Monitoring the progress of health-for-all strategies: the situation in South-East Asia

Analysis of the results of the recent monitoring and evaluation of the HFA strategies of the 11 countries in WHO's South-East Asia Region shows that, in most cases, the process adopted for implementing the strategy has been the extension of coverage by health services operated by trained personnel. This process has not necessarily resulted in the equitable provision of health care, since it does not take into account the widely varying needs of different population groups within a country. For example, the infant mortality rate (IMR) for India was 96 per 1,000 live births (1986), but state-by-state analysis shows that the range by state is from 27 to 132. The figure for urban IMR at the national level is 62, compared to 105 for rural areas. Similarly, the IMR of 28.4 for Sri Lanka (1983) obscures extremes of variation between districts of 10.2-51.5. The health needs of disadvantaged areas or population groups can only be met in collecting and analysing data at lower levels than the national. This should not be difficult or expensive to achieve through suitable reorientation of peripheral and intermediate-level personnel. Improvements in the collection of data on some of the global indicators are documented by tables showing reported levels of coverage with maternal and child health care in 1983 (first monitoring), 1985 (first evaluation) and 1988 (second monitoring). Obtaining data on the birthweight of newborns appears to be difficult for some countries, and it is suggested that this indicator be replaced by one that asks whether the baby is healthy or not.(ABSTRACT TRUNCATED AT 250 WORDS)