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Health action in crises

  WHO > Programmes and projects > Health action in crises > Technical guidelines for health action in crises > Tools > Analysing Disrupted Health Sectors
A Modular Manual

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Module 7. Analysing Patterns of Health Care Provision: Previous page | 1,2,3,4,5,6,7,8,9,10,11,12,13,14

Health Care Delivery Models

  Table of contents

The adequacy of dominant health care delivery models to present and future conditions and demands must be assessed. The country’s political climate and the development options being chosen by (sometimes for) the government are profoundly influential on the choices being made in the health sector.

In cases of dramatic political change, as with the emergence of new states, or after the crumbling of despised regimes, policy-makers may feel compelled to introduce a radically different health care delivery model. This may be chosen without a careful appraisal of the problems affecting the sector, and of the available policy options. The merits of previously-dominant models may be downplayed, whereas the benefits of a radical departure from them may be inflated. Rarely if ever, the implications and costs of changing the way health services are delivered receive adequate attention. The harried dismantling of Soviet-inspired health care delivery systems in Eastern Europe is an impressive example of this phenomenon.

The debate about the delivery model to be adopted may take precedence over the recognition of deep structural constraints. Extraordinary expectations about the benefits of a new delivery model may be nurtured, in this way postponing the tackling of the root distortions, without which no delivery model can live up to its promises. Fascinated by the magic bullet of the day, decision-makers may expect that the solution of all problems comes from adopting a single measure. In Afghanistan in 2002, the policy discussion was captured by the introduction of contracting-out arrangements, an appealing approach in a NGO-dominated health sector. Key structural distortions, like severe under-financing, a derelict health care network and an imbalanced workforce, were neglected, on the implicit assumption that they would heal by themselves, or that the new delivery model would indirectly induce their correction.

The table below sketches most of the alternative models a policy-maker may consider. In real life, the options truly open to policy-makers are narrower than the presented ones. In fact, contentious choices are usually discarded by insecure politicians. International agendas tend to eclipse local solutions in the eyes of donor officials. Powerful lobbies may block the introduction of novel approaches. And unfamiliar delivery models may fail to attract the attentions of policy-makers. Thus, changes may take place only at the margins.

In many situations, some of the described elements coexist simultaneously in various mixtures, although with different weight and influence over the whole health sector. Hybrid, ambiguous and transitional situations are very common. Among stressed decision-makers, uncertainty about the way forward to be chosen is prevalent.

Alternative health care models deserving consideration [pdf 25kb]

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