Suchergebnisse

1. Introduction / Gerald Bloom. [et al.] -- 2. Transition in the Indian healthcare market / Barun Kanjilal and Sumit Mazumdar -- 3. Lessons from an intervention programme to make informal health care providers effective in a rural area of Bangladesh / Mohammad Iqbal. [et al.] -- 4. Drug detailers and the pharmaceutical market in Bangladesh / M. Hafizur Rahman and Smisha Agarwal -- 5. China's rural hospitals in the transition to a market economy : a case study in two peri-urban counties in Guangxi province / Gerald Bloom. [et al.] -- 6. Informal markets in sexual and reproductive health services and commodities in rural and urban Bangladesh / Hilary Standing, Sabina Faiz Rashid, and Owasim Akram -- 7. Improving the performance of patent medicine vendors in Nigeria / Oladimeji Oladepo and Henry Lucas -- 8. Yes, they can : peer educators for diabetes in Cambodia / Maurits van Pelt. [et al.] -- 9. Evidence of the effects of market-based innovations and international initiatives to improve the performance of private providers / Claire Champion, Gerald Bloom, David Peters -- 10. A review of ICT innovations by private sector providers in developing countries / Henry Lucas -- 11. The economics of social franchising for health in low and middle income countries / David Bishai and Claire Champion -- 12. Conclusions : making health markets work better for poor people / Gerald Bloom. [et al].

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.

This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes. We focus on situations where 'country ownership' of HSR is relatively well established and where there is significant involvement of local researchers and close ties and relationships with policy makers are often present. We frame our discussion around two country case studies with which we are familiar, namely China and South Africa and discuss the implications for conducting 'embedded' research. We suggest that reflexivity is an important concept for health system researchers who need to think carefully about positionality and their normative stance and to use such reflection to ensure that they can negotiate to retain autonomy, whilst also contributing evidence for health system change. A research process informed by the notion of reflexive practice and iterative learning will require a longitudinal review at key points in the research timeline. Such review should include the convening of a deliberative process and should involve a range of stakeholders, including those most likely to be affected by the intended and unintended consequences of change.

AbstractThe aim of this article is to contribute to the understanding of the institutional arrangements within which China's rural health facilities are embedded and of the contribution of policy to the creation of these arrangements. Information collected through field observations and in‐depth interviews with the managers, staff and patients of a township health centre indicates that with the gradual evolution of markets, encouraged by state policies, health care in rural China took on more of the characteristics of a commodity. In order to adapt to this change, the health centre and its employees are adjusting their behavioural norms and reconstructing an institutional network within which daily activities of simultaneously fulfilling public health responsibilities and pursuing economic gain are legitimized. This article focuses on the interwoven relationship between politics and markets at the micro level and examines the negotiations between stakeholders in constructing new institutional arrangements. It also describes how health sector managers are creating regulations to influence the performance of their facility. The article argues that while government policies play a crucial role in shaping the direction of development, institutional arrangements strongly influence the attempts by rural health organizations to implement them. It concludes that it is critical to take institutional factors into account in analyzing China's rural health‐care reforms.