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Objectives:

To make health systems more accessible to poor people and to deliver better health services.

Background:

The poor, by definition, lack resources of their own with which to demand the minimum range of effective and good quality health services. Their access thus depends on intervention of some kind. Attempts to provide free and comprehensive services for all have failed in all but a few poor and transitional countries (PTCs). Funding is deficient. Many public services are of wholly inadequate quality. Low paid professionals are leaving the public sector or the country; others operate 'dual practice' across the public and private sectors both formally and informally; potential users too are voting with their feet. The private sector is booming but those who lack resources or information are commonly purchasing poor quality, ineffective and even dangerous services most frequently from small scale, unregulated and informal providers. The outcome is little different from that associated with a pure private market. Factors which underlie this situation include: (i) over ambitious expectations that the state can provide comprehensive services; (ii) perverse or weak incentives attached to public subsidies to achieve public goals; (iii) a tendency for richer and more politically powerful groups to attract and consume a disproportionate share of resources, even within the public sector; (iv) inefficiency of public sector management and regulation due to bureaucratic governance systems and political constraints. In middle income countries (MICs), where better coverage of the population can be afforded, growing inequities are leading to multi-tiered health systems which threaten their public components through competition for scarce (especially human) resources and sometimes for state subsidy. While it is not unrealistic for governments to aim to provide comprehensive services, points (ii), (iii) and (iv) above still tend to undermine these. In both types of countries, exogenous factors such as the HIV pandemic are placing further strain on the health system and the personnel within it.

Intended Outputs:

A substantial, cohesive, innovative and challenging body of policy-relevant new knowledge in the following areas:
Choice, access, quality and outcomes
Redefining the role of the government
Monitoring, quality and impact
Effective inter-sectoral policies and programmes.

New knowledge disseminated to key policy makers and opinion leaders (global and national).

Strengthen research capacities in:
CHP
PRU
IPH
MMA.

General Notes:

Read the id21 Research Highlights:
Policymakers in rich countries drive the health migration crisis
Primary health care reform in Russia : can it succeed?
Comparing maternal health services in four countries
The Global Fund: managing great expectations
Paying for 'free' health care: informal payments in Bulgaria
How would you like to pay? Health care financing reforms and popular values in Bulgaria
Pass or fail - ensuring successful transfer of health policy between countries
Global guidelines and the rise and fall of syndromic management for STIs
Coping, just - access to care in the new Bulgarian health system
Leading by example: GAVI's lessons for the Global Fund
Health sector reforms: what influences health worker responses?
The Russian health system after decentralisation: who really holds the power?

Paper File Reference:

HP1 0103 0470/1150/001