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The proof of the reform is in the implementation
Author(s) -
Blas Erik
Publication year - 2004
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.781
Subject(s) - tanzania , harm , china , economic growth , development economics , control (management) , public health , public economics , state (computer science) , political science , economics , medicine , socioeconomics , computer science , law , nursing , management , algorithm
In 2000, TDR funded a series of studies to examine the opportunities and threats of health sector reform to the control of tropical diseases. This article is a cross‐case analysis of ten of those studies, exploring the similarities in patterns across the countries covered: Colombia, China, Nigeria, the Philippines, Sudan, Tanzania and Uganda. The implementation experiences across countries were strikingly similar despite very different socio‐economic and epidemiological situations. The reform implementation was neither complete nor clean and had in all the countries found some sort of least‐energy equilibrium where the processes had stopped at a sub‐optimal stage needing considerable renewed ‘change‐energy’ to achieve its objectives. The role of the state had, in several cases, been reduced to a situation where it neither pursued the interest of the public nor protected the individual against harm caused by the behaviours of others. Whether one should follow a dedicated disease control programme or a systems approach is not a relevant question. Effective disease control cannot be implemented without strong and functioning health systems and health system performance cannot be improved without considering which purpose the system is to serve. Copyright © 2004 John Wiley & Sons, Ltd.