Slide 1: Making health-related markets work better for poor people: Improving provider performance
Gerald Bloom Institute of Development Studies, UK Abuja January 2009
Slide 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
Slide 3: Rapid spread of markets for healthrelated 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
Slide 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
Slide 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
Slide 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
Slide 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 wellorganised markets Organisations: ownership, motives, incentives and reputation Institutions: partners, co-production and the balance between social and individual interests
Slide 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
Slide 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)
Slide 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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 15: WORKSHOP OBJECTIVES
Build greater understanding of existing and proposed innovations Explore possibilities for building partnerships for innovation and learning
Slide 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
