The aim of this paper is to contribute to debates about how governments and other stakeholders ca... more The aim of this paper is to contribute to debates about how governments and other stakeholders can influence the application of ICTs to increase access to safe, effective and affordable treatment of common illnesses, especially by the poor. First, it argues that the health sector is best conceptualized as a 'knowledge economy'. This supports a broadened view of health service provision that includes formal and informal arrangements for the provision of medical advice and drugs. This is particularly important in countries with a pluralistic health system, with relatively underdeveloped institutional arrangements. It then argues that reframing the health sector as a knowledge economy allows us to circumvent the blind spots associated with donor-driven ICT-interventions and consider more broadly the forces that are driving e-health innovations. It draws on small case studies in Bangladesh and China to illustrate new types of organization and new kinds of relationship between organizations that are emerging. It argues that several factors have impeded the rapid diffusion of ICT innovations at scale including: the limited capacity of innovations to meet health service needs, the time it takes to build new kinds of partnership between public and private actors and participants in the health and communications sectors and the lack of a supportive regulatory environment. It emphasises the need to understand the political economy of the digital health knowledge economy and the new regulatory challenges likely to emerge. It concludes that governments will need to play a more active role to facilitate the diffusion of beneficial ICT innovations at scale and ensure that the overall pattern of health system development meets the needs of the population, including the poor.
Background: This paper explores the evolution of schemes for rural finance in China as a case stu... more Background: This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. Methods: The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. Results: The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. Conclusions: This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.
There is growing international concern about the threat to public health of the emergence and spr... more There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets. There is evidence that these markets have enabled people to treat many infections and reduce mortality. However, they also encourage overuse of antibiotics and behaviour likely to encourage the emergence of resistance. The paper reviews a number of strategies for improving the use of antibiotics. It concludes that effective strategies need measures to ensure easy access to antibiotics, as well as those aimed at influencing providers and users of these drugs to use them appropriately.
The policy capacity framework offers relevant analytical ideas that can be mobilized for health s... more The policy capacity framework offers relevant analytical ideas that can be mobilized for health system strengthening. However, the employment of this framework in the health field constitutes a relevant interdisciplinary gap in knowledge. This themed issue explores the relationships between the policy capacity framework and health system strengthening, in a multidimensional and interdisciplinary way, in high-income and low–middle-income countries. This introduction unpacks the dynamic interrelationships between the policy capacity framework and health system strengthening, bringing together common and distinct elements from both fields and summarizing possible relationships between them. The analysis shows that both fields together can increase our knowledge on health policies and system’s critical themes and reforms. This challenge could be followed by exploring the convergences between them, as far as concepts/themes (types of capacities and other themes) and levels of analysis ar...
This paper presents a case example from China, where detailed deliberations were instrumental in ... more This paper presents a case example from China, where detailed deliberations were instrumental in bringing together national and subnational managers to tailor implementation protocols for neonatal care strategies at provincial and county levels. The China National Health Development Research Center (CNHDRC) organised deliberations to support the formulation of strategies for improving early essential neonatal care for rural areas. The aim was to help counties, the lowest level jurisdiction in China, learn what could work locally, and to help provinces and the national government learn what should inform national policy and be disseminated widely in China’s decentralised health system. It became clear that central-level stakeholders needed to learn how to help counties support the pilots. CNHDRC staff, national-level experts and academics visited pilot provinces and counties to discuss local policies, initiatives and challenges (including with patients), build a common understanding ...
The concept of policy capacity is often used to explain the success or failure of governments or ... more The concept of policy capacity is often used to explain the success or failure of governments or countries in conceiving of, developing, and implementing policies, but is often poorly systematised. Wu et al provide a framework for understanding types of policy capacity, arguing that three kinds of capacity, distributed across policy systems, are needed for effective implementation. This paper applies that framework to a discussion of China, a country that has been managing a fundamental transformation since at least the late 1970s, which has underpinned the country’s growth and development. The paper focuses on a subset of China’s reforms – reforms to the healthcare system since the 1990s. Discussion of policy capacity shows (1) that policy capacity is dynamic and adaptive, in response to changing challenges due to rapid transformation in the country; (2) that the development and distribution of capacities has, overall, been government-directed, with strong research and analytical s...
