|
|
|
|
|
|
|
|
|
|
  |
 |
  |
This is an archived USAID document retained on this web site as a matter of public record.
Health systems and services: Progress, lags and a rising private role
>> Foreign Aid in the National Interest >> Chapter 3 >> Health Indicators: Advances and Obstacles Jump to Chapter 3 Sections:
>> Health, development and aid >> Broad progress, startling changes, persistent quandaries >> Health indicators: advances and obstacles >> Health systems and services >> To review the bidding >> Implications of trends for future directions >> Implications for the philosophy and pursuit of "foreign assistance" >> Notes >> Background paper >> References
As in other areas, the least developed countries have seen much less progress on controlling diseases and providing services. In some African countries oral rehydration use has increased by several times in recent years. Yet in countries such as Burkina Faso and Mali, use hovers below 20 percent-even while it is 30-50 percent in countries like Ghana, the Philippines, and Thailand.
As noted, the presence of skilled attendants at delivery helps prevent maternal deaths. In Latin America and the Caribbean trained personnel are present for 75 percent of births. Yet in Asia only 50 percent of births are attended by skilled personnel, 98 and in Africa just 40 percent and in some African countries, 20 percent.
Changes in financing
Financing has long been a central concern of global health efforts. Funding was traditionally seen as a matter of increasing and managing public health budgets, with most revenue coming from the state. But concerns about the adequacy of public budgets have grown as costs and public expectations have increased and as responsibilities of public health authorities have expanded.
More attention is being paid to the role of private resources in providing and paying for health services in developing countries. Over the past 10 years middle-income countries have experimented with prepaid insurance and service fees. But private resources are also crucial in low-income countries. Surveys in Indonesia, Pakistan, and Sri Lanka have found that most consumers bypass free public services, choosing to pay for services at private facilities or though traditional sources. In Burkina Faso just 17 percent of malaria patients were treated by professional public or private services. Most purchased treatments at pharmacies or paid traditional healers.
Data collected by the World Health Organization show the enormous importance of private spending on health care in most countries rich and poor, large and small. By 1998 more than 50 percent of health spending occurred in the private sector in most developing countries. Private funding exceeds 60 percent in countries as different as Bangladesh (63 percent), China (61 percent), Egypt (69 percent), India (82 percent), Indonesia (74 percent), Pakistan (76 percent), Morocco (70 percent), and Uganda (62 percent). This spending is almost always out-of-pocket. In most systems little or no role is played by risk-pooled payment mechanisms, which can enable individuals and employers to pay affordable health care premiums and receive quality care.
page 3
 |
|||
Last Updated on: October 07, 2009 |
