Pluralism and Marketisation in the Health Sector:
Meeting Health Needs in Contexts of Social Change in Low and Middle Income Countries
argue that over the last few decades there have been profound changes in the ways health goods are being produced and consumed in low income and transitional countries. outline the main categories of change in the health sector in terms of socio-economic changes, changes in health provision, knowledge and technologies, and political changes. examine the changing roles and functions of providers, asking what services health workers provide, what is the structure of rewards and incentives for health providers and how current arrangements affect transactions costs and quality of services. consider how households, particularly poor ones, manage health provisioning in a pluralistic environment where health goods and services have become increasingly marketised. ask how the balance between different sorts of provision has changed and whether there has been an expansion of the productive and reproductive functions of households. explore the roles of governments and other institutions in contexts of pluralism and marketisation. look at the implications for financing of health services, the management of expert knowledge, and the skill needs of practitioners. focus particularly on shifts in the location of specialised knowledge, such as the growing role of shops, pharmacies and sellers of medical techniques, and on strategies for disseminating health-related knowledge. note the possible role of IT and expert systems for transforming chaotic markets in health care and health knowledge..........."