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Making health-related markets work better for poor people: Improving provider performance


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This presentation was given by Gerry Bloom to the Future Health Systems meeting in Abuja, Nigeria, January 2009.

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Making health-related markets work better for poor people: Improving provider performance

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