PharmacoEconomics & Outcomes News 784, p19 - 12 Aug 2017
Health coverage low and access
inequitable in South Asia
Health coverage is low and access to healthcare is
inequitable in South Asian countries, according to
findings of a study published in JAMA Internal Medicine.
Universal health coverage (UHC) is a key target in the
UN Sustainable Development Goals. This study used
national survey data between 2010 and 2015 in a total of
335 373 households to investigate healthcare coverage
(access to healthcare services, equity, and financial risk
protection) in Afghanistan, Bangladesh, India, Nepal and
Access to basic healthcare varied across all countries;
the mean rate of overall prevention coverage was 53.0%
in Afghanistan, 76.5% in Bangladesh, 74.2% in India,
76.8% in Nepal and 69.8% in Pakistan, and the mean
treatment coverage rate was 51.2%, 44.8%, 83.5%,
57.8% and 50.4%, respectively. Financial risk protection
rates were low, and the proportion of households
incurring catastrophic healthcare costs ranged from
4.4% in Pakistan to 17.9% in India.
Access to maternity services including institutional
delivery and a skilled delivery attendant was greater
among women in the highest wealth quintiles in
Afghanistan, Bangladesh, Nepal and Pakistan.
Healthcare coverage was least equitable with respect to
sanitation, institutional delivery, and skilled birth
"The journey toward universal health coverage is far
from complete, but with proper attention to access and
equity in health, even the poorest nations in South Asia
can make steady progress toward achieving health care
for all," concluded the authors.
"These results suggest that a framework for UHC that
includes indicators of equity is required to prevent
coverage expansion from inadvertently widening health
disparities between rich and poor populations,"
commented Neelam Sekhri Feachem and Dr Saate
Shakil, from the University of California, San Francisco,
in an invited commentary published in JAMA Internal
"It will clearly require a major transformation
in commitment by national and subnational
governments and innovation on a heroic scale to put
South Asia on track for UHC by 2030." they said.
1. Rahman MM, et al. Progress Toward Universal Health Coverage. A
Comparative Analysis in 5 South Asian Countries. JAMA Internal Medicine : 7
Aug 2017. Available from: URL: http://dx.doi.org/10.1001/
2. Feachem NS, et al. Outcomes in South Asia Matter for the World. JAMA
Internal Medicine : 31 Jul 2017. Available from: URL: http://dx.doi.org/10.1001/
PharmacoEconomics & Outcomes News 12 Aug 2017 No. 7841173-5503/17/0784-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved