The wellness attention system of every state is governed by its ain set of typical characteristics. Pakistan and Indonesia are situated in really different parts of the Asia but portion their distinctive strong Muslim heritage. The intent of this paper is to give a comparative analysis of the wellness issues and several wellness systems of these two developing states. In making so the paper foremost summarizes the major wellness issues faced by both states in footings of insufficiency of the present maternal and kid wellness and nutrition. Second, it goes on to discourse the response by the several authorities on these wellness jobs in footings of programs and policies undertaken to turn to them. Finally the paper concludes with the treatment on the model of the constituents of wellness attention system runing in both states, their interaction with each other or deficiency of it, the factors which are regulating it and the deficits of the system.
( A ) Major Health Problems in Indonesia and Pakistan
Health and Nutrition:
Health and nutrition are a critical portion of the development of any state and lend widely to its growing in footings of societal and economic development. The wellness of a state is defined by the wellness and nutritionary position of the two chief groups of the society ; mother and kid. It is imperative to retrieve that a healthy female parent is the innovator of a hereafter healthy coevals.
1.1. Inadequate Maternal and Child Health:
Pakistan and Indonesia suffer to a great extent from hapless maternal and infant mortality rates as compared to other developed states. The maternal mortality ratio for Pakistan and Indonesia are 260 and 240 per 100,000 unrecorded births severally ( WHO 2010 ) . Siddiqi et Al. ( 2004 p.120 ) believes that major majority of the hapless maternal status in Pakistan are concentrated in the rural countries, where there are perennial gestation, hapless dietetic wonts, scarceness of proper antenatal and postpartum attention and deficiency of proper immunisation coverage, saying a figure of merely 48 % coverage for lockjaw anatoxin ( Federal Bureau of Statistics 2002 cited in Siddiqi et.al. 2004 ) .
Indonesia paints a really similar image in this respect with statistics demoing 59 % place bringings ; 39.5 % in urban and 76.1 % in rural countries ( Indonesian Health and Demography Survey 2002-2003 cited in WHO 2011 ) . Harmonizing to WHO ( 2011 ) Urban countries in Indonesia are over supplied with specializers and physicians but many community Centres in rural and distant countries lack even general physicians. The just distribution of work force has been a challenge for the authorities of both states and one of the greatest grounds of the high mortality rates.
Table 1. Maternal mortality ratio per 100,000 births in 1990-2008, by WHO, UNICEF, UNFPA and The World Banks Maternal Mortality Estimation Interagency Group 2010 ( WHO 2010 ) .
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However detecting the maternal mortality rates of these states from 1990 to 2008, a singular betterment has been seen particularly in Indonesia. The chief ground for this has been the execution of a figure of strategically good planned plans by both states. Indonesia tackled this by integrating wellness voluntaries, supervised by a visiting nurse or small town accoucheuse and by increasing skilled birth attenders who ensured prenatal and postpartum attention, nutritionary guidance, wellness instruction and better immunisation services ; these all came with the acceptance of the Integrated Management of Childhood Illness in 1997 ( Trisnantoro, L et.al 2010 ) . In Pakistan the Prime Minister ‘s Program for Family Planning and Primary Health Care was implemented, which aimed to supply services of generative wellness, female parent and kid wellness instruction, actuating and supplying household planning tools and intervention of minor complaint by a lady wellness worker, who was a local of the community ( Ghaffar et al. 2000 p40 ) . Therefore, the success of both these plans was based on two factors, the job was addressed at the grass root degree and local people and voluntaries of the community were utilized in supplying these services.
Poor maternal wellness translates into birth of kids who are under weight and under nourished, therefore lending to the high baby mortality rates. Both states have undertaken steps for rectifying their bing hapless maternal wellness position, however a comparing of their infant mortality rates reveals otherwise. Indonesia has been observed to hold had much more success with a reduced infant mortality rate of 31 per 1000 unrecorded births while Pakistan shows a markedly high rate of ( WHO 2008 ) . These rates clearly indicate that the Indonesian authorities was able to implement their policies and delivered to the community more efficaciously than the Pakistani authorities.
