Global Health Watch 1 in one file

professionalism, good clinical practice and ethical behaviour. However, selfregulation
in the private sector is often weak and must be complemented
by government and civil society intervention. Governments could consider
working with the non-profit private sector – good non-government providers
can develop and publicize standards for access and quality, and help undercut
providers of a lower standard.
Other policy instruments to regulate the private sector include licensing
requirements, formal accreditation and price controls. Licences can also be
used to negotiate explicit returns in the form of arrangements for the public
sector to use private sector facilities and equipment at a reduced cost, or for
the private sector to provide services for free or at low-cost to patients referred
from the government sector (Mackintosh and Tibandebage 2004). These recommendations
should be implemented in the context of broader reforms to
universalize the health care system and constrain commercial behaviour.
A key requirement for strengthening the public sector relative to the private
sector is to reduce the disparity in incomes between public and private
providers. This disparity should be regularly measured and monitored to draw
attention to the need for active measures to reduce the gap.
Governments should revoke any commitments they have made to liberalize
their health care and health insurance markets through the World Trade
Organization’s General Agreement on Trade and Services (GATS) or regional
and bilateral trade agreements, and should reverse any agreements that undermine
their ability to regulate the health care sector.
Making the public sector work – strengthening management Much more investment
needs to be directed at strengthening public sector health management
capacity at all levels of the health care system. Too often, however,
management-strengthening initiatives are ineffective, short-lived and decontextualized,
reflecting a general neglect of public administration in the
development sector. Key elements of health systems management are highlighted
below.
resource management and planning Ministries of Health need to
show where the money is spent, on whom and on what. A diagnostic health
sector review, which characterizes health and health care inequalities and
which describes resource levels and distribution, expenditure flows and the
relative positions of public and private health sectors, including the role of
non-government actors, is a necessity. Plans to reallocate and redistribute
resources can follow on from a transparent evidence base.
Approaches to health care
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