Searching for Essential Health Services in Low and Middle Income Countries

By José Luis Bobadilla (06/98, SOC-106, En)

Documents Searching for Essential Health Services in Low and Middle Income Countries (PDF, 189 Kb, En)
Introduction

Good health sector analyzes have found serious mismatches between the disease profile of the population and the distribution of resources. There are many complex reasons to explain why health services, all too often, fail to meet the health needs of the population. However, they are all related to technical issues and/or social values.

The technical reasons for this misallocation are generally based on the use of oversimplified models to set health care priorities and a lack of appropriate quantitative information. Explanations based on social values, on the other hand, focus on imperfect fits between population preferences and real health needs, and between population preferences and the content and distribution of health services.

This paper addresses the progress made, and the problems that result from applying technical criteria to set health priorities in a more rational way. The usefulness of technically derived priorities depends largely on their political feasibility and the extent to which they reflect social values. The paper draws freely from two unpublished earlier documents prepared for the World Health Organization: Research on Setting Health Priorities: the Case of Low- and Middle-Income Countries and Setting Priorities in the Newly Independent States.

The main focus of this paper is the application of explicit criteria to set health priorties in lending projects and sector work. It draws lessons from 24 studies undertaken in low- and middle-income countries from 1993 to 1996. The paper describes the main characteristics of the studies, assesses their technical quality and policy relevance, and summarizes the first two stages which culminated with the publication of the 1993 World Development Report: Investing in Health (World Bank 1993).

The paper is organized into six chapters: Chapter I summarizes the logic behind setting health priorities and briefly reviews their antecedents through explicit criteria. Chapter II describes the main characteristics of the studies. Chapters III and IV focus on the evaluation of information, methods and indicators to set priorities and design packages of essential health services. Chapter V reports on the main disease priorities and the results of cost effectiveness analyzes. Finally, and lastly, Chapter VI identifies research and development needs to improve future studies.

Several colleagues contributed to the analysis presented in this paper. Peter Cowley collaborated in the first inventory and assessment of health priorities studies, published in January 1995. Beatriz Zurita was responsible for the assessment of the cost-effectiveness analyzes and other issues on resource allocation. Adnan Hyder helped to evaluate the burden of disease component of the studies. Veronica Vargas summarized the inventory of studies presented in chapter II. Prabhat Jha and Kent Ranson prepared Box 3. As usual, the errors and inaccuracies remain my sole responsibility.

I am grateful to those who contributed with ideas and reviews of previous versions of this paper: Philip Musgrove, Cristian Baeza, Beatriz Zurita, and Veronica Vargas. The support from Richard Feachem, Helen Saxenian, and Xavier Coll in the Human Development Department of the World Bank was invaluable.

I am especially grateful to Jillian Cohen for her fast and sharp editing of the text. Euna Osborn improved the format, tables and presentation.

Last updated: 06/01/07