Health is now recognized as a driver of economic development. Healthy people are more productive,... more Health is now recognized as a driver of economic development. Healthy people are more productive, have higher average incomes, spend less on healthcare, and create savings that are an important source of economic investment. Health, particularly in the early years of life, also contributes to other forms of human capital, such as cognitive ability and higher educational achievement. The importance of health in human capital and economic development makes investment in health critical. In recognition of this, in 2015, the UN General Assembly adopted the 2030 Agenda for Sustainable Development; health is the focal point of Sustainable Development Goal 3 (SDG 3): “To ensure healthy lives and promote wellbeing for all at all ages.” Because the determinants of health include factors beyond coverage of health services, achieving SDG 3 will depend on progress in poverty reduction, education, nutrition, gender equality, clean water, sanitation, and transportation, among others. The UN resol...
will require substantial increases in health spending and the proportion funded through taxation ... more will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This presents a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.
This is a Free Book available to download from the publisher. This new collection draws on four b... more This is a Free Book available to download from the publisher. This new collection draws on four books in the series, together addressing three themes central to understanding how pathways to sustainability emerge in response to health and disease challenges. The three themes are Social justice (who wins or loses from disease and how health policy is focused), Politics (how health and disease responses are framed, both locally and internationally) and Governance (how health policies are defined, and how health technologies are regulated and controlled)
In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: T... more In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’, with the aim of generating dialogue and mutual learning among activists, researchers, policymakers, and funders working towards more equitable health systems and a commitment to Universal Health Coverage (UHC). This issue of the IDS Bulletin is based around three principal themes that emerged from the workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the cyclical aspects of efforts towards accountability for health equity. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology. For the first time in IDS Bulletin history, themes are explored...
This paper identifies innovations shown to affect the performance of providers in meeting the nee... more This paper identifies innovations shown to affect the performance of providers in meeting the needs of the poor and likely to have a major impact on health-related markets in the future. The authors faced major challenges in putting this information together. There are no definitive inventories of innovations in health-related markets and there is relatively little scientific literature on the performance of these providers. Much activity takes place outside a formal regulatory structure and is not subject to reporting requirements. Some of the most populous countries are experiencing very rapid increases in the demand for goods and services and in the growth of local companies. It is difficult to obtain information on these companies and the strategies they are formulating to capture market shares. Finally, it is impossible to generalize about a wide spectrum of low-and middle-income countries which differ in almost every way. Informal sector This section builds on the review by Bloom and Standing (2001) of the growing role of unorganized markets in the provision of health-related services to the poor and the reviews 1 by Shah, Brieger, and Peters (2008) and Cross and MacGregor (2008) of current knowledge on informal providers. It is difficult to draw a boundary around these markets. Informal providers include traditional practitioners, relatively untrained sellers of drugs, and providers of medical services and categories of health worker who provide expert services in the public sector but are not entitled to private practice, such as nurses and midwives, in some countries. Shah and colleagues (2008) undertook a systematic review of the published evidence on interventions to address problems with dangerous practices, ineffective treatment, and unnecessary costs. The analysis is not complete and the full findings will be presented in the final draft of this report. One striking finding is the small number (88) of distinct interventions on which evidence has been published over the past 15 year, of which 49 percent were in Africa. These interventions targeted a variety of providers, including commercial medicine vendors (30 percent), traditional birth attendants (26 percent), and community health workers (30 percent). The majority of the interventions were direct training (70 percent), and a small number employed other primary strategies such as supply provision, franchise creation, branding, regulation, and so forth. Many interventions combined training and other strategies. The review of the evidence
BACKGROUND The rapid growth of technology and its use as development solutions have generated muc... more BACKGROUND The rapid growth of technology and its use as development solutions have generated much interest in eHealth, globally. In line with global trends, Bangladesh too is integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper examines the equity implications of eHealth and mHealth considering who use electronic devices to access health information and services and why, in Bangladesh. OBJECTIVE To understand how access to healthcare through electronic means (eHealth and/or mHealth) is affected by socio-demographic determinants (age, gender, education, socioeconomic status, personal and household ownership of mobile phone) in a semi-urban community in Bangladesh. METHODS A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February t...
Eram os idos de outubro de 1972. O Cebrap lançava, então, o segundo número de sua revista, à époc... more Eram os idos de outubro de 1972. O Cebrap lançava, então, o segundo número de sua revista, à época denominada Estudos Cebrap. Como carro-chefe, oferecia ao leitor um longo ensaio de quase oitenta páginas que, nos dias atuais, seria certamente recusado por dez entre dez editores. Um artigo tão cônscio de sua ousadia que, já na frase de abertura, deixava claro o alcance almejado: A perspectiva deste trabalho é a de contribuir para a revisão do modo de pensar a economia brasileira, na etapa em que a industrialização passa a ser o setor-chave para a dinâmica do sistema, isto é, para efeitos práticos, após a Revolução de 1930. (p. 5, grifos meus)
There is growing international concern about the threat to public health of the emergence and spr... more There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets. There is evidence that these markets have enabled people to treat many infections and reduce mortality. However, they also encourage overuse of antibiotics and behaviour likely to encourage the emergence of resistance. The paper reviews a number of strategies for improving the use of antibiotics. It concludes that effective strategies need measures to ensure easy access to antibiotics, as well as those aimed at influencing providers and users of these drugs to use them appropriately.
