Challenge of Health Sector Reform

ANNE MILLS is Professor of Health Economics and Policy and Head of the Health Economics and Financing Programme at the London School of Hygiene and Tropical Medicine. She is author of many books and articles, including Reforming Health Sectors and Private Health Providers in Developing Countries: Serving the Public Interest. - SARA BENNETT is a Lecturer in the Health Economics and Financing Programme at the London School of Hygiene and Tropical Medicine and is currently based in Tbilisi, Georgia. - STEVEN RUSSELL is a Research Student at the Health Policy Unit, London School of Hygiene and Tropical Medicine.

'This book straddles two centuries. On the one hand, it looks at the health reform movement that marked the last decade of the twentieth century. On the other, it looks forward to some of the new ideas that will guide health systems development in the first years of the twenty-first century...this major piece of work focuses on the central issue in the health reform debate: the roles and capabilities of governments. The way such roles are redifined and such capabilities enhanced will determine the future performance of health systems throughout the world.' - Julio Frenk, Director, Evidence and Information for Policy Cluster, World Health Organization 'This is the first book I have encountered to challenge the conventional wisdom on health sector reform in developing countries in an integrated and comprehensive way, rooting the critical analysis of theoretical approaches in country experience. It highlights the dangers of uncritically transplanting developed country strategies to developing countries. The authors offer important new insights into how to reform the current health sector reform agenda, particularly in relation to adopting more realistic and gradual approach to reform and rethinking the role of government in the health sector. It should be read by anyone actively involved in designing and implementing health sector reform in developing countries, including government officials, international organisation technicians and academics who provide technical assistance. It is also extremely valuable to post-graduate students in the fields of international health, health economics and health policy.' - Professor Di McIntyre, Director, Health Economics Unit, University of Cape Town 'The health sector in many developing countries face twin institutional and policy reform challenges to increase effectivenes, coverage and quality of services while enhancing resource use efficiencies in both public and private sectors. The role of the government is critical in ensuring that institutions and policy reform processes are effective in implementing reforms. However, there is very little understanding of these challenges and processes - particularly relating to institutional aspects. Given the public sector institutional context and social and economic realities in developing countries, the tasks are multifaceted and complex. Through five country case studies of Ghana, Zimbabwe, Sri Lanka, India and Thailand, the book examines a number of these challenges. The case studies broaden our understanding of approaches to manage reform processes in the health sector. This is an important contribution in the area of managing and implementing health reform strategies and required reading for policy makers managing health sector reform.' - Professor Ramesh Bhat, Indian Institute of Management, Ahmedabad

• List of Tables List of Figures List of Boxes List of Acronyms Preface Notes on the Contributors Health Sector Reform and New Public Management The Structure and Performance of Health Systems Explanations of Performance and Reform Responses Bureaucratic Commercialisation: Decentralization of Hospital Management Increasing Government Finance: Charging the Users Government Purchase of Private Services Regulating and Enabling the Private Sector Taking Account of Capacity Reforming Health Sector Reform References Index