Publications

Health sector reforms (HSR) can be described as sustained, purposeful and fundamental changes intended to improve the performance of the sector in terms of efficiency, equity and effectiveness2.

Implementation of HSR in the region has not always been in response to identified gaps within the sector. Some reforms have been imposed as part of broader economic reform policy. The main reforms in the past two decades have included decentralization of health services management and operation to sub-national levels; health financing initiatives such as user fees in the public sector, community comanagement and co-financing mechanisms centred on essential drugs (Bamako initiative); organization of health services including autonomy of management to hospitals and promotion of public/private partnerships. More recently, some countries have considered the introduction of social health insurance.