Healthcare systems are increasingly recognised as complex, in which a range of non-linear and eme... more Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China's healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation, innovation, and learning. Multiple mechanisms exist within the government structure to allow and encourage flexible implementation of policies, and tailoring of reforms to context. These limit the risk of large-scale policy failures and play a role in exploring new reform directions and potentially systemically-useful practices. They have helped in managing the huge transition that China has undergone from the 1970s onwards. China has historically made use of a number of mechanisms to encourage learning from innovative and emergent policy practices. Policy evaluation is increasingly becoming a tool used to probe emergent practices and inform iterative policy making/refining. This paper examines the case of a central policy research institute whose mandate includes evaluating reforms and providing feedback to the health ministry. Evaluation approaches being used are evolving as Chinese research agencies become increasingly professionalised, and in response to the increasing complexity of reforms. The paper argues that learning from widespread innovation and experimentation is challenging, but necessary for stewardship of large, and rapidly-changing systems.
The WHO launched a Global Action Plan on antimicrobial resistance (AMR) in 2015. World leaders in... more The WHO launched a Global Action Plan on antimicrobial resistance (AMR) in 2015. World leaders in the G7, G20 and the UN General Assembly have declared AMR to be a global crisis. World leaders have also adopted universal health coverage (UHC) as a key target under the sustainable development goals. This paper argues that neither initiative is likely to succeed in isolation from the other and that the policy goals should be to both provide access to appropriate antimicrobial treatment and reduce the risk of the emergence and spread of resistance by taking a systems approach. It focuses on outpatient treatment of human infections and identifies a number of interventions that would be needed to achieve these policy goals. It then shows how a strategy for achieving key attributes of a health system for UHC can take into account the need to address AMR as part of a UHC strategy in any country. It concludes with a list of recommended priority actions for integrating initiatives on AMR and...
The aim of this paper is to contribute to debates about how governments and other stakeholders ca... more The aim of this paper is to contribute to debates about how governments and other stakeholders can influence the application of ICTs to increase access to safe, effective and affordable treatment of common illnesses, especially by the poor. First, it argues that the health sector is best conceptualized as a 'knowledge economy'. This supports a broadened view of health service provision that includes formal and informal arrangements for the provision of medical advice and drugs. This is particularly important in countries with a pluralistic health system, with relatively underdeveloped institutional arrangements. It then argues that reframing the health sector as a knowledge economy allows us to circumvent the blind spots associated with donor-driven ICT-interventions and consider more broadly the forces that are driving e-health innovations. It draws on small case studies in Bangladesh and China to illustrate new types of organization and new kinds of relationship between organizations that are emerging. It argues that several factors have impeded the rapid diffusion of ICT innovations at scale including: the limited capacity of innovations to meet health service needs, the time it takes to build new kinds of partnership between public and private actors and participants in the health and communications sectors and the lack of a supportive regulatory environment. It emphasises the need to understand the political economy of the digital health knowledge economy and the new regulatory challenges likely to emerge. It concludes that governments will need to play a more active role to facilitate the diffusion of beneficial ICT innovations at scale and ensure that the overall pattern of health system development meets the needs of the population, including the poor.
Background: This paper explores the evolution of schemes for rural finance in China as a case stu... more Background: This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. Methods: The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. Results: The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. Conclusions: This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.
There is growing international concern about the threat to public health of the emergence and spr... more There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets. There is evidence that these markets have enabled people to treat many infections and reduce mortality. However, they also encourage overuse of antibiotics and behaviour likely to encourage the emergence of resistance. The paper reviews a number of strategies for improving the use of antibiotics. It concludes that effective strategies need measures to ensure easy access to antibiotics, as well as those aimed at influencing providers and users of these drugs to use them appropriately.
The policy capacity framework offers relevant analytical ideas that can be mobilized for health s... more The policy capacity framework offers relevant analytical ideas that can be mobilized for health system strengthening. However, the employment of this framework in the health field constitutes a relevant interdisciplinary gap in knowledge. This themed issue explores the relationships between the policy capacity framework and health system strengthening, in a multidimensional and interdisciplinary way, in high-income and low–middle-income countries. This introduction unpacks the dynamic interrelationships between the policy capacity framework and health system strengthening, bringing together common and distinct elements from both fields and summarizing possible relationships between them. The analysis shows that both fields together can increase our knowledge on health policies and system’s critical themes and reforms. This challenge could be followed by exploring the convergences between them, as far as concepts/themes (types of capacities and other themes) and levels of analysis ar...
