Global Health Watch 1 in one file

Health care systems | B1
But improved health worker performance cannot be achieved through
money alone. The problems of demoralization and demotivation are more
complex and require a multi-dimensional programme involving:
• adequate supplies of essential equipment, consumables and medicines to
enable health workers to exercise their skills;
• systematic quality improvement programmes, including the training of
staff in health service quality, interpersonal relations and responsiveness
of care;
• support for health workers, especially those who work in isolated and difficult
circumstances;
• a participatory style of health service management; and
• an incentive structure of professional rewards for good performance.
At the same time, clear rules and sanctions must signal that theft, unethical
practices, and uncaring and abusive behaviour towards patients, especially the
poor, women, elderly and ethnic minorities, will not be tolerated. Disciplinary
procedures, however, must be consistent, fair and transparent.
There are also a range of management tools and processes that can be
employed to promote commitment, good performance and ethical behaviour
within public sector bureaucracies – these include non-financial incentives
such as peer recognition and public praise of good performance; and opportunities
to advance career and learning prospects. Ensuring improved performance
through a combination of rules, public accountability and non-financial
incentives requires much more emphasis to counter the prevailing focus on
economic and market-based incentives.
Resources to achieve health for all For many countries, the need for adequately
financed public sector health care systems is the paramount objective.
The outright cancellation of unpayable debt, fair trade reform, increased and
improved levels of overseas development assistance and the creation of new
forms of global financing (see part A, part E, chapters 5 and 6, and part F)
have to be part of any agenda for global health care systems development and
should be reflected more prominently in the lobbying of international health
agencies, including those of the major philanthropic foundations operating
in the health and development sector. External financing must, however, be
guaranteed with medium- to long-term commitments, and directed in ways
that will strengthen Ministries of Health.
Within countries, governments should strengthen their capacity to increase
their tax revenue in a progressive and fair manner. All countries should aim
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