58579




  
   :

  
 (LECS)

, , 2010
     
                             :
     (LECS)


                                                 ,  2010


              
         .      
      . 
  
             
    -  (Timothy Powell-Jackson  LSHTM)    
        
                          
 (Magnus Lindelow ). ,                  
    (Nina Fenton),    (Bart Jacobs),     (Jean Marc Tomé),  
                    
 (Adam Wagstaff)     (Christoph Kurowski).
                   




                                    
                                   .
,                
                          
                                    
.  
                                     

                                     . , 
.
                                             
 [1]. , 
                                   
 
                                   (LECS)   2002/03 
 
                                   2007/08   .       
,           
                                   ,             

                                                          
 : 
                                   : .
.

                                     
:              
,                                  ,             
                                       $28  2007, 
 .                                 
                                    $31 
                                    . 
                                    , 
                                                               1
                                                                                                               12%
                                                                                                                              LECS3 (2002-03)
                                                                                                                                                              9.6%




                                                                                                          % 
                                                                                                               10%            LECS4 (2007-08)
. , 
                                                                                                                  8%
: ,                                                                                                                                                                  6.4%




                                                                                                               
  :                                                                                                               6%

.                                                                                                                 4%
                                                                                                                       2.1%     1.8%
                                                                                                                  2%
 1.                                                                                                                                             0.4%   0.3%

  GDP                                                                                                             0%
                                                                                                                               Traditional  
                                                                                                               Modern provider practitioner Purchased medicines
          3.0%                                                                                                                         





          2.5%                                                                                            :            
    GDP




          2.0%                                                                                            

          1.5%
                                                                                                           (, , ). 
                                                                                                            
          1.0%
                                                                                                           .
          0.5%

          0.0%
                                                                                                          :                                            
                                     Indonesia
                        Bangladesh




                                                                                                Vietnam
                 Laos




                                                 Philippines

                                                               Cambodia

                                                                          Malaysia

                                                                                     Thailand




                                                                                                           : 
                                                                                                          
                                                                                                           2002/03  2007/08 (
 :  NHA  WHO 2007
                                                                                                           3). , 

:                                                                                                                                                      
                                                                                                          .
 (OPC)
 LECS                                                                                                      3. 
                                                                                                           
                                                                                                                    -
.                       :                                                            
  2.1 
  1.8  
  ( 2). 
 .


 2. 




                                                                                                                                                                      2
     3.0%
                   LECS3 (2002-03)                                                                 
                   LECS4 (2007-08)
                                                                          
% 



     2.5%

                                                                          ,  
     2.0%
                                                                          ,                                   
     




     1.5%
                                                                           ( 5).  
     1.0%                                                                                                                                
                                                                           :  
     0.5%
                                                                             
     0.0%                                                                 
             Poorest          Q2             Q3        Q4       Richest
                                                                
                                                                          .
:  
   
                                         (,             ,                  5. :  
).                                                                          
                                                                                                    (2007/8)
                                                                                                 
                                                                                                    Oth. or
                                                                                                                   
                                                                                                                  Cent. hosp.,
                                                                                   
                                                                                                 missing, 11.1%
                                                                                                 11.1%             9.6%
                                                                                                                      9.6%
                                                                                       Hosp.
                                                                                   
                                                                                    abroad, 3.5%
                                                                                   3.5%
                                         ( 4).


 4.  
                                                                          Priv. prov.,
      :                                                                   
                                                                                   23.7%
                                                                          
     0.70                                                                  23.7%





                   LECS3 (2002-03)
                   LECS4 (2007-08)                                                                                        Prov. /dist.
     0.60                                                                                                                   | 
                                                                                          Pub. HC,                       hosp., 39.8%
                                                                                                                            39.8%
                                                                                          6.0%
     0.50
                                                                                          6.0%

     0.40

     0.30                                                                 , 
     0.20                                                                  :  
     0.10                                                                 .  2007/8 : 70% 
     0.00                                                                   10  
            Health facility     Individual
                                                   
                                                  Traditional    Total
                                                                            50% 
                                private            provider
                                                   
            
                                providers
                                                  
                                                                           10   ( 6). 
                                                                           2002/3 : 
: : 
                                                                          
 .  
                                                                          
,   
 .


