Talukder Md Noorunnabi, Rob Ubaidur, Mahabub-Ul-Anwar Md
The Population Council, Dhaka, Bangladesh.
Int Q Community Health Educ. 2007;28(2):153-64. doi: 10.2190/IQ.28.2.e.
Various reforms have been undertaken to improve the functioning of health systems in developing countries, but there is limited comparative analysis of reform initiatives. This article discusses health sector reform experiences of four developing countries and identifies the lessons learned. The article is based on the review of background papers on Bangladesh, Pakistan, Indonesia, and Tanzania prepared as part of a multi-country study on health sector reform. Findings suggest that decentralization works effectively while implementing primary and secondary health programs. Decentralization of power and authority to local authorities requires strengthening and supporting these units. Along with the public sector, the private sector plays an effective role in institutional and human resources development as well as in improving service delivery. Community participation facilitates recruitment and development of field workers, facility improvement, and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach; therefore, the experiences of other countries will help countries undertake appropriate reforms. Here, it is important to examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency, and sustainability.
为改善发展中国家卫生系统的运作，已进行了各种改革，但对改革举措的比较分析有限。本文讨论了四个发展中国家的卫生部门改革经验，并总结了从中吸取的教训。本文基于对孟加拉国、巴基斯坦、印度尼西亚和坦桑尼亚的背景文件的审查，这些文件是作为卫生部门改革多国研究的一部分编写的。研究结果表明，在实施初级和二级卫生项目时，权力下放能有效发挥作用。将权力和职责下放给地方当局需要加强和支持这些单位。除了公共部门，私营部门在机构和人力资源开发以及改善服务提供方面也发挥着有效作用。社区参与有助于实地工作人员的招聘和发展、设施改善以及服务提供。为了为贫困人口提供经济保护，有必要审查使用者收费，并制定带有豁免机制的负担得起的医疗保险。不存在统一的卫生部门改革方法；因此，其他国家的经验将有助于各国进行适当的改革。在此，重要的是审视具体情况，并确定在公平、效率和可持续性方面构成最佳手段的改革措施。
