Making Health Care Work for the Poor
Efficiency in Health Delivery Systems
“Best of” in Primary Health Care
Review of the NGO experiences in selected Asian countries.
Purpose and approach of this paper
Our purpose has been to conduct a review of NGOs’ contributions
to health care in Asia . Taking
into consideration the
World Health report and the recommendations of the national consultations
on macroeconomics and health, we have focussed on these
NGOs which have Primary Health Care as a stated goal.
While we have reviewed the accomplishments of about 50 NGOs,
Asia is so vast that this can only be a small sampling.
We selected large NGOs which have a proven record of efficiency,
competence and field action, such as BRAC. On specific issues such
as mobile medicine, we focused on those selected by the United Nations
in organizing the World Summit on Information Society, while on
microcredit, we took a sample from the recently held
Summit on Microcredit organized by NGOs in
New York .
It is with these limitations in mind that we have selected those
NGOs which represent vast network of organisations sharing a common
objective and a common advocacy platform such as
the People’s Health Movement internationally which brings
together several thousand NGOs in Asia .
Outline of this document
The first section presents the contribution
of NGOs to poverty alleviation and their broad comprehensive approach
to health. Mechanisms such as microcredit to improve health and
experiments in community-based microinsurance schemes are discussed.
The second section considers the role of international
advocacy by NGOs on macroeconomic and national aspects of health care, discussing public
versus private health care, highlighting successful public health
systems from an NGO standpoint.
The third section defines Primary Health Care
Systems and indicates successful NGO experiments that are being
expanded. Innovative and efficient PHC systems are the way to the
The fourth section describes innovations to
improve access to health services through mobile medicine and the use of modern technologies (telemedicine,
the internet). What NGOs can contribute The World Health Report
20031 that has just been published strongly advocates for strengthening
integrated primary health care systems, and rebuilding efficient
ones where they are very weak or inexistent. Clearly, national macroeconomic
mechanisms, which bring together responsibility
for health and for finance, have a responsibility.
The task is bringing health back on top of the agenda, nationally
and globally. Rebuilding health systems today could not just be
State responsibility and NGOs have an increasingly important role
to play in partnership with States. NGOs cannot replace State funded
and State backed public health systems. However, NGOs can show the
way in building experimental health systems starting with people’s
needs, no matter how poor. States can then cooperate and assimilate
NGO’s health systems.
Health is an integrated state of well-being and requires
the fulfilment of basic needs - such as water and nutrition – and
therefore, the ideal set up of a health system would be funded and
staffed by the State and be linked to a large array of community
based organized groups and NGOs. This situation will mean: democratic
participation in the elaboration and functioning of health care
systems for the poor - who should become less poor as a result.
“One of the key roles of civil society organizations is
to hold health care providers as well as governments accountable
for what they do and how they do it. Where civil society is active,
organizations can monitor government policy choices and practice
advocacy … without mechanisms enabling people to hold officials
accountable, stewardship may falter”
For example, the problems of high quality affordable health care
for all in the highly populous countries of Asia, is also being
handled by large NGOs. While this paper could not pretend to offer
a comprehensive view of all NGO work in Asia, we have selected telling
examples of best off in NGO delivery of integrated health care to the poor
and NGOs’ expert reviews of the best achievements in public health
systems for the poor.
read more, click here (pdf)