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p. 3 of 27 BACK | NEXT Executive summary Introduction Major themes Development of the policy paper Regional health context The Bank’s involvementin the health sector Issues and options The Bank’s health policy

Policy for the Health Sector : Introduction

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Major themes

This paper addresses the challenges and opportunities facing the health sector in the Asian and Pacific region over the next decade. To have an impact on the overall health of Asians, a number of significant challenges need to be met. Chief among them is improving the health of the poor, women, and other vulnerable groups so that they too can participate in economic and social development. While the challenges are great, so too are the opportunities. New and affordable technologies advances, such as vitamin A supplementation that can reduce child mortality rates by 23 percent, and accumulating knowledge about managing, organizing, and financing health care, offer tremendous opportunities to dramatically improve the health conditions in the region. Making a difference to the health of these vulnerable groups will require an emphasis on tangible goals and practical means for accom-plishing them. Focusing on measurable results will help the Bank and its develop-ing member countries (DMCs) meet the challenges they face.

Results require resources, and therefore financial resource constraints in the Bank’s DMCs are of central importance. The ongoing economic and financial crisis is putting pressure on already tight health sector budgets. DMC governments have, historically, invested a smaller percentage of their budgets in health than governments in other developing nations.¹ Increasing budgetary allocations to the health sector, particularly for high impact, primary health care (PHC) services, is a priority, but it is not the only solution to the shortage of resources. Diversifying sources of financing, through such mechanisms as social health insurance schemes, is another major challenge facing the Bank’s DMCs. Increasing public expenditures will not be effective unless the governments of the region use their resources more efficiently. This will require carefully choosing priorities and focusing on activities that are efficacious and cost effective.

Given the challenges the region faces in the health sector, there is a need to innovate and evaluate new methods to address major issues. Since innovation is critical to success, the Bank can play a leadership role by actively encouraging and financing innovative approaches. Part of the process of innovation will involve careful testing and evaluation of these approaches so that useful ones can be separated from those that are merely novel. Many of the important innovations will arise in the area of the relationship between the public and private sectors. While this is an exciting area, it is also an area where little is known for certain and there will likely be important differences between countries. In settings such as this, it is inappropriate to be prescriptive. Rather, a learning, evolutionary, and empirically based approach is called for.

An empirical approach to testing new ideas in management and financing exemplifies the need to apply scientific rigor more generally to health sector activities. The application of scientific methods and approaches will be a critical means for achieving results. For example, rigorous monitoring and evaluation of the effectiveness of health care delivery will help ensure impact and emphasizes the need for appropriate management information systems. Support for certain types of health research will also reap great benefits and provide the interventions that will constitute the opportunities of the next ten years. Discovering new interventions will not be sufficient. A scientific approach will also emphasize the rapid deployment of cost-effective new technologies. Finally, scientific approaches are needed to critically appraise the evidence for the specific interventions that are prioritized and the broad organizational changes that are recommended. The Bank can play a catalytic role by helping in the accumulation and dissemination of such evidence.

The Bank has been involved in the health sector for 20 years and has made 35 loans aimed at improving health and population services (see Appendix 1). It has made a significant contribution to the region’s concerted effort to expand publicly provided health services. Starting in the 1960s, developing countries in the region recognized the need to invest in health services and established large public health care systems, including large hospitals. The public health systems, particularly the health centers and health posts at the periphery, brought modern health care to hundreds of millions of people, who previously had not had access to such services. The results are impressive. The under-five mortality rate in the region fell 60 percent over the last 35 years, by far the fastest decline in its history. However, the recurrent costs of running large public health care systems have outstripped the governments’ willingness to allocate budgetary resources to the sector. The resultant lack of funding and hollowing out of the public health systems has brought into sharp relief the issue of the state’s role in the health sector. There is a growing recognition that laissez-faire policies will not work and that governments need to be actively involved in the health sector but that they should do “more steering and less rowing.” Many of the most important activities in the sector deserve to be publicly financed; however, that does not mean that they need to be publicly provided. Delineating appropriate roles for the state and the private sector in regard to health care constitutes a key issue for the Bank’s DMCs.

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