Rebooting Asia's Health Systems

How do we measure good health care? Historically, we counted the number of hospital beds or measured the distance to a local health clinic. We then added up the numbers and decided where to build a new or larger hospital.

This is the wrong approach for Asia and the Pacific. The evidence shows that these metrics have failed to meet the demands of Asia's rising middle class, continued to neglect the needs of the most vulnerable, and diverted scarce resources from where they could be most effective.

As a result, health officials are often in the dark about where a disease outbreak is underway or the latest trends in chronic diseases. This hampers their ability to respond to health care crises and conduct long-term health planning for rapidly changing populations. It also deprives health care professionals of basic information about their patients' health, resulting in more out-of-pocket spending, higher insurance payments, and worse health outcomes. Economies suffer as precious financial resources are wasted.

The good news is that Asia is uniquely placed to beat these challenges - and perhaps even leapfrog more developed regions - by deploying low-cost technologies that deliver outsized health benefits.

But this will take a revolution in health care systems. What practitioners refer to as eHealth - or the use of information and communications technologies (ICT) in health - can help drive changes that improve coverage and boost quality.

To start, Asian countries need a systemic approach to adopting new technology and collecting data.

ICT systems are often poorly designed, patient records are rarely digitised, and insurance reimbursement claims trundle through bureaucratic, error-prone systems. The World Health Organisation (WHO) estimates that up to 40 percent of global spending on health care is wasted.

To reduce inefficiencies, investments in new technologies and their benefits should match the needs of the population.

Official record keeping must also improve. Before recent reforms, Indonesian authorities estimated that anywhere between 29 percent and 76 percent of Indonesians under the age of 18 did not have a birth certificate. An unregistered birth can deny a child access to the most basic social services, including health care. Statistically sound data collection is a low cost way for governments to efficiently allocate health spending and respond to the needs of the most vulnerable.

Moreover, technology must be much more widespread. Remote, rural populations have long been underserved by national health systems, especially when it comes to preventative and chronic care.

But it's not just in rural areas. Those with the financial resources can afford high-quality (often private) health care 24/7 in most countries across the region. Anyone lacking resources or living in underserved areas may only see a doctor once a month.

New, low-cost solutions are one way forward. In more advanced economies health databases are cobbled together from decades of piecemeal system upgrades, and often struggle to communicate with each other.

Rather than repeat these mistakes, developing countries can deploy new solutions, like open source software, to develop common eHealth blueprints.

Mobile technology can also help. Because it is cheap and easy to use, developing countries have been quick to adopt it in health care - whereas rich countries are only starting to do so. A mother can now receive a reminder message on her mobile phone to take her baby for a check-up and arrive at a clinic where all her child's previous records are accessed electronically.

This kind of practice is happening in places you might not expect.

Bangladesh - a country often associated with persistent poverty - has made some of the biggest strides. The Ministry of Health and Family Welfare has invested in both hardware and human capital to revolutionise its health information system.

More than 7,000 health facilities across the country now report routine data, linked by a national data warehouse. The administrative burden on health care workers has been reduced and more routine information is available to health policymakers.

Similarly in Thailand, public and private health care systems are now connected and managed through a unified ICT system. Individual records enable health care workers to track patients in any health care facility nationwide.

This means health care providers make better treatment decisions, and the system reinforces quality care. Most important, these innovations empower patients to take control of their own health decisions.

While these efforts should be lauded, countries still need support to implement these and other options. As part of achieving universal health care across Asia, public and private sectors should make efforts to support health sectors - including eHealth programmes like those in Bangladesh and Thailand.

Those initiatives are helping medical professionals and technology companies to coordinate and leverage financial support from public and private financial institutions.

Rebooting Asia's health care systems demands new thinking. Through better policies, smoother coordination, and innovative technology we can achieve universal health care - and improve the lives of millions in this region.

The writer is Vice President, Asian Development Bank.