                                                                                                                                         3
,                                                                   8.  
                                                                                              
. ,                                                                     3.5%
                                                                        3.0%
                                                                                      LECS3 (2002-03)




                                                                   12
  ( 0.4 )                                                                             LECS4 (2007-08)
                                                                        2.5%
 ;                                                        
                                                                        2.0%

                                                                        1.5%

10    ( 6).                                                             1.0%

                                                                        0.5%
 6. ,                                                                   0.0%
                                                                                Poorest           Q2          Q3        Q4         Richest
                     (2007/8)
                                                                    2007/08,  
    0.50                                                           /,  75 
                                        Govt. health facility
    0.45                                Private provider            





    0.40                                Traditional healer
                                        

    0.35                                                            ( 9).  : 
    0.30                                                            5   2002/3.
    0.25
    0.20
    0.15                                                            9. 
    0.10                                                                                               
    0.05
    0.00                                                                                  Hosp.          5%
                                                                                                        Other, 5%
                                                                                4% 4%
                                                                               abroad,                                
                                                                                                                    Cent. hosp.,
           0-1 km    1-2.5 km 2.5-5 km 5-10 km 10-25 km   > 25km               Priv. prov.,
                                                                                                                       11%
                                                                    4%
                                                                                   4%

                                                                          1%
                                                                               Pub. HC, 1%

: 
 
. ,  
                                                                                                                              |
                                                                                                                             Prov./dist. 
                                                                                                                             hosp., 75%
                                                                                                                              75%

.  
 : 
                                                                   
2.3  2002/03  1.9 
2007/08,                                                                                                                     

                                                                                                                    

 ( 8).                                                              
                                                                    
                                                                   .  

                                                                                                                                             4
                                                                                     
 `,' :                                                          
                                                                 LECS.  
                                                                                  
.                                                               .
                                         
                                                                , :
                                                                  
.                                                                           
                                                                 . ,
LECS                                                            , 
.  5                                                              
,                                                                20  1,144,699 
                                                                 2002/03  1,390,223 
 63,408  (US$ 6.6)  2002/03                                     2007/08.   
 81,947  (US$ 8.5)  2007/08 (                                   
10).                                                            .
,  
                                                                
.                                                                
                                                                - ( 11).  2002/2003 
                                                                 
  10.                                                           
                 :                                               13 , 
       90,000                                                   





       80,000                                                                        
       70,000                                   24,914          LECS3  2002/03.
       60,000            9,933
   




       50,000
       40,000
       30,000                                   57,033
                        53,475
       20,000
       10,000
           0
                    LECS3 (2002-03)         LECS4 (2007-08)

        user
       Spending on,fees,transport, etc
                       ,                   
                                         Spending onmedicines
        



:  (
 2007/08).  

                                                                                     5
 11.                                                       12. 
                                                          
                                                                        8.0%
                                                                                     LECS3 (2002-03)
      300,000                                                           7.0%




                                                          
                                                                                     LECS4 (2007-08)





                    LECS3 (2002-03)
                                                                        6.0%
      250,000       LECS4 (2007-08)




                                                              ( 10% )
   




                                                                        5.0%
      200,000                                                           4.0%

                                                                        3.0%




                                                          
      150,000
                                                                        2.0%
      100,000
                                                                        1.0%

       50,000                                                           0.0%
                                                                               Poorest
                                                                                          Q2           Q3   Q4   Richest   Total
           0

                
                                                
                                                          
                Poorest      Q2       Q3   Q4   Richest

:  (
                                                           
 2007/08).  
                                                          .                                                                  
                                       
                                                          

                                                            
 LECS.  
                                                           
                                      
                                                          . ,  
.
                                                          . 
                                                          :                    
 10 
                                                           .                                           
                                                 
                                                           
 4.2  2002/03  3.8 
                                                          
 2007/08, : 
                                                          
                                           
                                                          : 
 ( 12). 
                                                                                                       
                                      
                                                           . :
.                         
                                                           
  
                                                          .
. , 
 
                                                          ,                                    
,               
                                                           4  
 
                                                            
 .
                                                          .                                                 :              
                                                                                                (HEF),      
                                                           (CBHI), 
                                                                                                                                   6
(CSS),   (SHI)     
                 .  
.   ,   :          , : 
                 .
            
                 , 
 ( 10%            
).               . 
                          
:                           (:
.  1%  GDP       ), 
 .               (:  ) 
, :               (:  
                 ). ,   
.                
                  .
 
                 ,    
                 .    
. , :             
                  CBHI  HEFs.  
                 ,           
,                :   
.                  
                      (   
                  HEFs). 
                 
                 : ,    
. , :             
.    ,              
                 .
         
                  
                 
.                            
                   .   
 :                   
                  
                              7
.   
  
   : 
 .




        8