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1. Investing in the foundation of sustainable development: pathways to scale up for early childhood development

Author

Richter, Linda M, Daelmans, Bernadette, Lombardi, Joan, Heymann, Jody, Boo, Florencia Lopez, Behrman, Jere R, Lu, Chunling, Lucas, Jane E, Perez-Escamilla, Rafael, Dua, Tarun, Bhutta, Zulfiqar A, Stenberg, Karin, Gertler, Paul, Darmstadt, Gary L, and Committee, Paper 3 Working Group and the Lancet Early Childhood Development Series Steering

Subjects
Biomedical and Clinical Sciences, Health Sciences, Pediatric, Prevention, Generic health relevance, Quality Education, Child Development, Child Health Services, Child Protective Services, Child, Preschool, Developing Countries, Early Intervention, Educational, Financing, Government, Humans, Maternal Health Services, Politics, Poverty, Paper 3 Working Group and the Lancet Early Childhood Development Series Steering Committee, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

Published
2017

2. Multiple vulnerabilities and maternal healthcare in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011

Author

Chul Ou Lee, Hoang Van Minh, Vu Duy Kien, Tran Thi Huong, Luu Ngoc Hoat, Juhwan Oh, Kim Bao Giang, You Seon Nam, and This paper was written as part of collaborative project on strengthening health system in Viet Nam which is being implemented by Hanoi Medical University, University of Medicine and Pharmacy of Ho Chi Minh City, Viet Nam and LEE Jong-wook Center for Globa

Subjects
Rural Population, Program evaluation, inequality, Ethnic group, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, Health care, Ethnicity, Medicine, 030212 general & internal medicine, Socioeconomics, media_common, education.field_of_study, Multiple Indicator Cluster Surveys, lcsh:Public aspects of medicine, Health Policy, healthcare, Public Health, Global Health, Social Medicine and Epidemiology, multiple socioeconomic vulnerabilities, Vietnam, Female, Original Article, Public Health, 0305 other medical science, Adult, Inequality, media_common.quotation_subject, Population, Developing country, 03 medical and health sciences, Environmental health, Humans, Maternal Health Services, Healthcare Disparities, education, Socioeconomic status, 030505 public health, skilled antenatal care, business.industry, Public Health, Environmental and Occupational Health, skilled delivery, inequity, lcsh:RA1-1270, Patient Acceptance of Health Care, Delivery, Obstetric, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Cross-Sectional Studies, Socioeconomic Factors, Special Issue: Millennium Development Goals in Vietnam: the Progress and Social Determinants, business
Abstract

Background: Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in maternal healthcare.Objective: This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam.Design: This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities – low education, ethnic minority, poverty, and rural location – were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare.Results: In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities.Conclusions: Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups.Keywords: healthcare; skilled antenatal care; skilled delivery; multiple socioeconomic vulnerabilities; inequity; inequality(Published: 29 February 2016)Citation: Glob Health Action 2016, 9: 29386 - http://dx.doi.org/10.3402/gha.v9.29386This paper is part of the Special Issue: Millennium Development Goals in Vietnam: the Progress and Social Determinants. More papers from this issue can be found at www.globalhealthaction.net

Published
2016