Making health-related markets work better for poor people: Improving provider performance
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Transcript of Making health-related markets work better for poor people: Improving provider performance
Making health-related markets work better for poor people:
Improving provider performance
Gerald BloomInstitute of Development Studies, UKAbujaJanuary 2009
Background to this meeting
2004 Workshop on Future Health Systems and 2008 special issue of Social Science and Medicine
2005 launch of Future Health Systems Consortium, scoping studies in China, Bangladesh, India, Uganda and Nigeria and interventions designed
2008 Preparation of report for the Rockefeller Foundation
2008 Meeting in Dhaka with innovators and researchers and launch of programme on making markets work better for the poor
Partnerships for Future Health Systems in Nigeria
Rapid spread of markets for health-related goods and services
Out-of-pocket payments account for a large proportion of health expenditure in many countries
Emergence of pluralistic health systems with a variety of providers of health-related goods and services in terms of skills and relationship to legal framework
Blurring of boundaries between public and private sectors and increased role of market relations within the public sector
Increased channels for health related information through education, mass media, information technologies and promotion of drugs
Performance of poorly organised health markets
Overemphasis on curative services
Dangerous practices (sub-standard drugs, iatrogenic illness)
Ineffective treatment, unnecessary costs and late referral
Segmented system and lack of access by poor
Understanding market systems (M4P)
Relationship between providers and purchasers of goods and services
Performance influenced by formal and informal rules and a variety of agencies
Local and global markets are linked
Interventions need to bridge micro and macro and take into account power and the existence of segmented markets
Health-related markets
Information asymmetry and trust-based institutional arrangements
Path dependency, increasing returns and the importance of history
Emergence of pluralistic health systems and the challenge of creating organised markets
A turning point in global health markets
The health knowledge economy and the creation of market order
Spread of markets faster than creation of appropriate institutional arrangements
From low efficiency equilibrium to well-organised markets
Organisations: ownership, motives, incentives and reputation
Institutions: partners, co-production and the balance between social and individual interests
Organisations for better provider performance
Informal providers and the creation of market order
Building and maintaining reputations (branding, franchises and accreditation)
Public providers in health markets
Co-production of organised markets for health-related goods and services
Local and national government
Traditional accountability structures
Faith-based and philanthropic organisations
Trade and professional associations
Citizen and community groups
International organisations (market, philanthropic and government actors)
New technologies and institutional development: the case of ICTs
Tools for building and maintaining reputations (management systems, performance monitoring)
Multiple channels for spread of knowledge and information
Proliferation of content providers
Regulating the new knowledge economy
Support for innovations: where innovations arise
Spread from advanced market economies (investment and training)
Adaptation to different contexts
New markets, sources of innovation and regulatory challenges (eg drugs)
Pro-poor innovation in unorganised markets and bottom-up approaches
Support for innovation: entrepreneurship and learning
Identify, test and take local innovations to scale
Facilitate spread of knowledge, experience and organisations
Role of social entrepreneurs (blurred boundary between social and commercial entrepreneurship)
Securing new sources of finance and establishing new service delivery organisations
Creating new markets, new organisations and new institutional arrangements
Building an evidence base: learning approaches to innovation and scaling up
New organisations and new understandings of their role
Co-production of institutions, rules and ethical norms
Risk, unintended consequences, interests and the importance of path dependency
Little systematic evidence on alternative strategies for improving provider performance
Monitoring studies for design and redesign to adapt to context
Evaluation, learning and development of indicators for regulation
A time of opportunities and challenges Major political changes and a move beyond
ideological understandings of the roles of states and markets
New sources of finance for non-government actors (public and donor funds, IFC, social entrepreneurs)
Involvement of new private and state actors from China, India and other countries
Economic crisis (implications for aid flows, increased competition, growing importance of regulatory issues)
New understandings of the need for regulatory partnerships
Responding to a window of opportunity
WORKSHOP OBJECTIVES
Build greater understanding of existing and proposed innovations
Explore possibilities for building partnerships for innovation and learning
PLANNED OUTPUTS
Improved innovations
A multi-disciplinary team to support learning approaches
Proposals for collaboration on making health-related markets work better for the poor