 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Francois Diop, PhD, Abt Associates Inc., Mermoz Pyrotechnie no 74, BP 274, Dakar Fann, Dakar, Senegal, 221-869-7055, fdiop@sentoo.sn
After three decades of health improvements between the 60s and 80s, enduring health inequalities, stagnation and reversal of health gains over the 90s, even in countries with very low levels of HIV infection, suggest that centralized and supply-based health sector organization have reached its limits in African countries. Building on democratization and decentralization movements developing since the end of the 80s, a systemic shift toward a decentralized and demand-based health sector organization is emerging in the continent. Decentralized health financing institutions are emerging as a consequence of political and administrative reforms, but also as a result of combinations of formal social insurance systems, medical-aid societies, and emerging community-based health insurance systems in many countries. These systemic changes are deepening the separation of service delivery and financing functions, enlarging diversity and learning opportunities for adaptive efficiency of health sector organizations, strengthening consumer representation for better quality and responsiveness in African health systems.
While the alignment of these health system changes with ongoing institutional changes in many African countries provides for a supportive environment, limited applied research has be done in the continent on how resource allocation mechanisms and provider payments should be adapted to foster deeper changes in the incentive regimes facing health actors. The evolving health environment calls for economists’ contribution to the adaptation of grant design, contractual arrangements, provider payment methods, and demand-based subsidies in order to translate the opportunities being opened by the new environment into improvements in the responsiveness, equity and efficiency of African health systems.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.