id21 insights #76, March 2009

Making health markets work for poor people

People use a variety of market-based providers of health-related goods and services ranging from highly organised and regulated hospitals and specialist doctors to informal health workers and drug sellers operating outside the legal framework. Many encounters with health workers and suppliers of pharmaceuticals involve a cash payment.

The boundary between public and private sectors is often very porous, with people either paying government health workers informally or consulting them outside their official hours. Unregulated markets, in particular, raise problems with safety, efficacy and cost. This issue of id21 insights explores some of the responses to these problems.

In Sierra Leone, street vendors have a number of different medicines in stock (prescription and non-prescription) but many are not in their original box or are out of date
Rob Huibers, Panos Pictures, 2002

Other articles in this issue:

Improving provider performance

Poor quality and high costs are associated with the informal provision of health care. New research in Bangladesh, India and Nigeria offers innovative strategies to improve performance. Poor people often use informal providers for health care. In Bangladesh formally trained workers account for only five percent of providers. The private sector comprises around 180,000 informal providers practising as village doctors and/or drug vendors.

The benefits of health insurance

Well-implemented public or private health insurance programmes create a platform for pooled strategic purchasing that can drive improvements in quality of care and increase availability of services for poor people.

Retail pharmacy chains

Retail pharmacy chains and franchise networks have the potential to change the way drug markets work in low and middle income countries, standardising quality, lowering prices, and increasing access to medicines for people across all income levels.

Life-long burden

The rise of chronic diseases, such as diabetes or heart disease, is strongly related to ageing populations, increased smoking, less physical exercise, and increased consumption of processed and fatty foods.

Vision entrepreneurs

The packaging of health services as commodities to be distributed through the private sector has been used in the likes of family planning, the treatment of sexually transmitted disease and for insecticide-treated bednets. This approach aims to standardise and assure quality of care while minimising costs and creating incentives to providers to make cost-effective services available.

The impact of ICTs on health care

There is growing consensus that the impact of information and communications technologies (ICTs) on health systems could be substantial or even revolutionary.

About this issue

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