The institutional aspects of health sector reform: whither primary care? [abstract]

ABSTRACT

In recent years, there has been a great deal of discussion about the need for health sector reform. Most of the general discussions have centred around the need for ensuring equity, efficiency, effectiveness and quality, financial sustainability and intersectoral action and community participation. In practice, however, the large majority of the official efforts have focussed on health finance reform, as the several governments in the region have sought to cope with what has been defined as the health resource gap that is, the difference between available revenues and rising health costs. In addition, the focus of most reform efforts has largely been on improving the health delivery systems. So far, there has been insufficient attention given to those factors affecting the demand for health and health care. Since one of these factors is likely to be the reform package itself, it is critical to seek to assess and evaluate the impacts of the reforms implemented. In this paper, it will be argued that socio-economic circumstances, as well as particular health finance reforms may be significantly changing the character of the demands for health care. It will be also suggested that to the extent that the inefficiency and ineffectiveness of the primary health care system has negatively contributed to the changing character of health demands, it may be necessary to raise questions about the current locus, viability and strength of the ideals of the primary care approach to health care. In this discussion, case material and data from selected countries in the Caribbean will be presented. (AU)