Responding to the marketisation of health

The drafters of the Alma Ata Declaration drew on the experiences of those post-revolutionary and post-colonial regimes, which were rapidly overcoming a lack of health facilities, health workers and drugs. Their governments were the major actor in building a modern health sector through direct provision of services. The situation has changed a great deal since then. Although some remote areas still lack health services, this is much less often the case. One commonly finds both trained and untrained people, in a variety of settings, providing health care and selling drugs. The boundary between public and private sectors is blurred and government health workers frequently ask for informal payments or see patients privately. Many of these activities occur outside an organised, regulated framework of health care provision. Potential users are much more likely to live near a health facility or some kind of provider than 30 years ago, but now they face major challenges in paying for care and finding competent providers and effective and appropriate drugs.
Controversy rages over how best to deal with the reality of private and informal provision of health services with some advocating for investment in public systems alone and others calling for support to improvements in access and quality however services are delivered.