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Analysis on demand: ‘demand side’ issues in pro-poor health policy

The term ‘demand side’ is seen more and more in health planning and policy documents. It refers to the behaviour and inputs of health service users but means different things to different people. These multiple demand side approaches pose major challenges for governments and aid agencies.

An Issues Paper from the UK Department for International Development's Health Systems Resource Centre points out that the current focus on demand side issues is due to:

high levels of out-of-pocket spending on health care by households in poor countries
increasing multitude of different providers
collapse of some public sector services
governance and regulatory failures
limited success of supply side health sector reforms.

This has led to two concerns: understanding health-seeking behaviours and patterns of utilisation with a view to either changing them or catering better to them; and finding ways to harness the demand side to press for change and responsiveness in the supply side.

There are different ways of understanding the demand side. The paper reviews the six main approaches, in terms of the themes, actors and tools involved and the challenges they present:

understanding and changing user behaviour to improve health outcomes
recognising the rights of people to health care
using demand to improve provider accountability
encouraging participation in policy amongst users and providers
partnerships across users and public, private and voluntary sectors
channelling resources directly to the demand side to obtain health goods and services through vouchers, coupons or cards.

From this analysis, the paper concludes that for development agencies, working more actively with the demand side may involve:

analysing the contexts within which service delivery occurs and the politics of working simultaneously with governments, civil society and local communities
providing financial support to civil society organisations
working with governments, professional bodies and intermediate organisations to support demand side interventions
building capacity for monitoring service delivery using demand-sensitive indicators on quality, accountability and outcomes
negotiating greater service user influence into aid instruments and macro-economic policy.

Source(s):
‘Understanding the ‘demand side’ in service delivery. Definitions, frameworks and tools from the health sector’, DFID Health Systems Resource Centre Issues Paper – Private Sector, by H. Standing, March 2004 Full document.
DFID/Eldis Health Systems Resource Guide Full document.

Funded by: UK Department for International Development

id21 Research Highlight: 19 October 2005

Further Information:
Hilary Standing
Health and Social Change Team
Institute of Development Studies
University of Sussex
Brighton BN1 9RE
UK

Tel: +44 (0) 1273 606261
Fax: +44 (0) 1273 621202 / 691647
Contact the contributor: H.Standing@ids.ac.uk

UK Department for International Development's Health Resource Centre

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