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Report by the Chairperson of the Round Table Discussions at
Ministerial Level on Health Systems Development: Defining the Roles of the Public and
Private Sector (including NGOs), in an equity-based health system
H.E. Dr Carlos D Martinez, Minister of
Health, Cuba
Lead discussant Dr A Tounkara, Deputy Minister of Health Mali
Facilitated by H.E. Mr. N. M. Lenneiye, World Bank, Washington DC
From the informative presentation by
member states, a summary was outlined at the end using a two-part outline of the main
concepts identified: (a) a framework on systems development, and (b) responding to
challenges of systems development.
Framework on Systems Development
Framework
item |
Important
considerations |
Organisation |
- There should be multiple factors in defining the
organisation.
- There should be local, national, and international factors.
|
Resources |
- The Ministry of Finance could mobilise resources from taxes
and from international agencies.
- Communities could mobilise either their own resources or
those from NGOs.
- Insurance companies and national health insurance schemes
should be important sources.
|
Goals/values |
- Anti-poverty and poverty eradication (food, medicines,
houses, etc., were important considerations).
- Health for all, especially for women and children.
- Socio-cultural considerations.
- Increased access, for women, children, mentally ill, etc.
|
Strategies |
- PHC principles were still valid (with respect to issues of
cost-effectiveness and implementation of the referral system).
- Competitive partnership (where active resolutions were taken
in a framework of co-operation).
- Reform for equity to ensure user satisfaction.
|
Environment |
- Globalisation and its contribution to inequalities and
inequities.
- Existence of better informed citizens.
- Growing resource constraints.
- Conflict, both internal and external.
- Continued poverty made health a development issue.
|
From this framework, a fundamental question
posed was why the goal of health for all by the year 2000 had not been achieved.
Responding to the challenges of health
systems development
Target
for challenge |
Main
responsibilities/issues |
Communities |
- Anti-poverty concerns and activities had been implemented
and have led to increased access.
- Direct channelling of resources to communities had proved
quite effective in several contexts.
- Getting value for money was important within a context of
promoting comprehensive health care.
|
Civil
society/NGOs |
- There had been a rapid growth of NGOs.
- Some NGOs had been contracted to provide services and had
proved quite efficient in several instances.
- NGOs were important partners.
|
Private sector |
- The challenge of making the private sector invest in the
public sector to compensate for the use of resources such as health workers trained by the
public sector.
- The private sector complemented the public sector.
- The private sector was an important partner (especially in
the pharmaceutical sector).
|
International
agencies |
- The management of international agencies was critical to
ensure sustainable strategies and to retain country ownership.
- Debt remained a challenge to health and poverty.
- Brain drain and other human resources issues could benefit
from actions by these agencies.
- Need to remain responsive to country-specific situations.
|
Governments |
- Governments remained the referees (policies, regulations,
setting standards, and licensing).
- Governments mobilised most of the budgets for health.
- Governments should disseminate monitoring and evaluation
results.
- Governments play leadership roles in disease eradication.
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