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Viewpoint (December 2002)

Author: Jo Ritzen, Vice President, HumanDevelopment Network, The World Bank

Jo-RitzenWhat type of health system should India have in the21st century?  That was the question posed by the government of India when it asked the World Bank to help analyze India's Health System. The recognition was growing that conditions in India were changing rapidly, that the health system needed to keep up with these changes, and that important aspects of the health system were being overlooked by current approaches.  Through a wide consultative process that included many of India's internal and external development partners, a set of topics was selected for study, with results reviewed as they emerged. More than a dozen Indian institutions, in partnership with the World Bank and the Government of  India, conducted the research. The studies provided new data and analysis that have not been available before on a number of fundamental issues of health care in India:

  • The behavior of the private market in health.
  • The prevalence of chronic disease risk factors.
  • The distribution of benefits from different types of public and private health services.
  • The degree of financial protection in health care.
  • The degree of protection of patients' interest The laws and practices guiding health care.

Better Health Systems for India's Poor fills many gaps in understanding and synthesizes much about what can be learned from India's health system. Emerging from this analysis is an important set of principles for reform:

  • Look after the health needs of the poor and vulnerable sections of society
  • Prepare for the health transition with appropriate health financing systems and programs
  • Harness the energy of the private sector while counteracting its failures.
  • Focus on quality and accountability in health services.

The key features of this work - the consultative processes, the sensitivity to variations in conditions among groups and regions, the clarity of analysis, and the tangibility of the alternatives for reform - make this study relevant to any country interested in making its health systems more effective, equitable, and accountable.

Jo Ritzen

Further Reading  

  • Bennett S., B. Mcpake and A. Mills, Eds. (1997). Private Health Providers in Developing Countries. London, ZED Publishers. 
  • Hanson K. and P. Berman (1998). "Private Health Care Provision in Developing Countries: A Preliminary Analysis of Levels and Composition." Health Policy and Planning 13(3): 195-211. 
  • Harding A. and A.S. Preker, Eds. (2003). Private Participation in Health Services. Health, Nutrition, and Population Series. Washington, World Bank. 
  • Lewis M. (1988). The Private Sector and Health Care Delivery in Developing Countries: Definition, Experience, and Potential. Washington, USAID, Resources for Child Health Project (REACH).Peters D.H., A.S. Yazbeck, R.R. Sharma, G.N.V. 
  • Ramana, L. Pritchett and A. Wagstaff, Eds. (2002). Better Health Systems for India's Poor: Finding, Analysis, and Options. HNP Publication Series. Washington, World Bank.


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