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An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion

Piya Hanvoravongchai1, Irwin Chavez2, James W Rudge3*, Sok Touch4, Weerasak Putthasri5, Pham Ngoc Chau6, Bounlay Phommasack7, Pratap Singhasivanon2, Richard Coker3 and the AsiaFluCap Project Consortium

Author Affiliations

1 Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

2 Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand

3 Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, 9th Floor, Satharanasukwisit Building, Mahidol University, 420/1 Rajwithi Road, Ratchathewi, Bangkok, 10400, Thailand

4 Cambodia Ministry of Health, Department of Communicable Disease Control, 151-153 Kampuchea Ground Avenue, Phnom Penh, Cambodia

5 International Health Policy Programme-Thailand, Ministry of Public Health, Nonthaburi, 11000, Thailand

6 Vietnam Military Medical University, Hanoi, Vietnam

7 National Emerging Infectious Diseases Coordination Office, Fa Ngoum Road, Vientiane, Laos

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International Journal of Health Geographics 2012, 11:53  doi:10.1186/1476-072X-11-53

Published: 14 December 2012



There is increasing perception that countries cannot work in isolation to militate against the threat of pandemic influenza. In the Greater Mekong Subregion (GMS) of Asia, high socio-economic diversity and fertile conditions for the emergence and spread of infectious diseases underscore the importance of transnational cooperation. Investigation of healthcare resource distribution and inequalities can help determine the need for, and inform decisions regarding, resource sharing and mobilisation.


We collected data on healthcare resources deemed important for responding to pandemic influenza through surveys of hospitals and district health offices across four countries of the GMS (Cambodia, Lao PDR, Thailand, Vietnam). Focusing on four key resource types (oseltamivir, hospital beds, ventilators, and health workers), we mapped and analysed resource distributions at province level to identify relative shortages, mismatches, and clustering of resources. We analysed inequalities in resource distribution using the Gini coefficient and Theil index.


Three quarters of the Cambodian population and two thirds of the Laotian population live in relatively underserved provinces (those with resource densities in the lowest quintile across the region) in relation to health workers, ventilators, and hospital beds. More than a quarter of the Thai population is relatively underserved for health workers and oseltamivir. Approximately one fifth of the Vietnamese population is underserved for beds and ventilators. All Cambodian provinces are underserved for at least one resource. In Lao PDR, 11 percent of the population is underserved by all four resource items. Of the four resources, ventilators and oseltamivir were most unequally distributed. Cambodia generally showed higher levels of inequalities in resource distribution compared to other countries. Decomposition of the Theil index suggests that inequalities result principally from differences within, rather than between, countries.


There is considerable heterogeneity in healthcare resource distribution within and across countries of the GMS. Most inequalities result from within countries. Given the inequalities, mismatches, and clustering of resources observed here, resource sharing and mobilization in a pandemic scenario could be crucial for more effective and equitable use of the resources that are available in the GMS.

Health system; Pandemic influenza; Health equity; Resource mapping; Resource allocation; Antivirals; Southeast Asia