PS009 - Future Health Systems: Regional Perspectives

The increased political importance and the rapid technological advances are presenting "a window of opportunity" for financing and innovation according to Dr. Gerald Bloom (Knowledge, Technology and Society Team, Institute of Development Studies, Brighton, UK).  Health systems need to respond more effectively to the health expectations of the global community and to the burden from the changing pattern of disease, especially in poor countries. They need to engage with burgeoning health related markets, the health technology and the pharmaceutical industry while ensuring quality, safety, affordability and access to the poor.

"We need to figure out the best path" says Dr. Alok Mukhopdhyay, (Chief Executive, Voluntary Health Association of India) who describes Health Promotion in Asia as a veritable kaleidoscope. With 22% of the world population living in South Asia of which 40% live in absolute poverty, all health promotion activity must be placed in a "wider social and political context". On comparing the health outcomes from public health spending in two districts in India, a strong point was made for the need for better governance and restructuring. Clear benefits to health resulted in West Bengal following land reform, regulation of wages and working hours as well as addressing women's rights. "The Public is not part of Public Health" and the KHOJ (search) initiative was a specific intervention in response to this failure. This initiative empowered village councils to plan and allocate resources, gave vocational training and encouraged entrepreneurship for income generation. The results observed included an improvement in both health and economic situations and a reduction in health expenditure in spite of increased utilization of health services. This initiative has now gained the recognition of other important partners and with the support of government is now spreading to other districts.

The access to safe and effective health services in rural areas is one of the major health challenges in Bangladesh were 75% of the population lives in rural areas and are poor. In a study of the informal health system in Chakaria, Dr. Mohammad Iqbal (Public Health Sciences Division, ICDDR,B, Dhaka, Bangladesh) reports that 94% of treatment facilities are privately run by village doctors. Up to 75% of villagers interviewed refer themselves to allopathic village doctors for first line treatment. These practitioners often have no formal medical training but have a financial incentive to prescribe drugs, as sale of drugs is their only source of income. Through Patient exit interviews, it was determined that in only 18% of cases the appropriate treatment was given and harmful treatment administered in 7% of cases. These results prompted an intervention aimed at harm reduction from inappropriate prescribing through formal training and increased accountability. The role of the village doctors in rural areas of Bangladesh has become an indivisible part of the health system and scaling up this sector could be one solution to increasing access to health services. Challenges remain especially with regards to training, accreditation, regulation and formal recognition of these informal health providers by government and medical professional bodies.

"What is happening now will transform the health system in South Africa" says Dr. Wim Vam Damme (Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium). The challenge to the current scale up efforts for ART (Anti Retro Viral Treatment) in many high burden countries in Africa is no longer financial, but there are not enough "people who will do the job". With PLHIV (people living with HIV) today requiring lifelong treatment compounded with a high disease burden, there are just not enough skilled professionals to deliver. ART has received much political backing in recent years and there are a number of possible scenarios for the evolution of its scale up. One of the main messages is the need to reduce the "brain drain", as well as to make "best use of all people on the ground". Task shifting together with simplifying protocols could allow staff other than medical professionals to take over some of the labour intensive taks. In a setting where it is projected that 15-20% of adults will be receiving ART in South Africa, the potential role of expert patients, who have unique knowledge and experience in dealing with all aspects of this chronic condition, cannot be ignored.