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

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