ASEAN for Women and Child Health
As a community that has stood for more than three decades, ASEAN has been forged by different experiences in different ways. In the midst of development and political and economic challenges that continue to change, ASEAN has revitalized by starting to talk about strategic aspects in the context of regional cooperation.
Since the signing of the ASEAN Charter through the ASEAN Summit 2007 in Singapore, ASEAN began metamorphosed into an entity that rule-based, people-oriented, and more integrated in order to realize the so-called “ASEAN community”.
New commitment within the ASEAN context, of course, need to be forged with the concrete challenges. One of the challenges in front of the eye that needs to get immediate response was how to achieve the MDGs by 2015.
For ASEAN, the achievement of the MDGs is important to show that ASEAN as part of a global society. The challenge not limited only to reach economic growth, but to do the exercise on the design of sustainable development, equitable, and fair within the region.
In general, ASEAN is a region showing substantial progress in terms of achieving the MDGs. However, these achievements do not occur evenly. In fact, the gap between ASEAN countries is quite sharp and perhaps the sharpest in the world.
The gap is most sharply seen in the two goals of the most under the spotlight in a UN-High Level Meeting on MDGs in September 2010, namely on the 4th goal of decreasing child mortality and the 5th goal of improving maternal health.
Let’s we check on the data on infant and under five mortality rate (IMR) in ASEAN. Of the 10 ASEAN member countries, only three countries with the highest IMR below 10/1000 live births; Brunei, Singapore, and Malaysia. Two countries, namely Thailand and Vietnam, in the last two decades, was able to demonstrate significant achievement to 15/1000 live births.
While Indonesia and the Philippines tend to be static at the level of 30-50/1000 live births. IMR worst in ASEAN occurred in Cambodia, Myanmar and Laos are still in the range of 50-70/1000 live births in 2008.
In the context of maternal mortality ratio (MMR), in 2008, occurred about 18 thousand maternal deaths and 400 thousand deaths of children in Southeast Asia than 350 thousand maternal deaths were reported in the same year the United Nations. Laos and Cambodia into two of the seven countries that record the highest MMR in the outer regions of Sub-Saharan Africa. And Indonesia is one country-one of 11 countries contributing 65% of maternal mortality in the world.
As a region, ASEAN could reach the child mortality reduction targets as stipulated in the UN MDGs. However, it should be noted if the progress in Cambodia and Myanmar are still not encouraging. The decrease of MMR in Indonesia, the Philippines, and Laos were cendeung unstable. Similarly, in the context of MMR, although all countries reported a decline in MMR, but the rate of MMR decline in Indonesia, the Philippines, and Myanmar tends to slow down.
In a paper entitled “Maternal, neonatal, and child health in Southeast Asia: Towards Greater regional collaboration” (published www.thelancet.com January 25, 2011), Cecilia S Aquin et al difference intervention strategies and social situation, economic, and geographic regions across the country ASEAN member countries have an effect on achievement differences in an effort to reduce maternal and child mortality.
For Singapore, Brunei, and Malaysia, the ability of the economy, social security system, and facilities and technologies enabling the three countries recorded the lowest child and maternal deaths in the ASEAN region. Meanwhile, Vietnam and Thailand, the health development of effective strategies can reduce the ratio of child and maternal mortality significantly.
Unlike the case with Indonesia and the Philippines, which although generally implement the strategy more or less the same with Thailand and Vietnam, but the differences in geography and a relatively large population, makes the lack of significant progress achieved.
Meanwhile, Laos, Cambodia, and Myanmar, although the population is not as large as Indonesia and the Philippines, but has not been able to maximize the geographical advantage to develop and implement a strategy of achieving the MDGs, particularly the MMR and IMR is focused and precise as that shown in Thailand and Vietnam.
In the context of ASEAN, it is needed to design the regional strategy to distribute resources and lesson Learns evenly throughout the ASEAN countries. It needs a framework that allows countries that have more advance capacity on resources such as Singapore, Brunei, and Malaysia to also feel responsible to help meet the resource gap in other countries in need.
There should also consider mechanisms that enable strategy and best practices owned by Thailand and Vietnam in the context of MMR and IMR can be repackaged so adaptive for countries that have geographical differences with both of them, such as Indonesia and the Philippines. There should also consider how the benefits of sharing resources and knowledge processes can take place continuously and mutually reinforcing.
One of the objectives set out in the document “Toward Roadmap for an ASEAN Community 2009-2015” is to guarantee access to health care, medical, and drugs decent and affordable and to promote healthy behavior among the people of ASEAN.
Objective was lowered into the “ASEAN Strategic Framework on Health and Development 2010-2015” by listing four major focus, namely (1) food safety, (2) access to health services consisting of access to pharmaceuticals, medical traditional medicine, maternal and child health, and health care for migrants, (3) health behavior, and (4) handling of infectious disease of, preparedness to face outbreaks of disease.
Both documents indicate a basic understanding of the importance of cooperation to address maternal and child health issues at the regional level. If the commitment is juxtaposed with the lessons learned above, it is definitely the ASEAN will be able to formulate action plans are far more focused to achieve the target of reducing mortality among children and mothers giving birth in 2015.
Keep in mind, the problem of maternal and child mortality, is not really a simple matter that can be dealt with sectorally. Poverty, underdevelopment, low access to basic education, and gender inequality, into the factors that convolute the high cases of maternal and child mortality.
What is needed now is strong leadership to guide ASEAN towards negotiations on the discussion of substantive issues that could benefit the wider community at the ASEAN level. This is where the main challenges the Government of Indonesia as chairman of ASEAN to bring the container of the nations of Southeast Asia is getting closer to the vortex of the problems experienced by the majority of people in the region.
While preparing ourselves towards the ASEAN Summit in May 2011 that will come, there is a question that perhaps we can ponder, Could Indonesia answer these challenges?