The Challenge of Health Sector Reform : What Must Governments Do?

New thinking about the management of public health services has stimulated a widespread movement for health sector reform across the world. This book examines the feasibility and desirability of common reforms in low income countries, based on in-depth case studies in Ghana, Zimbabwe, Sri Lanka, India and Thailand, and asks whether governments possess or can develop the capacities needed for these new and often complex roles. The book challenges conventional reform wisdom, and argues that reform approaches are needed that are more sensitive to the institutional characteristics of individual countries. New approaches to the management of publicly funded health services in developed countries, plus acknowledgement of government failure to ensure equity and efficiency, have combined to stimulate a widespread movement for health sector reform in low- and middle-income countries. Common policy trends include separating purchaser and provider functions; increased autonomy for public sector organizations such as hospitals; encouraging competition between providers; and increased funding from non-tax sources, such as user fees. This book examines the feasibility and desirability of such reform in low-income countries, based on in-depth case studies in Ghana, Zimbabwe, Sri Lanka, India and Thailand. It asks what capacities governments require to assume effectively these new and often complex roles, and how capable governments appear to be in performing these new functions. On the basis of research findings, the book challenges the conventional reform wisdom, and argues that reform approaches are needed that are more deeply rooted in, and sensitive to, the institutional characteristics of individual countries Front Matter....Pages i-xiv Health Sector Reform and the Role of Government....Pages 1-20 The Structure and Performance of Health Systems....Pages 21-41 Explanations of Performance and Reform Responses....Pages 42-67 Bureaucratic Commercialisation: Decentralisation of Hospital Management....Pages 68-93 Increasing Government Finance: Charging the Users....Pages 94-117 Government Purchase of Private Services....Pages 118-142 Regulating and Enabling the Private Sector....Pages 143-169 Taking Account of Capacity....Pages 170-199 Reforming Health Sector Reform....Pages 200-223 Back Matter....Pages 224-245