Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Sophie Witter - ORCID 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.Department for International Development, Grant/Award Number: Supported by the ReBUILD and ReSYST RPCshttps://doi.org/10.1002/hpm.288234pubpub

Corruption in Privatization and Governance Regimes

(ISSN 1827-3580

International Assistance After Conflict: Health, Transitional Justice, and Opportunity Costs

After violent conflicts, international actors face difficult choices about whether and how to provide assistance. These decisions can have immense consequences. As aid always occurs under conditions of scarcity, theoretical reflection is crucial to reveal the opportunity costs and potential tensions between alternative courses of action. Yet, there has been relatively little scholarly reflection on what should constitute priorities for post-conflict assistance and why. This paper advances this debate by comparing two very different areas of assistance that both embody compelling values and goals: public health and transitional justice. It argues that aid for public health deserves greater attention based on powerful normative considerations and its impressive empirical record. It also suggests the need to examine not only clearly underperforming areas, but also tough cases. Transitional justice, despite its strong normative foundations, faces challenges and limitations that justify reform and a reconsideration of the emphasis commonly placed on it. Our intention is not to suggest that long-standing commitments ought to be abandoned or that all aid should be allocated to health. Rather, by scrutinizing the priorities of international assistance, we hope to start a general discussion about how the international community can best help societies heal after conflict

Competition and Market Strategies in the Swiss Fixed Telephony Market. An estimation of Swisscom’s dynamic residual demand curve.

Fixed telephony has long been a fundamentally important market for European telecommunications operators. The liberalisation and the introduction of regulation in the end of the 1990s, however, allowed new entrants to compete with incumbents at the retail level. A rapid price decline and a decline in revenues followed. Increased retail competition consequently led a number of national regulators to deregulate this market. In 2013, however, many European countries (including Switzerland) continued to have partially binding retail price regulation. More than a decade after liberalisation and the introduction of wholesale and retail price regulation, sufficient data is available to empirically measure the success of regulation and assess its continued necessity. This paper develops a market model based on a generalised version of the traditional “dominant firm – competitive fringe” model allowing the incumbent also more competitive conduct than that of a dominant firm. A system of simultaneous equations is developed and direct estimation of the incumbent‟s residual demand function is performed by instrumenting the market price by incumbent-specific cost shifting variables as well as other variables. Unlike earlier papers that assess market power in this market, this paper also adjusts the market model to ensure a sufficient level of cointegration and avoid spurious regression results. This necessitates introducing intertemporal effects. While the incumbent's conduct cannot be directly estimated using this framework, the concrete estimates show that residual demand is inelastic (long run price elasticity of residual demand of -0.12). Such a level of elasticity is, however, only compatible with a profit maximising incumbent in the case of largely competitive conduct (conduct parameter below 0.12 and therefore close to zero). It is therefore found that the Swiss incumbent acted rather competitively in the fixed telephony retail market in the period under review (2004-2012) and that (partial) retail price caps in place can no longer be justified on the basis of a lack of competition