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2. Transforming health markets in Asia and Africa: Improving quality and access for the poorwww.futurehealthsystems.org Gerry Bloom, IDSDavid Peters, JHSPH Gina Lagomarsino, R4D17 October 2012 3. The spread of health markets. Complex markets with a wide variety of sellers of health-related goods and services in terms of ownership, mission, reputation and accountability Blurred boundaries between public and private sectors and importance of market relationships (informal payments, dual practice, perverse incentives) Largely privateproductionand distribution of drugs and diagnostic tests2 4. .... faster than institutions to ensure theyperform well Lack of mechanisms to identify and reward quality Inadequate systems of accreditation, regulation and accountability Often segmented systems with organised and regulated services for the rich and unorganised markets for the poor Vicious circle of low trust, efficacy and efficiency3 5. Wide availability of drugs and medical advicebut Low quality High costsInadequate Exacerbationreferral of inequality4 6. Building knowledge of health markets:a scoping studyFocus on outpatient servicesReview global knowledgeCase studies in Bangladesh, Cambodia, China, India,NigeriaAnalytical framework combining a development andpublic health approach (understanding of markets forpoor people and the special characteristics of health-related goods and services)5 7. The health market systems approach 8. Actors, relationships and power Established role of informal providers as trusted sources of advice and treatment (Bangladesh) Strong links to drug wholesalers (Bangladesh) The role of associations of informal providers (Bangladesh, Nigeria) New ways of organising citizens to manage chronic illness (Cambodia) The importance of the media and ICTs as a source of information New kinds of relationships between governments and market actors (China, India)7 9. From working with private providers toengaging with health markets. Analyse local health market system Understand and support innovators Design interventions based on an understanding of the likely responses of different actors Use a learning approach to build new kinds of partnership and respond to unintended outcomes8 10. ImprovedanalyticsGreaterMorerole forsegmented ICTsmarkets Dependence on informalprovidersNeed forIncreasingtrusted informationlocalasymmetryinstitutions 11. People depend on informally trained providersPeters DH and Bloom G. 2012. Bring order to unregulatedhealth markets. Nature. 487: 163-165 12. Key Message 1: Marketized health care needs better analyticsHealth care in LMICs are highly marketized andpluralistic.There is a large gap between the public goals and themessy reality.Better analytical and practical understanding of thisreality is needed.11 13. Key Message 2: Health systems are segmented, but markets affect everyone Health systems are highly segmented, though markettransactions affect all socio-economic groups. Markets are segmented in complex ways that reflect: Users purchasing power (or lack of it) Cultural and social needs Understandings of health and disease Assessments of provider reputation12 14. Key Message 3: Markets need trusted institutions emerging from local contextsTrust-based institutional arrangements to provide anassurance of competence and effectiveness has lagged behindthe growth of markets.Path dependency of health systems means cant just copyOECD models need to develop from the actors and emerginginformal and formal institutional arrangements in a country.They will reflect a countrys political economy, including therole of government and factors affecting legitimacy of theregime.13 15. Key Message 4: Information asymmetry harms the poor, but lessons from other sectors offer new opportunitiesInformation asymmetry pervades health markets andputs the poor at a disadvantage.Information asymmetry pervades all knowledge-basedmarket transactions, not only health.There is much to be learned from other marketsapproaches to reducing information asymmetries in waysthat benefit the poor.14 16. Key Message 5: Health ICTs can change provider and public behavior to improve access to healthRecent developmentsin informationandcommunications technology (ICT) and knowledgeintermediaries are creating new opportunities forstructuring access to health knowledge and influencingproviders and the public.15 17. Questions for Gina How do findings compare with work of CHMI? What are the most promising opportunities forintervening in health markets? What can we learn from other markets about reachingthe poor?16 18. From shortage of access to unruly marketsWe argue that shortage is no longer the main problem, but hasbeen replaced by issues with large, unruly markets. There areproblems with quality and accountability, but alsoopportunities for expanding access.Is the diagnosis wrong?Will health markets fix themselves on their own? E.g. willinformal providers be crowded out as people get wealthier andsmarter?What is needed to change the thinking of governments,development agencies, general public to address healthmarkets?17 19. Informal regulation Informal arrangements for regulation are emerging inmany health markets Are they effective?Can they be influenced to support public objectives?Are they sustainable?18 20. Model for transforming health markets: What are the prospects?We propose public participation, iterative learning, goodtechnical management, and top-down institutionalsupport as a process for transforming health markets. Is this feasible, testable, compatible with how keystakeholders operate in health markets? What are the opportunities for testing this? What arethe alternatives?19 21. 20%Discount Code: MRJ81http://bit.ly/THMiaa