Proceedings of the 13th Meeting of the
COMCEC Poverty Alleviation Working Group
9
The case studies were conducted using literature review, data analysis and key informant
interviews as method and tool.
The Indonesia case study showed that Growing economy and government’s aim of universal
healthcare coverage (UHC) by 2019 led to an increase in the demand for health services; Life
expectancy has increased, both child and maternal mortality rates have decreased, still there is
evidence of stunting; height for age, slow progress in controlling infectious diseases, HIV is still high
and NCD is on the rise (73% of all deaths). There is considerable evidence of health-related
inequality especially geographic distribution and income group wise. The country has improved in
terms of increasing facilities and hospital beds ratio but still lagging behind other East Asian
countries. There has been number of health initiatives and system strengthening in the country
over the years, many of which has specific focus on decentralization. However, increased focus on
decentralization has weakened health information systems due to lack of obligation to report to a
central level.
Turkey case study shows that there has been significant improvement in health outcomes and
related access to healthcare; life expectancy increased (78 yr.), maternal mortality dropped to a
sixth (16/100,000 live births), infant, neonatal and under-5 dropped to a fifth. The country has
almost achieved UHC; dramatic increase in coverage -99% (75.2 million people), insurance is
delivered by the Social Security Institution (SSI) and free for all earning less than 279 TL per month.
Further analysis shows that the improved access to health has resulted mostly from expansion of
health benefits, infrastructure and human resources, supply of health services, increase in
efficiency and decrease in out-of-pocket expenses. All these have been achieved due to its hall mark
health initiatives called Health Transformation Program (HTP), Family Medicine Program and
Green Card Program. The main areas of further improvement for Turkey appeared to be improving
the quality of diagnostic and curative care, Primary health care system –number of staff, skill
development, physical and technical resources, community-based prevention and screenings for
cancer and chronic illnesses and fiscal sustainability –potential rise of out-of-pocket expenditure.
The Uganda case study shows that in spite of considerable progress in controlling the infectious
diseases (HIV, TB, Malaria), the country’s overall performance of MDG was poor; only goal achieved
was under-5 mortality rate. And there is evidence of marked socioeconomic and geographical
health-related inequities; high out-of-pocket expenses and most health centers are found in urban
and peri-urban areas. The major challenges for the country in regards to access to health are; 72%
lives within 5 km of a health facility; rural and remote areas, 43% of total health expenditure is
coming from out-of-pocket, long waiting times, long distance perception also restricts access public
health centers, outdated and old health infrastructure; recently adopted DHIS2 as the new HMIS
platform, low and frequently non-existent stock of medicines and supplies and lack of trained health
staff (doctors, nurses, midwifes per 1,000 ratio was 0.4 in 2017).
The Tunisia case study shows that the country has made remarkable progress in health and related
access; fertility rates are low and stable, maternal and infant mortality rates have decreased, life
expectancy has risen dramatically, immunization coverage is almost at 100%, HIV/aids is almost
non-existent, and Malaria has been officially eliminated. However, the major challenges for the