The document discusses strategies to enhance health-related markets for impoverished populations by improving provider performance and addressing the inefficiencies of current health systems. It highlights the fragmentation of health services, the need for effective institutional arrangements, and the importance of partnerships among various stakeholders including governments, NGOs, and social entrepreneurs. The report aims to foster innovation and collaboration to create better-organized markets that can effectively serve poor communities.

1. Making health-related markets work better for poor people: Improving provider performance Gerald Bloom Institute of Development Studies, UK Abuja January 2009

2. Background to this meeting 2004 Workshop on Future Health Systems and 2008 special issue of Social Science and Medicine 2005 launch of Future Health Systems Consortium, scoping studies in China, Bangladesh, India, Uganda and Nigeria and interventions designed 2008 Preparation of report for the Rockefeller Foundation 2008 Meeting in Dhaka with innovators and researchers and launch of programme on making markets work better for the poor Partnerships for Future Health Systems in Nigeria

3. Rapid spread of markets for health-related goods and services Out-of-pocket payments account for a large proportion of health expenditure in many countries 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 Blurring of boundaries between public and private sectors and increased role of market relations within the public sector Increased channels for health related information through education, mass media, information technologies and promotion of drugs

4. Performance of poorly organised health markets Overemphasis on curative services Dangerous practices (sub-standard drugs, iatrogenic illness) Ineffective treatment, unnecessary costs and late referral Segmented system and lack of access by poor

5. Understanding market systems (M4P) Relationship between providers and purchasers of goods and services Performance influenced by formal and informal rules and a variety of agencies Local and global markets are linked Interventions need to bridge micro and macro and take into account power and the existence of segmented markets

6. Health-related markets Information asymmetry and trust-based institutional arrangements Path dependency, increasing returns and the importance of history Emergence of pluralistic health systems and the challenge of creating organised markets A turning point in global health markets

7. The health knowledge economy and the creation of market order Spread of markets faster than creation of appropriate institutional arrangements From low efficiency equilibrium to well-organised markets Organisations: ownership, motives, incentives and reputation Institutions: partners, co-production and the balance between social and individual interests

8. Organisations for better provider performance Informal providers and the creation of market order Building and maintaining reputations (branding, franchises and accreditation) Public providers in health markets

9. Co-production of organised markets for health-related goods and services Local and national government Traditional accountability structures Faith-based and philanthropic organisations Trade and professional associations Citizen and community groups International organisations (market, philanthropic and government actors)

10. New technologies and institutional development: the case of ICTs Tools for building and maintaining reputations (management systems, performance monitoring) Multiple channels for spread of knowledge and information Proliferation of content providers Regulating the new knowledge economy

11. Support for innovations: where innovations arise Spread from advanced market economies (investment and training) Adaptation to different contexts New markets, sources of innovation and regulatory challenges (eg drugs) Pro-poor innovation in unorganised markets and bottom-up approaches

12. Support for innovation: entrepreneurship and learning Identify, test and take local innovations to scale Facilitate spread of knowledge, experience and organisations Role of social entrepreneurs ( blurred boundary between social and commercial entrepreneurship) Securing new sources of finance and establishing new service delivery organisations Creating new markets, new organisations and new institutional arrangements

13. Building an evidence base: learning approaches to innovation and scaling up New organisations and new understandings of their role Co-production of institutions, rules and ethical norms Risk, unintended consequences, interests and the importance of path dependency Little systematic evidence on alternative strategies for improving provider performance Monitoring studies for design and redesign to adapt to context Evaluation, learning and development of indicators for regulation

14. A time of opportunities and challenges Major political changes and a move beyond ideological understandings of the roles of states and markets New sources of finance for non-government actors (public and donor funds, IFC, social entrepreneurs) Involvement of new private and state actors from China, India and other countries Economic crisis (implications for aid flows, increased competition, growing importance of regulatory issues) New understandings of the need for regulatory partnerships Responding to a window of opportunity

15. WORKSHOP OBJECTIVES Build greater understanding of existing and proposed innovations Explore possibilities for building partnerships for innovation and learning

16. PLANNED OUTPUTS Improved innovations A multi-disciplinary team to support learning approaches Proposals for collaboration on making health-related markets work better for the poor