Title : National health system capacities across Asia, 2010-2023: A temporal analysis of prevention, detection, response, and sustainability using WHO SPAR data
Abstract:
Background: WHO State Party Annual Report (SPAR) submissions provide self-assessed national capacities under the International Health Regulations. While preparedness gaps in low-resource settings are well described, the trajectory of capacity across Asia’s diverse subregions, and how it compares with global benchmarks, has not been systematically quantified.
Methods: We analyzed SPAR submissions from 47 Asian countries grouped into five un-defined subregions (Central, Eastern, South-eastern, Southern, Western Asia) from 2010-2023. Four functional domains (prevention, detection, response, sustainability) were scored as the mean of mapped indicators per country and aggregated to subregional and regional means. Because SPAR indicator definitions were substantially revised in 2018, trend interpretation focused on the harmonized 2018-2023 period; the global pooled mean served as the external benchmark. Trends were assessed by linear regression, pre/post-pandemic change by paired comparison (2018 vs 2023), and subregional differences by one-way ANOVA with Tukey correction.
Results: In 2023, Asia exceeded the global benchmark across all four domains (prevention 70.1 vs 63.9; detection 76.8 vs 72.2; response 73.9 vs 68.1; sustainability 72.8 vs 64.2). Detection was highest but had plateaued (2018-2023 slope +0.1/yr, p=0.82). Response showed the clearest improvement, rising from 65.3 (2018) to 73.9 (2023) (paired p=0.005; regression +2.1/yr, p=0.013), with prevention also increasing (+1.1/yr, p=0.003). Eastern Asia scored numerically highest in every domain and Southern and Central Asia lowest, but inter-subregional differences were not statistically significant (ANOVA p=0.23-0.62).
Conclusions: Across 2018-2023, Asian health system capacities sat at or above global averages and improved most in emergency response following the pandemic, while detection capacity appeared to plateau near ceiling. In contrast to more heterogeneous regions, subregional capacity was relatively even, with no significant gaps. Findings rely on self-reported data and an evolving indicator framework, but support sustaining post-pandemic response gains and targeting the comparatively lower prevention and sustainability scores in Southern and Central Asia.
