Health inequities come in all shapes and sizes. For some people, the cost of medicines is unaffordable. For others, the nearest clinic is simply too far away. For many people in the WHO Western Pacific Region, the barriers to accessing health care are complex.
May Alcantara knows these barriers well. She lives in a depressed area - the densely populated Barangay 105 in Tondo, Metro Manila in the Philippines – and has struggled to vaccinate her children.
When measles hit May’s neighbourhood, it was a shock. “We were all surprised when measles became widespread here,” she says. “It all started with the family living above our home. Then the family living beside us also got infected.”
May’s older children had already been vaccinated under a free government scheme. But, with her husband away working, long waiting times at the health centre and a lack of childcare, May’s three youngest children, aged 9 months, 3 years and 4 years were not vaccinated.
When measles swept through the settlement, all three became sick.
“First, they had fever, then cough, then they had rashes. After a few days, the rashes became black and turned into big blotchy patches.
“My other children were also scared. One of them said, ‘Ma, why can't we bring them to the hospital?’ I told them, ‘How can I bring your siblings to the hospital, when there’s no one to look after the other kids?’
“I told myself, ‘If I could only turn back time.’ I was full of regrets at that time. If only I’d had them vaccinated, then they wouldn't have been infected,” she recalls.
Unfortunately, May’s situation is all too common. Measles is a strong marker of health inequity - measles cases usually arise from gaps in access to essential health services.
The obstacles and worries May faced are among five barriers to equitable access to healthcare that a WHO study analysed: physical barriers including distance, transport, restricted opening hours and long waiting times; financial barriers including direct and indirect financial costs; quality of care, including the skills of staff and availability of drugs and equipment; a lack of information on available services or confidence in them; and sociocultural barriers including constraints related to gender or age, beliefs and cultural preference.
WHO is working with countries around the Region to address these barriers. In the Philippines, WHO is supporting the immunization programme to reach the last mile and last child through securing uninterrupted vaccine supply, bringing vaccination services closer to the population especially vulnerable communities and boosting trust and confidence in vaccines.
Amid the COVID-19 pandemic, WHO has supported the government in conducting a nationwide vaccination campaign, vaccinating over 8.5 million children between October 2020 and March 2021, preventing large measles outbreaks such as what May has experienced.
May, a mother from Tondo, Manila, with her three youngest children. (WHO/M Limchoa)
Thankfully, all three of May’s children made a full recovery from measles.
She now champions vaccination in her family and community.
“My first grandchild completed her vaccines. I made sure she was vaccinated. I told my daughter, ‘It’s free. It does not cost a thing. Why not get vaccinated?’
“Vaccines are really important.
“Don’t be complacent. Vaccines work,” she says.
There are hundreds of people like May around the Western Pacific who are advocating for people in their communities to take care of their health and the health of their families. These efforts must be bolstered by action on health equity from policy makers and governments.
On 7 April 2021, World Health Day, WHO will launch a campaign on building a fairer, healthier world for everyone.
To achieve this, everyone must work together to end health inequities. Communities, individuals and leaders all have a role to play in highlighting and tackling the root causes of health inequities. We will have most impact when governments and communities work together to reduce health inequities, which lead to unnecessary suffering, avoidable illness, disability and premature death.
We are calling on leaders to ensure that communities are at the forefront in decision-making processes as we move forward to a new future, and that everyone has living and working conditions that are conducive to good health. At the same time, we urge leaders to monitor health inequities, and to ensure that all people are able to access quality health services depending on their needs and values within their communities.
Watch May Alcantara’s story
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Watch how Malaysia is promoting health equity by removing financial barriers to the early detection and treatment of non-communicable diseases.