BIOETYKA / WPROWADZENIE

BIOETYKA / WPROWADZENIE - Przeglądy aktów prawnych

Better health for poor children. A special report – 2002

Characteristics of Health System s. 12

Characteristics of the health system and health services are a third important set of underlying factors that affect child health.

• Availability of services for example, through the presence of a health worker trained in the management of childhood conditions and illnesses is an important determinant of which services families use, how often and for what types of problem.

• Accessibility, or the ease with which people can get to and use facilities, is also important. Various factors influence service utilization, such as distance to the facility, opening hours, and availability of trained staff and drugs.

• Affordability plays a key role in utilization. Higher prices have been associated with reduced or delayed care-seeking, especially among the poor.

• Perceived quality of health services also makes a difference. Caregivers take their children to providers or facilities that they believe provide the best care for the childand the most support for themselves.

Compared to the rich, the poor are consistently disadvantaged in the availability, accessibility and quality of health services. Poor families also spend a higher proportion of their income on out-of-pocket fees for health care.

Allocating resources for improved service delivery for poor children and families s. 25

Child health policymakers and planners often overlook the importance of financing in their efforts to improve service delivery for poor children. There is an array of financing sources and options available to governments, although few reports of systematic evaluation of their impact and implications are yet available. Options that go beyond the types of donor initiatives described above for strengthening the financing of health services for poor children include:

_ Government budgets. There are strong and repeated recommendations that governments increase their routine spending for health care, despite shrinking economies and uncertain political futures. The key recommendation of the Macroeconomic Commission on health, as identified by the commissioners themselves, is that the governments of all countries should “…scale up the access of the world’s poor to essential health services, including a focus on specific interventions”.

_ Insurance. Insurance schemes are being tried in several countries as a way to extend coverage to the poor and other specific population groups. Examples include Mexico, where school enrolment in poor regions carries health insurance with it; South Africa, where an insurance scheme has been developed for poor children; and Egypt, where insurance coverage has been extended to all children and includes the poorest groups. There are few instances of systematic evaluation of these or other insurance strategies for improving health service delivery to the poor.

_ Community-based financing. Such schemes have been widely promoted, but a recent review of community-based approaches to health care financing for the poor has found that most had not been sustained after the end of the initial pilot period.

_ Donor assistance, including low-cost loans and grants available through regional and international lending institutions. High-income countries need to greatly increase amounts of money available as grants and low-cost loans to the poorest countries to address health needs Whatever the mechanism used to finance health services, it is essential that the needs of the poorest be recognized as special, and that specific steps be taken to avoid further restricting their access to health services. Monitoring and evaluation mechanisms should be put in place to detect any possible adverse effects on the health of the poorest of new approaches to financing.

Involving the private sector

In settings where private-sector health services exist, the poor as well as the rich use them. Better coordination with the private sector has also been proposed as a way for governments and donors to improve the availability, quality, and effectiveness of child health services. Few data are yet available to evaluate this claim. There is, however, an increasing bank of experience in involving the private sector in child health services. One specific option, contracting, is receiving increasing attention as a possible strategy to improve health sector efficiency. Governments may contract with either government or non-government providers to provide health services to the public. In addition to service provision, the private sector plays a significant role in a number of other areas that are critical for child health, such as manufacturing and marketing of fortified foods, impregnated bed-nets, vaccines, and drugs. Many nongovernmental organizations are active in promoting healthy behaviours and social marketing. Collaboration with the private sector also presents significant challenges. For example, the diversity of private sector providers can make it difficult for governments and donors to identify opportunities and establish mechanisms for cooperation. More rigorous evaluation is needed of the impact and sustainability of private-sector strategies as a way to improve the health of poor children.