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.

Introduction

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 future.

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.

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