1. Financing Health Promotion in Southeast Asia Does it match with current and future challenges? Phusit Prakongsai, Kanitta Budhamcharoen, Kanjana Tisayatikom, Viroj Tangcharoensathien International Health Policy Program (IHPP) – Thailand Background There is a policy concern over the growing trend of the economic burden from non-communicable diseases (NCD) around the globe. NCD accounted for 60% of total 58 million global deaths in 2005, double that of infectious diseases. Approximately 80% of the deaths due to NCD took place in low- and middle-income countries. In Thailand, two burden of disease (BOD) studies in 1999 and 2004 consistently confirmed NCD as a major and increasing cause of total disability adjusted life year (DALY) loss. WHO called for member states in the Southeast Asian region to apply and invest more in the innovative financing health promotion by the resolution WHO SEA/RC59/R4 made in Dhaka in 2006. Objectives This multi-country study [India, Indonesia, Nepal, Sri Lanka, and Thailand] aimed to: review current profile and the trend of chronic NCD burden and policy concerns among key stakeholders on health promotion and financing health promotion; assess current health care finance and financing sources for health promotion [public, private, and donor resources]; and assess the structure, function, and achievements of innovative sources in financing health promotion, and assess how this mechanism makes a difference For further information, contact Dr. Phusit Prakongsai (phusit@ihpp.thaigov.net). This project was funded by the WHO Regional Office for South-East Asia. Conclusions & policy recommendations Methods A comprehensive literature review on the profile of BOD in five selected countries in Southeast Asia, namely India, Indonesia, Nepal, Sri Lanka, and Thailand, and trend of expenditure on health promotion; Literature review on experience in innovative financing on health promotion in these five selected countries; Self-administered questionnaire surveys on views of policy-makers and key stakeholders on innovative health financing. Current levels and effectiveness of spending on health promotion in these countries are far from amounts realistically needed to halt the trend of chronic NCD; Innovative financing for health promotion is one of several policy choices needed to mobilize additional resources; Policy maker’s views consistently confirm the under funding of health and health promotion, which will require a significant increase in the current level of spending; and earmarked tax from alcohol and tobacco is a highly desirable and feasible source for health promotion; In view of resource constraints, it is recommended to increase value for money of the current health promotion program by addressing primary reduction of risk factors, and mobilize more resources from hazardous products such as tobacco and alcohol. This movement towards additional resource availability and efficient spending requires strong political leadership and commitments by countries in this region. Results Figure 1: DALY profile of 11 member states of WHO-SEA Region and the World The profile of BOD indicates advanced stage of epidemiological transition in Sri Lanka, Thailand, and Indonesia towards NCD burden, whereas Nepal and India are facing dual burdens from infectious diseases and NCD (Figure1). Figure 2: Total health expenditure as percent of GDP, 2000-2004 In 2004, total health expenditure in five selected countries of SEA region ranged from 3% to 5% of GDP. Most countries in five selected nations, except Thailand, relied on private resources notably household out-of- pocket payments in financing healthcare (Figure 2). Limited data of National Health Accounts (NHA) show a small proportion of total health expenditure (THE) spent on health promotion, disease prevention, and public health services, 5% of THE in Sri Lanka, and with a large fluctuation of 8% to 12% of THE in Thailand. Nepal had the highest share of THE on disease prevention, 15% to 21% (Figure 3). Figure 3: Share of health expenditure on prevention and public health services A very small amount of health resources were spent on health promotion, mostly on conventional clinical based prevention and health promotion services; Only Nepal and Thailand have innovative financing from tobacco and alcohol earmarked tax (sin tax); Nepal Health Tax Fund is oriented towards treatment of cancers, while the Thai Health Promotion Foundation focuses more on social mobilization and a strong campaign against tobacco and alcohol consumption, and healthy lifestyles. Results from the questionnaire surveys of policy makers and key stakeholders indicate serious under-funding for health and especially health promotion. In view of the current burden from chronic NCD, the government should spend more than double or triple of the current spending level on health promotion. A consensus view emerged in favour of the potential role of earmarked tax from alcohol and tobacco, as the most desirable and most feasible sources.