1.2. Nutritional lacks in kids:
In developing states like Pakistan and Indonesia major wellness concerns revolve around nutritionary lacks in kids. Pasricha & A ; , Biggs ( 2010 p.2 ) believes that blowing acrobatics and underweight are a contemplation of nutritionary want, chronic malnutrition including micronutrient lack and associated factors like low birth weight, infective diseases and enteric parasitic infections et cetera.
Table 2. Prevalence of malnutrition among kids under 5 old ages, World Health Organization growing criterions 2008 ( Pasricha & A ; , Biggs 2010 p. 2 )
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The high rates evident from the information for acrobatics, scraggy and blowing from the above tabular array highlight the prevalence of malnutrition in both states. David & A ; Lobo ( 1995 p.1 ) believe that the major cause of morality in under 5 twelvemonth olds in developing states is, diarrhoea and malnutrition. But the informations from WHO ( 2008 ) speaks otherwise pneumonia as the taking of under five mortality with prematureness and diarrhoea following it, in both provinces. On the other manus Iram & A ; Butt ( 2006 ) argued that the causes of child malnutrition in developing states are non merely those related to traditional 1s like hygiene, respiratory or diarrhoeal disease but include the impact of a state ‘s political instability, economical growing and resources and without taking into history these the overall purpose of diminishing malnutrition would be near to impossible.
Pakistan is one of the three states in the universe to hold the highest figure of ill-fed kids ( Nuruddin, R 2009 p. 712 ) . This can clearly be seen by the high mortality rate for under 5 twelvemonth olds in Pakistan for 2009 which come to be 87 per 1000 as compared to 39 For Indonesia ( World Bank 2009 ) . These high rates highlight the failure on the portion of the Pakistani wellness ministry to better the factors responsible for better wellness results in kids. Indonesia although in comparing to Pakistan has a lower under 5 twelvemonth old mortality rate, but is still plagued by a batch of issues lending well to the present mortality rates, one of them being malaria. Malaria contributes to around six million clinical instances and 700 deceases each twelvemonth ( Laihad F cited in Sipe & A ; Dale 2003 p.1 ) . Thus it can be overall concluded that the high rates reported in respects to nutritionary lacks and diseases prevalent in both states indicate that there is much room for betterment and revolves around the attempts of the several states to decrease them.
Major constituents of the wellness attention system
The wellness of a state depends upon how its wellness attention system is planned and organized. The wellness system of a state is controlled by a figure of characteristics like the legal system, the political system and its economical position. The basic model of Indonesia and Pakistan is rather similar, with a cardinal authorities responsible for the ordinance of all facets of the wellness industry and allied.
1. Leadership & A ; Administration:
Pakistan has a federal system of authorities with a cardinal authorities, states, territories and sub territories while Indonesia has a cardinal authorities. Both states have a ministry of wellness which is the chief government organic structure which comes under the cardinal authorities responsible for deputing power to the provincial and territory degree. In Pakistan the federal ministry of wellness is the premier regulating organic structure responsible for preparation of national wellness policies, Torahs and statute laws refering wellness, nevertheless the execution of these policies, under the fundamental law of Pakistan, is the duty of the provincial authorities ( Ghaffar et al. 2000 p. 38 ) . Furthermore after the Devolution program of the authorities of Pakistan in 2000 ( Govt. of Pakistan 2000 cited in Shaikh & A ; Hatcher 2005 p. 50 ) the territory authorities were given complete powers in all affairs of finance allotment, schemes and intercessions based on the demand identified by them ( Shaikh & A ; Hatcher 2005 p. 50 ) . In Indonesia the construct of decentalisation is more recent and came with ‘The Decentralization Policy ‘ in 1999 where the three regional degrees of Province, District and City regional were given liberties ( WHO SEARO 2007 p. 8 ) . Owing to this policy it was expected that the wellness attention system of Indonesia would better. Heywood & A ; Harahap ( 2009 ) nevertheless believe otherwise, reasoning that the cardinal determinations like finance at territory degree were still made by the cardinal authorities and small power had been really allocated to the territory authorities.
Finance is one of the basic pillars that a wellness attention system sustains itself on. The per centum of budget that a state allocates for wellness, defines the degree of wellness commissariats available to its people. The % of the entire GDP that both Indonesia and Pakistan have assigned for wellness is 2.2 and 2.7 severally ( World Bank 2007 ) . With the % of the budget assigned for wellness it is seen that both states rely to a great extent on foreign AIDSs to fund their wellness attention systems. It has besides been observed that the more the input of financess by foreign bureaus in wellness sectors in developing states, there is less disposition to apportion fundss to the wellness sector.
