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Abstract Background Assessments over the last two decades have showed an overall low level of performance of the health system in Indonesia with wide variation between districts. The reasons advanced for these low levels of performance include the low level of public funding for health and the lack of discretion for health system managers at the district level. When, in 2001, Indonesia implemented a radical decentralization and significantly increased the central transfer of funds to district governments it was widely expected that the performance of the health system would improve. This paper assesses the extent to which the performance of the health system has improved since decentralization. Methods We measured a set of indicators relevant to assessing changes in performance of the health system between two surveys in three areas: utilization of maternal antenatal and delivery care; immunization coverage; and contraceptive source and use. We also measured respondents' demographic characteristics and their living circumstances. These measurements were made in population-based surveys in 10 districts in 2002-03 and repeated in 2007 in the same 10 districts using the same instruments and sampling methods. Results The dominant providers of maternal and child health in these 10 districts are in the private sector. There was a significant decrease in birth deliveries at home, and a corresponding increase in deliveries in health facilities in 5 of the 10 districts, largely due to increased use of private facilities with little change in the already low use of public facilities. Overall, there was no improvement in vaccination of mothers and their children. Of those using modern contraceptive methods, the majority obtained them from the private sector in all districts. Conclusions There has been little improvement in the performance of the health system since decentralization occurred in 2001 even though there have also been significant increases in public funding for health. In fact, the decentralization has been limited in extent and structural problems make management of the system as a whole difficult. At the national level there has been no real attempt to envision the health system that Indonesia will need for the next 20 to 30 years or how the substantial public subsidy to this lightly regulated private system could be used in creative ways to stimulate innovation, mitigate market failures, improve equity and quality, and to enhance the performance of the system as a whole.

This Policy Note sets out the options for future development of the health system together with the Department of Health and Family Welfare, based on an analysis of existing data on health outcomes, health financing utilization of current health infrastructure in the public and private sector, a description and assessment of the Government of West Bengal's current policy and developments, and of donors' recent investments and plans for the future. The purpose of this Note would be to set the basis for identifying key strategic directions for reform of the health sector. The report is structured as follows: After the executive summary, section 1 discusses the current health status. Section 2 examines health care financing. Section 3 describes health delivery systems. Section 4 measures health system performance. Section 5 reviews recent health reforms. Section 6 elaborates what needs to be strengthened and what needs to be done differently.

Cochrane is an international network that produces and updates new knowledge through systematic reviews for the health sector. Knowledge is a shared resource, and can be viewed as a commons. As Cochrane has been in existence for 25 years, we used Elinor Ostrom's theory of the commons and Institutional Analysis and Development Framework to appraise the organisation. Our aim was to provide insight into one particular knowledge commons, and to reflect on how this analysis may help Cochrane and its funders improve their strategy and development. An assessment of Cochrane product showed extensive production of systematic reviews, although assuring consistent quality of these reviews is an enduring challenge; there is some restriction of access to the reviews, open access is not yet implemented; and, while permanence of the record is an emerging problem, it has not yet been widely discussed. The assessment of the process showed that the resource, community, and rules-in-use are complex, vary between different groups within Cochrane, and are not well understood. Many of the rules have been informal, and the underlying ethos of volunteerism where reviews get done are important features and constraints to the organisation. Like all collective efforts, Cochrane is subject to collective action problems, particularly free-riding and variable commitment, and the under-production of public goods and internal processes, such as surveillance of product quality and procedures for transparent resolution of conflicts.

The population of Assam is 26.64 million (2001), more than 85% of which live in rural areas. The state is one of the poorer states in the country, with an estimated GDP per capita equal to Rs. 12,163, which is less than two thirds of the national average (2001-02). Growth in the 1980-90s has been one of the lowest in the country (just above 1 percent real per capita growth), although the economic situation is reported to have improved in more recent years. The economy is predominantly rural (40 percent of Net State Domestic Product is from agriculture, and 74 percent of the population is engaged in agriculture), and it is heavily dependent on the tea estate sector (800 tea gardens that produce 15% of the world tea). The non-agricultural principal activity is oil and gas extraction and transformation (there are two oil refineries in the North-Eastern part of the state, plus a third one is under construction). Population below poverty line is estimated to be 36 percent, scheduled caste 7.4 percent and scheduled tribe 12.8 percent of the total population.

Public health in the early 21st century increasingly considers how social inequalities impact on individual health, moving away from the focus on how disease relates to the individual person. This 'new public health' identifies how social, economic and political factors affect the level and distribution of individual health, through their effects on individual behaviours, the social groups people belong to, the character of relationships to others and the characteristics of the societies in which people live. The rising social inequalities that can be seen in nearly every country in the world today present not just a moral danger, but a mortal danger as well. Social inequality and public health brings together the latest research findings from some of the most respected medical and social scientists in the world. It surveys four pathways to understanding the social determinants of health: differences in individual health behaviours; group advantage and disadvantage; psychosocial factors in individual health; and healthy and unhealthy societies, shedding light on the costs and consequences of today's high-inequality social models. This exciting book brings together leaders in the field discussing their latest research and is a must-read for anyone interested in public health and social inequalities internationally