There isn’t an off-the-shelf solution to health sector reform. Priorities differ across countries and health systems, and change over time. For example, countries dealing with HIV epidemics not only need to address dwindling external financing but also rise to the challenges of integrating AIDS service delivery structures into the main health service framework. While appropriate policies that motivate health care professionals are a priority for others.
Most governments have well-constructed health policies and impressive strategy documents. But turning such high-level thinking into practical results on the ground requires systematic attention to processes and the systems to make it happen, underpinned by the in-depth analysis needed to identify and tackle barriers such as resource and skills shortages.
Good governance and organisational development is about creating institutions that last, establishing a culture of openness and trust and, above all, bringing about change that can be sustained in the long term.
In the past, lack of resources has not been a big issue for AIDS initiatives. ‘Exceptionalism’ – the view that the severity of the disease justifies donor funding regardless of the long-term financing implications – has been the financing paradigm. Now tougher economic conditions are challenging this paradigm and raising questions about how low and middle income countries will fund their AIDS responses.
There is a growing consensus that health workers are essential to health service delivery in developing countries. Yet the lack of an adequate framework for understanding their performance and labour market choices means that policy-makers often struggle to achieve their objectives.