Strategies for promoting equity: experience with community financing in three African countries


Gilson, L; Kalyalya, D; Kuchler, F; Lake, S; Oranga, H; Ouendo, M; (2001) Strategies for promoting equity: experience with community financing in three African countries. Health policy (Amsterdam, Netherlands), 58 (1). pp. 37-67. ISSN 0168-8510

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Abstract

Although the need for a pro-poor health reform agenda in low and middle income countries is increasingly clear, implementing such policy change is always difficult. This paper seeks to contribute to thinking about how to take forward such an agenda by reflection on the community financing activities of the UNICEF/WHO Bamako Initiative. It presents findings from a three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, which was initiated in order to better understand the nature of the equity impact of community financing activities as well as the factors underlying this impact. The sustained relative affordability gains achieved in Benin emphasise the importance of ensuring that financing change is used as a policy lever for strengthening health service management in support of quality of care improvements. All countries, however, failed in protecting the most poor from the burden of payment, benefiting this group preferentially and ensuring that their views were heard in decision-making. Tackling these problems requires, amongst other things, an appropriate balance between central and local-level decision-making as well as the creation of local decision-making structures which have representation from civil society groups that can voice the needs of the most poor. Leadership, strategy and tactics are also always important in securing any kind of equity gain-such as establishing equity goals to drive implementation. In the experiences examined, the dominance of the goal of financial sustainability contributed to their equity failures. Further research is required to understand what equity goals communities themselves would prefer to guide financing policy.

Item Type: Article
Keywords: Benin, Comparative Study, Consumer Participation, *Financing, Organized, Health Care Reform/*economics, *Health Services Accessibility, Human, Kenya, Poverty, Quality of Health Care, *Social Justice, Support, Non-U.S. Gov't, Zambia, Benin, Comparative Study, Consumer Participation, Financing, Organized, Health Care Reform, economics, Health Services Accessibility, Human, Kenya, Poverty, Quality of Health Care, Social Justice, Support, Non-U.S. Gov't, Zambia
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
PubMed ID: 11518601
Web of Science ID: 170835400004
URI: http://researchonline.lshtm.ac.uk/id/eprint/16541

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