• Inducing a change in policy

Inducing a change in policy

How can health policies and health system developments improve the health of poor people? This initial working paper for the UK Department for International Development (DFID) by the DFID Health Systems Resource Centre (HSRC) is their first output on pro-poor health policies. It looks at the options for health policies and health system development to improve the health of poor people, and attempts to clarify issues and set out an agenda for further work.

Poverty can be defined in a number of ways, however it is important to know the characteristics of the poor and vulnerable at a country level. The paper begins by considering definitions of ‘poor’ and discussing approaches to measuring poverty, followed by what studies have shown about the health of the poor and their use of and need for health services. This information forms the basis for designing interventions and monitoring their impact. Three strategies for pro-poor health policy are discussed: ensuring the poor are covered by public health services; improving access to and quality of health services used by the poor; and avoiding heavy expenditures by the poor on health care which exacerbates their poverty. Resource allocation and Sector Wide Approaches (SWAps) are also considered.

Rather than improving equity as a goal, pro-poor health policies are those that ensure the following:

• Public health services actually reach the poor. Both geographical targeting and targeting by disease are found to be the best methods.
• Access and quality of personal health services is improved. Options to be considered include: the identification of a basic package which focuses on providing key interventions; management and organisational reforms in the public sector; regulating and improving performance of the private health sector.
• Heavy expenditure on health care by the poor is avoided. Possibilities include exemptions or waivers of user fees targeted at specific groups for services used by the poor, health insurance such as social insurance and community health insurance and local solidarity schemes.
• Resources are adequately allocated. In many countries basic services and primary health care are not receiving an adequate proportion of the health budget, and difficulties exist in getting staff to move to less favoured regions and services.

The paper concludes by suggesting that further work needs to be performed on the following issues:

• Encouraging the poor in accessing appropriate healthcare. The poor need to be included and participate in the policy process in order that appropriate healthcare systems are developed.
• Trying to do too much with too little. Ministries of Health need to work with the resources they’ve got in producing an affordable and effective range of services.
• Reorienting health systems towards provision of primary health care.
• Improving public sector performance. Factors to consider include organisational structure and management, resource allocation, human resources, monitoring and supervision roles, and drugs. Similarly, private sector performance needs improving.
• Financing health systems. Private expenditure, which accounts for the majority of health expenditure in most developing countries, is an inequitable means of financing.
• Increasing knowledge about what causes ill health in the poor. More evidence and research is required.

• Full text of document
• Publisher details
• Send to a friend