Introduction to Health Sector

Reforms
Background

■ Since the Alma Ata declaration of PHC, there

have been different interventions to aimed at
improving health

■ These interventions include the World Bank

and IMF promoted Reforms that affected
various sectors including Health
 Why Health Sector Reforms
1. 1980s to 90s there were scarce resources for
health care in developing countries because of:

a. political instability

b. economic crisis

c. donor fatigue
 Why Health Sector Reforms
2. The little public resources resources
available were being misused:

a. inappropriate services focussing more on

curative and less on preventive aspects
b. A lot of resources used for services that are not
essential
c. Too much money lost in procurement
 Why Health Sector Reforms
■ Poor utilisation of services due to:
■ inadequate staff, supplies & drugs
■ poor access & quality

The main aim of the reforms was, therefore, to

improve efficiency, equity, access and quality
of health services for the better health of the
population
 Why Health Sector Reforms
■ In the 1980s most African countries were
experiencing economic crises leading to a
breakdown in their social services systems

■ In response, many African countries were

“advised” to adopt structural adjustment
programs by WB and IMF
Structural Adjustment Programs

■ Uganda adopted the HSRs based on four

major market principles:
1. Individuals, charities and private
organisations should be made responsible
for health care service delivery
2. Public funding of health care should be
restricted to health promotion and
prevention of diseases
 Structural Adjustment Programs

Principles of HSRs in Uganda: cont’d

3. Central government’s role should be restricted
to policy formulation and technical guidance,
delivery of services left for the private sector
and local authorities
4. The private sector and non-government
organisations should be supported to become
the key providers of health and social services
Structural Adjustment Programs

The reforms resulted into:

■ Health sector budget reduction

■ Promotion of the private sector (PPPH)

■ Liberalization of prices

■ Downsizing of the public service sector

(retrenchment) and,
■ Decentralisation of health service delivery
Reforms to be discussed in this module

■ Public-Private Partnership in Health

■ Sector-wide Approaches

■ Decentralization

The successes or failure of these reforms

have generated a lot of international debate