A key challenge in the region is to reach society’s most disadvantaged. Sadly, these are often those most vulnerable – children with disabilities, children from migrant groups or ethnic minorities, rural dwellers and the urban poor, those in contact with the law or living in institutions, and sometimes girls. These inequities also have roots in other challenges to education (particularly for women), reproductive health and maternal health. It is often policies – or the lack of them – that determine whether a child is healthy and educated, or poor and excluded.
Some of the more specific challenges include widespread poverty. Low public expenditures in health that persist in the region - often below 4 per cent of GDP means that families are exposed to high out-of pocket expenditures. Limited access to health is linked to higher rates of child mortality, which, in some of the poorer countries, is comparable to child mortality rates in parts of Africa.
The quality of maternal and newborn care remains an important concern. Although the region has traditionally had health services that are widely available – with, for example, more than 90 per cent of deliveries in the region taking place in maternity hospitals – more needs to be done to improve the quality of these services. Introducing innovations such as quality control systems, improved management practices based on full and transparent data and more attention to the needs and preferences of users are some of the areas for improvement.
The polio outbreak of 2010 and ongoing measles outbreaks are sobering reminders that some segments of the population are being missed by routine services. This comes against a background of an increasing anti-vaccination sentiment, misinformation and a reluctance to bring children in for immunization – often fuelled by sensationalist media coverage. Chronic malnutrition problems, exacerbated by poverty and rising food prices, are reflected in high rates of child stunting. The prevalence of stunting in Tajikistan is as high as 39 per cent of under-five-year-olds while the regional average is 16 per cent.
Progress on MDG 6 – combating HIV and AIDS, malaria and other diseases – is simply inadequate. The number of people living with HIV in this region has almost tripled since 2000. Yawning gaps in immunization means that many countries are also witnessing the resurgence of vaccine-preventable diseases such as polio and measles.
Last updated November 2013