Great advances in health have been achieved, yet one in ten children in the developing world die before the age of five. How can universal levels of health be improved? What is the role of governments in health provision? This World Development Report examines the interplay between human health, health policy and economic development. The report takes a global perspective, distinguishing between high, medium and low-income countries. The recommendations made in the report contribute to the goal of ‘attainment for all people of a level of health that will permit them to lead a socially and economically productive life’.
The report advocates a shift in investment from specialised and tertiary services to the provision of a broad base of widely accessible care in community facilities and health centres, referred to as a minimum ‘essential clinical package’. The conclusions are reached by applying a cost-benefit analysis to the provision of health services.
Drawing on experiences in the health sector worldwide, the report presents the following findings:
- Advances in income and education have allowed households almost everywhere to improve health. The poor are most likely to spend additional income in ways that enhance health
- Major problems that affect health services worldwide are misallocation of funds (disproportionate amounts on low cost-effective treatments), inequity (services largely inaccessible to the poor) and inefficiency
- New challenges continue to emerge as advances in health are achieved, such as dealing with an ageing population and finding new malarial drugs. AIDS prevention is a current major challenge
- Basic interventions are fundamental. Immunization saves around three million lives a year
- Competition between suppliers of health services/inputs/insurance in the private sector can improve quality and keep down costs of health provision
- There are no easy answers or universal formulas for managing public finance for health. Each country varies and requires different approaches depending on epidemiological conditions, levels of income, local preferences, etc.
Overall, the report recommends a shift from direct government involvement in health provision to a regulatory role for governments, providing a policy framework for increased private sector involvement. The following areas require particular attention on the part of governments:
- Ensuring the provision of essential clinical care, including pregnancy and family planning services, TB control and control of STDs
- Dissemination of health information, especially control of contagious diseases and hygienic practices, and investment in scientific research
- Fostering and managing private sector competition in the supply of health services and inputs
- Enforcing adjustment policies that preserve cost-effective health expenditure (particularly in the health insurance sector)
- Targeting the needs of the poor through investment in schooling and appropriate economic growth policies
- Decentralising management of the health sector to regional and district-level offices
