke, drinking herbs and cleaning outside environment. FINDINGS: 68% of households owned at least one bed net and 27% had treated their nets in the past six months. 29% were unable to afford a net. Every fortnight, households spent an average of US $0.18 on nets and their treatment, constituting about 47$0.21). Factors positively related to expenditure were household wealth, years of education of household head, household head being married and rainy season. Poor quality roads and living in a rural area had a negative impact on expenditure. CONCLUSION: Expenditure on bed nets and on alternative malaria prevention products was comparable. Poor households living in rural areas spend significantly less on all forms of malaria prevention compared to their richer counterparts. Breaking the cycle between malaria and poverty is one of the biggest challenges facing malaria control programmes in Africa

Infancia, vulnerabilidad y segmentación urbana en Ciudad Autónoma de Buenos Aires (CABA). Aportes para su medición

Fil: Ferrer, M., . Universidad Nacional de Villa María; Argentina.Fil: Arias, C., . Universidad Nacional de Villa María; Argentina.Fil: Minujin, A., . Universidad Nacional de Villa María; Argentina

The measurement of flows in social statistics: an example from Argentinian experience

This paper explores the possibilities of using the results of a multipurpose household survey to obtain data about the movements of individuals -- or other units -- between different states, and also deals with methods for improving this information. There is an increasing need for this kind of information in order to complement information about stock. In this sense certain aspects of the methodology employed in a multipurpose household survey for Greater Buenos Aires are examined (in section 2 of the paper). The design of this survey permits the reinterviewing of a part of the sample, and therefore the measurement of flows is possible. However, certain shortcomings arise from the method used, and these are analysed. Then some ways of improving the information by changing some aspects of the survey are put forward. Section 3 of the paper deals with nonsurvey methods for improving the quality of the information by use of data from other sources. Therefore alternative methods for the adjustment of matrices (which are frequently used for updating input - output tables) are discussed and applied to one of the tables presented in section 2. Finally, in section 4, an evaluation of this method is given in order to gain some insights into the possibilities of this approach.

“Delivering” on the MDGs?: Equity and maternal health in Ghana, Ethiopia and Kenya

Objective(s): The Millennium Development Goals (MDGs) have put maternal health in the mainstream, but there is a need to go beyond the MDGs to address equity within countries. We argue that MDG focus on maternal health is necessary but not sufficient. This paper uses Demographic and Health Survey (DHS) data from Kenya, Ethiopia and Ghana to examine a set of maternal health indicators stratified along five different dimensions. The study highlights the interactive and multiple forms of disadvantage and demonstrates that equity monitoring for the MDGs is possible, even given current data limitations. Methods: We analyse DHS data from Ghana, Kenya and Ethiopia on four indicators: skilled birth attendant, contraceptive prevalence rate, AIDS knowledge and access to a health facility. We define six social strata along five different dimensions: poverty status, education, region, ethnicity and the more traditional wealth quintile. Data are stratified singly (e.g. by region) and then stratified simultaneously (e.g. by region and by education) in order to examine the compounded efect of dual forms of vulnerability. Results: Almost all disparities were found to be significant, although the stratifier with the strongest effect on health outcomes varied by indicator and by country. In some cases, urban-dwelling is a more significant advantage than wealth and in others, educational status trumps poverty status. The nuances of this analysis are important for policymaking processes aimed at reaching the MDGs and incorporating maternal health in national development plans. Conclusion(s): The article highlights the following key points about inequities and maternal health: 1) measuring and monitoring inequity in access to maternal health is possible even in low resource settings—using current data 2) statistically significant health gaps exist not just between rich and poor, but across other population groups as well, and multiple forms of disadvantage confer greater risk and 3) policies must be aligned with reducing health gaps in access to key maternal health services. Conflict of Interest: The authors declare that there are no conflicts of interest. The lead author had full access to the data used in this paper and the final responsibility for the decision to submit for publication. East African Journal of Public Health Vol. 5 (3) 2008: pp. 133-14

Ambition is Golden: Meeting the MDGs

Jan Vandemoortele in the face of the different views about the MDGs asks that we should not ask what we can do for the MDGs but what the MDGs can do for our cause – that is, the realization of fundamental economic and social rights. He suggests we can compensate for the slow start of the 1990s and still achieve the global targets by 2015. It is pessimism, scepticism and cynicism that are the three worst enemies of the global anti-poverty agenda. Its three best friends are the space to adapt and tailor global targets, an explicit focus on equity, and a quantum leap in imagination. Development (2005) 48, 5–11. doi:10.1057/palgrave.development.1100100