3. Service Delivery:
Health attention bringing in both states comprises of public and private sectors which provide services in infirmaries, wellness Centre, clinics et cetera.
3.1. Public wellness sector:
The public wellness sector is the constituent of the wellness system which is regulated by the authorities in footings of funding and allotment of work force and wellness units. Pakistan ‘s public wellness sector is set up in footings of degrees of attention get downing from Basic Health Units which serves a population of 10,000 to 20,000, and rural wellness Centres which serve a larger population of 25,000 to 50,000 ; following are the tehsil infirmaries which cover 0.5 to 1 million population and eventually the third degree infirmaries functioning 1-2 million people ( Shaikh & A ; Hatcher 2005 p.50 ) . The public sector of Indonesia starts from bomber Centres which cover the small towns, following are the wellness Centres or Puskemas which are the focal point of primary wellness attention which come at the sub-district, following are the third infirmaries at territory, provincial and cardinal degree ( WHO SEARO 2007 ) . Despite the apparatus of these Centres, the rural and distant countries of both states suffer from non-availability of wellness staff due to the glut of the work force in urban countries.
3.2. Private Health sector:
Private wellness sector includes all the wellness suppliers outside the authorities sphere. In Pakistan it serves 70 % of the population and is a fee-for-service system ( Ghaffar et al. 2000 p.39 ) . This includes non merely all the infirmaries and general practicians but besides wellness professionals belonging to alternate medical specialties like homoeopaths, hakims, herb doctor, religious therapists and quacks ( Shaikh & A ; Hatcher 2005 p. 50 ) . Similar tendencies are besides seen in the private sector of Indonesia, where the authorities is seen to be actively promoting it therefore private disbursement on health care doing up 75 % of the sum ( Healthcare & A ; Pharmaceuticals Forecast Asia & A ; Australasia 2005 ) . Majority of the community prefers the private services due to better quality of attention provided and better handiness of resources. Thus the private sector in both provinces has rather efficaciously closed the spread in the wellness services but is limited as people with limited fiscal resources can non entree them, foregrounding the defect of the system.
4. Health work force
The major issue when it comes to workforce is about understanding the demographics of a state. It is non about increasing measure but just distribution of work force. In both states at that place have been important additions in the figure of physicians and nurses but yet there is lack in rural countries. In Pakistan there has been a ample addition in the figure of medical colleges, postgraduate medical colleges and nursing colleges ( Ghaffar et al. 2000 p.40 ) , yet there is scarceness in rural countries. This is because the bulk of the wellness work force is cantered in the urban countries go forthing the rural countries deficient of equal wellness workers. In Indonesia every bit good although the figure of physicians and installations has been increased but these are more inclined in favor of the metropoliss ( Healthcare & A ; Pharmaceuticals Forecast Asia & A ; Australasia 2005 ) .
It has besides been observed that when undertaking shifting was applied in both states by using the services of local voluntaries of the community who are non needfully physicians or nurses, and developing them, as using Lady Health workers in Pakistan ( Ghaffar et al. 2000 p40 ) and Skilled birth attenders in Indonesia ( Trisnantoro, L et.al 2010 ) better consequences were received as can be seen by the decrease in the maternal mortality ratios.
To reason it was seen that in supplying a comparative position of the Pakistan and Indonesia, there came up some similarities and some important differences. In respects to prevalence of wellness issues it was observed that there were some dramatic resemblance in the class of the diseases that plagues both states but the difference was observed in their incidence rates. This was observed majorly due to the rigorous base taken by the Indonesian authorities on their execution policies while some deficits were seen in the Pakistan authorities in this respect. However comparing their wellness attention systems revealed rather similar methods of administration, similar lacks in the system. There was seen to be a inclination of the authoritiess to trust on foreign support, and saving less for their wellness budget, a weak public sector with an increasing disposition towards the private wellness sector and an unequal distribution of work force. Overall there was a deficiency of turn toing the issues at the grass root degree seen in both states.