PHA-Exchange> Private provision in its institutional context: Lessons from health

[claudio at hcmc.netnam.vn]

from "Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG> -----

Private provision in its institutional context:
Lessons from health

Gerald Bloom, Institute of Development Studies, University of Sussex, UK

The DFID Health Systems Resource Centre (HSRC), March 2004         
 

Available online as PDF file [41p.] at: 
http://www.dfidhealthrc.org/Shared/publications/Issues_papers/private-se
ctor/Bloom.pdf

.....     One characteristic of discussions about strategies for the
provision of services to poor people has been the persistence of
ideological debates about the relative roles of public and private
sectors. These debates are strongly influenced by the experiences of the
advanced market economies and often do not reflect the reality of
countries where most poor people live. This paper's aim is to contribute
to the development of common understandings of this reality and to the
formulation of practical strategies for meeting the needs of the poor.

During the second half of the twentieth century, the health policies of
many low and middleincome countries were largely based on expanding
government health services. Some countries created effective and
equitable government health services. Many did not, and some government
health systems have faced difficulties associated with major social and
economic change. Pluralistic health systems have emerged in which the
boundaries between public and private sectors are blurred, with negative
consequences for quality and cost. This is particularly the case in
countries that have experienced prolonged economic crisis and in
countries in transition to market economies. 
 
The private sector is not a single entity. Providers can be classified
by the economic characteristics of different health goods, the type of
service, the degree to which they are part of an organised institutional
arrangement and the social group whose members use them. Different
strategies are needed to influence different classes of provider.

Better analysis for improved understanding

There are no simple frameworks to guide the formulation of comprehensive
national strategies towards private providers in low and middle-income
counties. In developing such strategies, policy analysts need to:

* learn how to analyse pluralistic health systems;

* do rigorous local and national institutional analyses (covering
governments, private sector actors and civil society organisations) that
focus on (local) inter-institutional relationships, including the
'social contracts' that underpin these relationships and other forms of
accountability

* understand local stakeholders, their interests and how they influence
policy outcomes at national and local levels;

* be cautious and selective in drawing on insights from the experiences
of the advanced market economies;

* learn from a variety of institutional innovations from around the
world......."

            Content: 

1      Introduction 
2      Public and private in advanced market economies 
2.1   The ideological nature of understandings of public and private 
3     Public and private in low and middle-income countries 
3.1 Informalisation in Africa 
3.2 Transition from a command economy 
3.3 The analysis of public and private in situations of rapid change 
4     Private providers in low and middle-income countries 
4.1 Economic characteristics of health care goods 
4.2 Organised and unorganised health care economy 
4.3 Segmented health care systems 
4.4 Institutional arrangements 
5     Interventions 
6     Building appropriate institutional arrangements 


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