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Transforming Health Markets in Asia and Africa


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Gerry Bloom and David Peters introduce the key concepts from their new book, Transforming Health Markets in Asia and Africa, at a recent launch event hosted by the Results for Development Institute for the DC Health systems Board.

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Transforming Health Markets in Asia and Africa

  1. 1. IDS_Master Logo IDS_Master Logo_Minimum Size X X Minimum Size Minimum Size X :15mm X :15mm
  2. 2. Transforming health markets in Asia and Africa: Improving quality and access for the poor Gerry Bloom, IDS David Peters, JHSPH Gina Lagomarsino, R4D 17 October 2012
  3. 3. The spread of health markets…. •Complex markets with a wide variety of sellers of health-related goods and services in terms of ownership, mission, reputation and accountability •Blurred boundaries between public and private sectors and importance of market relationships (informal payments, dual practice, perverse incentives) •Largely private production and distribution of drugs and diagnostic tests2
  4. 4. .... faster than institutions to ensure they perform well •Lack of mechanisms to identify and reward quality •Inadequate systems of accreditation, regulation and accountability •Often segmented systems with organised and regulated services for the rich and unorganised markets for the poor •Vicious circle of low trust, efficacy and efficiency3
  5. 5. Wide availability of drugs and medical advice but…… Low quality High costs Inadequate Exacerbation referral of inequality4
  6. 6. Building knowledge of health markets: a scoping study •Focus on outpatient services •Review global knowledge •Case studies in Bangladesh, Cambodia, China, India, Nigeria •Analytical framework combining a development and public health approach (understanding of markets for poor people and the special characteristics of health- related goods and services)5
  7. 7. The health market systems approach
  8. 8. Actors, relationships and power •Established role of informal providers as trusted sources of advice and treatment (Bangladesh) •Strong links to drug wholesalers (Bangladesh) •The role of associations of informal providers (Bangladesh, Nigeria) •New ways of organising citizens to manage chronic illness (Cambodia) •The importance of the media and ICTs as a source of information •New kinds of relationships between governments and market actors (China, India)7
  9. 9. From working with private providers to engaging with health markets…. •Analyse local health market system •Understand and support innovators •Design interventions based on an understanding of the likely responses of different actors •Use a learning approach to build new kinds of partnership and respond to unintended outcomes8
  10. 10. Improved analyticsGreater Morerole for segmented ICTs markets Dependence on informal providers Need for Increasing trusted information local asymmetry institutions
  11. 11. People depend on informally trained providersPeters DH and Bloom G. 2012. Bring order to unregulatedhealth markets. Nature. 487: 163-165
  12. 12. Key Message 1: Marketized health care needs better analytics •Health care in LMICs are highly marketized and pluralistic. •There is a large gap between the public goals and the messy reality. •Better analytical and practical understanding of this reality is needed.11
  13. 13. Key Message 2: Health systems are segmented, but markets affect everyone • Health systems are highly segmented, though market transactions affect all socio-economic groups. • Markets are segmented in complex ways that reflect: • Users’ purchasing power (or lack of it) • Cultural and social needs • Understandings of health and disease • Assessments of provider reputation12
  14. 14. Key Message 3: Markets need trusted institutions emerging from local contexts •Trust-based institutional arrangements to provide an assurance of competence and effectiveness has lagged behind the growth of markets. •Path dependency of health systems means can’t just copy OECD models – need to develop from the actors and emerging informal and formal institutional arrangements in a country. •They will reflect a country’s political economy, including the role of government and factors affecting legitimacy of the regime.13
  15. 15. Key Message 4: Information asymmetry harms the poor, but lessons from other sectors offer new opportunities •Information asymmetry pervades health markets and puts the poor at a disadvantage. •Information asymmetry pervades all knowledge-based market transactions, not only health. •There is much to be learned from other markets’ approaches to reducing information asymmetries in ways that benefit the poor.14
  16. 16. Key Message 5: Health ICTs can change provider and public behavior to improve access to health •Recent developments in information and communications technology (ICT) and knowledge intermediaries are creating new opportunities for structuring access to health knowledge and influencing providers and the public.15
  17. 17. Questions for Gina • How do findings compare with work of CHMI? • What are the most promising opportunities for intervening in health markets? • What can we learn from other markets about reaching the poor?16
  18. 18. From shortage of access to unruly markets •We argue that shortage is no longer the main problem, but has been replaced by issues with large, unruly markets. There are problems with quality and accountability, but also opportunities for expanding access. •Is the diagnosis wrong? •Will health markets “fix” themselves on their own? E.g. will informal providers be crowded out as people get wealthier and smarter? •What is needed to change the thinking of governments, development agencies, general public to address health markets?17
  19. 19. Informal regulation • Informal arrangements for regulation are emerging in many health markets • Are they effective? •Can they be influenced to support public objectives? •Are they sustainable?18
  20. 20. Model for transforming health markets: What are the prospects? •We propose public participation, iterative learning, good technical management, and top-down institutional support as a process for transforming health markets. • Is this feasible, testable, compatible with how key stakeholders operate in health markets? • What are the opportunities for testing this? What are the alternatives?19
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