This paper presents a case example from China, where detailed deliberations were instrumental in ... more This paper presents a case example from China, where detailed deliberations were instrumental in bringing together national and subnational managers to tailor implementation protocols for neonatal care strategies at provincial and county levels. The China National Health Development Research Center (CNHDRC) organised deliberations to support the formulation of strategies for improving early essential neonatal care for rural areas. The aim was to help counties, the lowest level jurisdiction in China, learn what could work locally, and to help provinces and the national government learn what should inform national policy and be disseminated widely in China’s decentralised health system. It became clear that central-level stakeholders needed to learn how to help counties support the pilots. CNHDRC staff, national-level experts and academics visited pilot provinces and counties to discuss local policies, initiatives and challenges (including with patients), build a common understanding ...
The concept of policy capacity is often used to explain the success or failure of governments or ... more The concept of policy capacity is often used to explain the success or failure of governments or countries in conceiving of, developing, and implementing policies, but is often poorly systematised. Wu et al provide a framework for understanding types of policy capacity, arguing that three kinds of capacity, distributed across policy systems, are needed for effective implementation. This paper applies that framework to a discussion of China, a country that has been managing a fundamental transformation since at least the late 1970s, which has underpinned the country’s growth and development. The paper focuses on a subset of China’s reforms – reforms to the healthcare system since the 1990s. Discussion of policy capacity shows (1) that policy capacity is dynamic and adaptive, in response to changing challenges due to rapid transformation in the country; (2) that the development and distribution of capacities has, overall, been government-directed, with strong research and analytical s...
Health is now recognized as a driver of economic development. Healthy people are more productive,... more Health is now recognized as a driver of economic development. Healthy people are more productive, have higher average incomes, spend less on healthcare, and create savings that are an important source of economic investment. Health, particularly in the early years of life, also contributes to other forms of human capital, such as cognitive ability and higher educational achievement. The importance of health in human capital and economic development makes investment in health critical. In recognition of this, in 2015, the UN General Assembly adopted the 2030 Agenda for Sustainable Development; health is the focal point of Sustainable Development Goal 3 (SDG 3): “To ensure healthy lives and promote wellbeing for all at all ages.” Because the determinants of health include factors beyond coverage of health services, achieving SDG 3 will depend on progress in poverty reduction, education, nutrition, gender equality, clean water, sanitation, and transportation, among others. The UN resol...
will require substantial increases in health spending and the proportion funded through taxation ... more will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This presents a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.
This is a Free Book available to download from the publisher. This new collection draws on four b... more This is a Free Book available to download from the publisher. This new collection draws on four books in the series, together addressing three themes central to understanding how pathways to sustainability emerge in response to health and disease challenges. The three themes are Social justice (who wins or loses from disease and how health policy is focused), Politics (how health and disease responses are framed, both locally and internationally) and Governance (how health policies are defined, and how health technologies are regulated and controlled)
In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: T... more In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’, with the aim of generating dialogue and mutual learning among activists, researchers, policymakers, and funders working towards more equitable health systems and a commitment to Universal Health Coverage (UHC). This issue of the IDS Bulletin is based around three principal themes that emerged from the workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the cyclical aspects of efforts towards accountability for health equity. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology. For the first time in IDS Bulletin history, themes are explored...
