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Publications

Filtering by Tag: Gerald Bloom

Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts

Future Health Systems

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.

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Informal rural healthcare providers in North and South India

Future Health Systems

Rural households in India rely extensively on informal biomedical providers, who lack valid medical qualifications. Their numbers far exceed those of formal providers. Our study reports on the education, knowledge, practices and relationships of informal providers (IPs) in two very different districts: Tehri Garhwal in Uttarakhand (north) and Guntur in Andhra Pradesh (south).

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Innovation in regulation of rapidly changing health markets

Future Health Systems

The rapid evolution and spread of health markets across low and middle-income countries (LMICs) has contributed to a significant increase in the availability of health-related goods and services around the world. The support institutions needed to regulate these markets have lagged behind, with regulatory systems that are weak and under-resourced. This paper explores the key issues associated with regulation of health markets in LMICs, and the different goals of regulation, namely quality and safety of care, value for money, social agreement over fair access and financing, and accountability.

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Engaging with Health Markets in Low and Middle-Income Countries

Future Health Systems

Many low and middle-income countries have pluralistic health systems with a variety of providers of health-related goods and services in terms of their level of training, their ownership (public or private) and their relationship with the regulatory system. The development of institutional arrangements to influence their performance has lagged behind the spread of these markets. This paper presents a framework for analysing a pluralistic health system. 

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E-health and M-health in Bangladesh: Opportunities and Challenges

Future Health Systems

There is growing enthusiasm amongst analysts of global health for the possibilities opened up by the rapid spread of mobile phone coverage. This includes substantially increasing access to health-related information and advice and to expert medical consultations.This report presents a snapshot of how information and communication technologies (ICTs) are influencing health system development in Bangladesh.

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Building institutions for health and health systems in contexts of rapid change

Future Health Systems

Many Asian countries are in the midst of multiple interconnected social, economic, demographic, technological, institutional and environmental transitions. These changes are having important impacts on health and well-being and on the capacity of health systems to respond to health-related problems. This paper focuses on the creation of institutions to overcome information asymmetry and encourage the provision of safe, effective and affordable health services in this context of complexity and rapid change.
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Institutional Solutions to the Asymmetric Information Problem in Health and Development Services for the Poor

Future Health Systems

The world’s poorest pay for professional services and thus are in a “market,” whether the services are provided in the public or private sectors. The associated problems of unequal information are particularly acute in under governed countries, where state regulation is weak. We systematically review the evidence on solutions to these problems in a variety of professions. Payments by clients are more likely to have a positive effect on quality if they are made through locally-managed organizations rather than directly to individual practitioners, particularly if those organizations have an institutionalized history of other—regarding values and incorporate client participation.
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Health care: Order health systems in developing world

Future Health Systems

In this correspondence, the authors note that governments and policy-makers are aiming to improve health markets in developing countries as they take up the challenge of last year's United Nations resolution to move towards universal health coverage. We caution that they must do more than simply legislate their way to a more orderly health system.
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Transforming Health Markets in Asia and Africa: Improving quality and access for the poor

Future Health Systems

There has been a dramatic spread of health markets in much of Asia and Africa over the past couple of decades. This has substantially increased the availability of health-related goods and services in all but the most remote localities, but it has created problems with safety, efficiency and cost. The effort to bring order to these chaotic markets is almost certain to become one of the greatest challenges in global health. This book documents the problems associated with unregulated health markets and presents innovative approaches that have emerged to address them. It outlines a framework that researchers, policy makers and social entrepreneurs can use to analyse health market systems and assess the likely outcome of alternative interventions. The book presents a new way of understanding highly marketised health systems, applies this understanding to an analysis of health markets in countries across Asia and Africa and identifies some of the major new developments for making these markets perform better in meeting the needs of the poor. It argues that it is time to move beyond ideological debates about the roles of public and private sectors in an ideal health system and focus more on understanding the operation of these markets and developing practical strategies for improving their performance. This book is ideal reading for researchers and students in public health, development studies, public policy and administration, health economics, medical anthropology, and science and technology studies. It is also a valuable resource for policy makers, social entrepreneurs, and planners and managers in public and private sector health systems, including pharmaceutical companies, aid agencies, NGOs and international organisations.
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Exploring the Ethics of Long-Term Research Engagement With Communities in Low- and Middle-Income Countries

