New approaches to the management of publicly funded health services in developed countries, plus ackwledgement of government failure to ensure equity and efficiency, have combined to stimulate a widespread movement for health sector reform in low- and middle-income countries. Common policy trends include separating purchaser and provider functions; increased automy for public sector organizations such as hospitals; encouraging competition between providers; and increased funding from n-tax sources, such as user fees. This book examines the feasibility and desirability of such reform in low-income countries, based on in-depth case studies in Ghana, Zimbabwe, Sri Lanka, India and Thailand. It asks what capacities governments require to assume effectively these new and often complex roles, and how capable governments appear to be in performing these new functions. On the basis of research findings, the book challenges the conventional reform wisdom, and argues that reform approaches are needed that are more deeply rooted in, and sensitive to, the institutional characteristics of individual countries.
NIMAL ATTANAYAKE Senior Lecturer and Coordinator of the Health Economics Study Programme, Department of Economics, University of Colombo, Sri Lanka CHARLES HONGORO Medical Research Officer, Public Health Unit, Blair Research Institute, Ministry of Health and Child Welfare, Zimbabwe V.R. MURALEEDHARAN Associate Professor of Economics, Department of Humanities and Social Sciences, Indian Institute of Technology, Madras PAUL SMITHSON Health Sector Policy and Systems Adviser, Department for International Development