This paper identifies innovations shown to affect the performance of providers in meeting the nee... more This paper identifies innovations shown to affect the performance of providers in meeting the needs of the poor and likely to have a major impact on health-related markets in the future. The authors faced major challenges in putting this information together. There are no definitive inventories of innovations in health-related markets and there is relatively little scientific literature on the performance of these providers. Much activity takes place outside a formal regulatory structure and is not subject to reporting requirements. Some of the most populous countries are experiencing very rapid increases in the demand for goods and services and in the growth of local companies. It is difficult to obtain information on these companies and the strategies they are formulating to capture market shares. Finally, it is impossible to generalize about a wide spectrum of low-and middle-income countries which differ in almost every way. Informal sector This section builds on the review by Bloom and Standing (2001) of the growing role of unorganized markets in the provision of health-related services to the poor and the reviews 1 by Shah, Brieger, and Peters (2008) and Cross and MacGregor (2008) of current knowledge on informal providers. It is difficult to draw a boundary around these markets. Informal providers include traditional practitioners, relatively untrained sellers of drugs, and providers of medical services and categories of health worker who provide expert services in the public sector but are not entitled to private practice, such as nurses and midwives, in some countries. Shah and colleagues (2008) undertook a systematic review of the published evidence on interventions to address problems with dangerous practices, ineffective treatment, and unnecessary costs. The analysis is not complete and the full findings will be presented in the final draft of this report. One striking finding is the small number (88) of distinct interventions on which evidence has been published over the past 15 year, of which 49 percent were in Africa. These interventions targeted a variety of providers, including commercial medicine vendors (30 percent), traditional birth attendants (26 percent), and community health workers (30 percent). The majority of the interventions were direct training (70 percent), and a small number employed other primary strategies such as supply provision, franchise creation, branding, regulation, and so forth. Many interventions combined training and other strategies. The review of the evidence
BACKGROUND The rapid growth of technology and its use as development solutions have generated muc... more BACKGROUND The rapid growth of technology and its use as development solutions have generated much interest in eHealth, globally. In line with global trends, Bangladesh too is integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper examines the equity implications of eHealth and mHealth considering who use electronic devices to access health information and services and why, in Bangladesh. OBJECTIVE To understand how access to healthcare through electronic means (eHealth and/or mHealth) is affected by socio-demographic determinants (age, gender, education, socioeconomic status, personal and household ownership of mobile phone) in a semi-urban community in Bangladesh. METHODS A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February t...
Eram os idos de outubro de 1972. O Cebrap lançava, então, o segundo número de sua revista, à époc... more Eram os idos de outubro de 1972. O Cebrap lançava, então, o segundo número de sua revista, à época denominada Estudos Cebrap. Como carro-chefe, oferecia ao leitor um longo ensaio de quase oitenta páginas que, nos dias atuais, seria certamente recusado por dez entre dez editores. Um artigo tão cônscio de sua ousadia que, já na frase de abertura, deixava claro o alcance almejado: A perspectiva deste trabalho é a de contribuir para a revisão do modo de pensar a economia brasileira, na etapa em que a industrialização passa a ser o setor-chave para a dinâmica do sistema, isto é, para efeitos práticos, após a Revolução de 1930. (p. 5, grifos meus)
There is growing international concern about the threat to public health of the emergence and spr... more There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets. There is evidence that these markets have enabled people to treat many infections and reduce mortality. However, they also encourage overuse of antibiotics and behaviour likely to encourage the emergence of resistance. The paper reviews a number of strategies for improving the use of antibiotics. It concludes that effective strategies need measures to ensure easy access to antibiotics, as well as those aimed at influencing providers and users of these drugs to use them appropriately.
Healthcare systems are increasingly recognised as complex, in which a range of non-linear and eme... more Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China's healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation, innovation, and learning. Multiple mechanisms exist within the government structure to allow and encourage flexible implementation of policies, and tailoring of reforms to context. These limit the risk of large-scale policy failures and play a role in exploring new reform directions and potentially systemically-useful practices. They have helped in managing the huge transition that China has undergone from the 1970s onwards. China has historically made use of a number of mechanisms to encourage learning from innovative and emergent policy practices. Policy evaluation is increasingly becoming a tool used to probe emergent practices and inform iterative policy making/refining. This paper examines the case of a central policy research institute whose mandate includes evaluating reforms and providing feedback to the health ministry. Evaluation approaches being used are evolving as Chinese research agencies become increasingly professionalised, and in response to the increasing complexity of reforms. The paper argues that learning from widespread innovation and experimentation is challenging, but necessary for stewardship of large, and rapidly-changing systems.
The WHO launched a Global Action Plan on antimicrobial resistance (AMR) in 2015. World leaders in... more The WHO launched a Global Action Plan on antimicrobial resistance (AMR) in 2015. World leaders in the G7, G20 and the UN General Assembly have declared AMR to be a global crisis. World leaders have also adopted universal health coverage (UHC) as a key target under the sustainable development goals. This paper argues that neither initiative is likely to succeed in isolation from the other and that the policy goals should be to both provide access to appropriate antimicrobial treatment and reduce the risk of the emergence and spread of resistance by taking a systems approach. It focuses on outpatient treatment of human infections and identifies a number of interventions that would be needed to achieve these policy goals. It then shows how a strategy for achieving key attributes of a health system for UHC can take into account the need to address AMR as part of a UHC strategy in any country. It concludes with a list of recommended priority actions for integrating initiatives on AMR and...
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Papers by Gerald Bloom