Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening.


Balabanova, D; Mills, A; Conteh, L; Akkazieva, B; Banteyerga, H; Dash, U; Gilson, L; Harmer, A; Ibraimova, A; Islam, Z; Kidanu, A; Koehlmoos, TP; Limwattananon, S; Muraleedharan, VR; Murzalieva, G; Palafox, B; Panichkriangkrai, W; Patcharanarumol, W; Penn-Kekana, L; Powell-Jackson, T; Tangcharoensathien, V; McKee, M; (2013) Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening. Lancet, 381 (9883). pp. 2118-33. ISSN 0140-6736 DOI: https://doi.org/10.1016/S0140-6736(12)62000-5

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Abstract

: In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.<br/>

Item Type: Article
Faculty and Department: Academic Services & Administration > Academic Administration
Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
ECOHOST - The Centre for Health and Social Change
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 23574803
Web of Science ID: 320924800035
URI: http://researchonline.lshtm.ac.uk/id/eprint/768450

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