Dr.Sundari Raveendran

The present monograph examines the experiences of four Asian countries in reforming their health sector and the implications of these reforms for universal access to reproductive health services. The countries included are Pakistan, Lao PDR, Cambodia and Thailand. Each of these countries has undergone health reforms as part of larger economic reforms. Cambodia, Lao PDR and Pakistan have severely under-resourced their health sectors, whereas Thailand is relatively well-resourced in its finances. The trajectories of reforms in these countries are very different. In Pakistan, the health sector has been swept in the direction of increasing privatization and farther away from universal health care coverage.

Access to reproductive health services is poor and inequitably distributed. Cambodia and Lao PDR also have limited public investment in health, but are experimenting with substantial donor funding and Social Protection Schemes to ensure access to essential health care for low-income groups. Both countries appear to be making conscious efforts to progress towards a greater and larger health care coverage, in which Cambodia has been more successful than Lao PDR. Access to reproductive health services is also relatively better in Cambodia when compared to Lao PDR, and low-income women are assured of basic maternal health care where facilities exist. Thailand, however, offers a contrast, with the public sector predominantly funding health care provisions and Thailand has been successful in achieving the Universal Health Care Coverage through its Universal Health Care Coverage Scheme implemented since 2001. A comprehensive range of publicly financed reproductive health services are available to a vast majority of the population at little or no cost. Examples from the case study appear to validate the position of universal access to reproductive health care, which cannot be viewed or advocated in isolation but has to be a demand vested in the larger quest for universal healthcare coverage.

Each of the four case studies begin with a general background of the country, which provides an overview of the health sector and its system, especially in its financing, followed by traversing the history of privatization as well as progress towards universal coverage. Each case study then examines how these larger changes in the health sector have affected universal access to quality reproductive health services.


“Engaging Public Health Professionals In the Process of Change”