Future Health Systems

Over the past few decades, there has been increasing attention focused on the ethics of health research, particularly in low- and middle-income countries. Despite the increasing focus on the literature addressing human protection, community engagement, appropriate consent procedures and ways to mitigate concerns around exploitation, there has been little discussion about how the duration of the research engagement may affect the ethical design and implementation of studies. In other words, what are the unique ethical challenges when researchers engage with host communities for longer periods (10 years or more), and what special considerations does this time commitment generate when applying ethical principles to these kinds of studies? This article begins to outline key areas of ethical concern that arise during long-term, sustained research activities with communities in low-resource settings. Through a review of the literature and consultations with experts in health systems, we identified the following key themes: fair benefits and long-term beneficence; community autonomy, consultation and consent; impacts on local health systems; economic impacts of research participation; ethical review processes; and institutional processes and oversight within research organizations. We hope that this preliminary exploration will stimulate further dialogue and help inform ethical guidance around long-term research engagements in the developing world.
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Bring order to unregulated health markets

Future Health Systems

In this commentary in Nature, the authors argue that the rapid expansion of health markets in Asia and Africa has made medicines, information and primary-care services available in all but the most remote areas. But it also creates problems with drug safety and efficiency, equity of treatment and the cost of care. Poorly trained practitioners often prescribe unnecessary pills or injections, with patients bearing the expense and the costs to their health. Counterfeit drugs are rife and drug resistance is growing. Bringing order to unruly health markets is a major challenge.
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Building institutions for an effective health system: Lessons from China’s experience with rural health reform

Future Health Systems

This paper is concerned with the management of health system changes aimed at substantially increasing the access to safe and effective health services. It argues that an effective health sector relies on trust-based relationships between users, providers and funders of health services, and that one of the major challenges governments face is to construct institutional arrangements within which these relationships can be embedded.
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Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda

Future Health Systems

Although a number of intermediate transport initiatives have been used in some developing countries, available evidence reveals a dearth of local knowledge on the effect of these rural informal transport mechanisms on access to maternal health care services, the cost of implementing such schemes and their scalability. This paper, attempts to provide insights into the functioning of the informal transport markets in facilitating access to maternal health care. It also demonstrates the role that higher institutions of learning can play in designing projects that can increase the utilization of maternal health services.
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Making health markets work better for poor people: the case of informal providers

Future Health Systems

There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria.
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WP6 - Making health markets work better for poor people: Improving provider performance

Future Health Systems

Much analysis of health care markets draws heavily on the experiences of the advanced market economies where there is a much clearer demarcation of the roles of, and boundaries between, the public and private sectors in delivering services. This has led to a tendency to seek models for ―working with the private sector‖ from these countries, without taking sufficient account of their strong institutional and regulatory arrangements for both market and non-market services (Bloom and Standing 2008). This paper argues for a different approach to policy formulation that bases the assessment of the likely outcome of different reform options on a closer understanding of the realities of the markets that have emerged in developing and transitional economies.
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Lessons from the Chinese Approach to Health System Development

Future Health Systems

China is managing major health system reforms against a background of rapid economic and institutional change. In doing so it is developing a learning approach to transition management and institution-building. This approach includes testing innovations at local level, encouraging learning from success, and then gradually building institutions that support new ways of doing things. Chinese policymakers and analysts are also developing strategies for drawing on international experience. Analysts from other countries and officials in organisations that support international health need to understand this approach if they are to strengthen mutual learning with their Chinese counterparts.
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