Improving innovative health care delivery systems that serve the poor

Ndola Prata, University of California, Berkeley
Dominic Montagu, University of California, San Francisco

The general argument for the decentralization of health care is the potential for improved service quality and coverage. However, the experience of decentralization in developing countries has been confounded by subsequent decline of public health care spending. As a result the quality of care in many cases has been compromised and the poorest segments of the population left without access to publicly subsidized services. Decentralization may therefore be seen as an important factor in the dramatic expansion of private health care provision in developing countries in the past decade. This paper presents available evidence on health seeking behaviour by socio-economic status, using data from the World Bank’s HNP Poverty Thematic Reports of 22 countries in Africa. We provide evidence from health franchise delivery systems in Africa and Asia, that such a system can be a support for the public health care system suffering from weaknesses of decentralization.