Primary Health Care meets the Market: Lessons from China and Vietnam

Many low and middle income countries are considering radical health sector reforms. Their policy-makers are asking fundamental questions about how services should be financed, the relationship between service providers and government, and the role of the state in ensuring that health services are cost-effective and equitable. This paper outlines some lessons they can learn from China and Vietnam. Both countries developed low cost rural health services during the period between the early 1950s and the mid-1970s. Their example strongly influenced international health policy. However, other countries did not give adequate consideration to how to adapt structures developed in egalitarian command economies for market economies with substantial socio-economic inequalities. China and Vietnam have been liberalising their economies for several years. This has affected their health services in a number of ways. Those who can afford them have a wider choice of health services, but costs have risen and there are greater differences in access to medical care. The Chinese and Vietnamese governments are seeking strategies to make their health services more cost effective and equitable. Policy-makers and researchers in low and middle income countries can learn useful lessons from their efforts to adapt their services during the transition to a market economy

Universal Health Coverage and Primary Healthcare: Lessons From Japan; Comment on “Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries”

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant

Service Delivery Transformation for UHC in Asia and the Pacific

This article was drafted as part of a review of strategiesfor making progress toward universal health coverage in the coun-tries of Asia and the Pacific. It focuses on strengthening thedelivery of services, in the context of population aging. It arguesthat it is important to take into account big differences in develop-ment contexts and also the rapid, interconnected changes that manycountries are experiencing. The article focuses especially on coun-tries with relatively undeveloped institutions and pluralistic andhighly segmented health sectors. It argues that attempts by thesecountries to import institutional arrangements from outside arelikely to be complicated. It argues that government needs to focuson both short-term measures to meet immediate needs and thelonger-term aim of establishing effective institutional arrangements.This means that they need to take into account the political factorsthat influence the direction of health system change. The articleemphasizes the need to strengthen the capacity of the health systemto address the growing challenge of chronic noncommunicablediseases to avoid heavy political pressure to expand hospital ser-vices. It then explores the opportunities and challenges associatedwith the rapid expansion of digital health services. It concludeswith a discussion of government stewardship and management ofhealth system transformation to address the major challenges asso-ciated with population aging

Science and Technology for Health: Towards Universal Access in a Changing World

Most anti-colonial movements in the second half of the 20th Century promised to provide universal access to health services. The Alma Ata Declaration of 1978 presented a consensus view of how governments could deliver on this promise. During the next thirty years, people experienced dramatic health improvements in some countries or districts, but they continued to suffer high levels of avoidable disease and early death in many others. The existence of effective health care technologies combined with the reality that hundreds of millions of people still do not have access to effective health services has led in recent years to national and international political pressure for action and significant funding to address this reality. This paper argues that effective strategies for increasing access to the benefits of health-related science and technology cannot just be viewed as technical challenges but must be grounded in the profound changes in political economy of the last thirty years. These include demographic shifts and changes to national and global economic arrangements, channels of knowledge flow, the organisation of politics and governance and the understanding of how innovations arise and are spread. Failure to take this into account could reduce the impact of these investments or even lead to unintended adverse consequencesESR

What Does the End of Africa's Boom Mean for Universal Health Coverage?

Achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This presents a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage