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The health professions and the performance of future health systems in low-income countries: Support or obstacle?

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  • Dussault, Gilles

Abstract

This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.

Suggested Citation

  • Dussault, Gilles, 2008. "The health professions and the performance of future health systems in low-income countries: Support or obstacle?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2088-2095, May.
    • Handle: RePEc:eee:socmed:v:66:y:2008:i:10:p:2088-2095
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    References listed on IDEAS

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    1. M. Mackintosh & P. Tibandebage, 2002. "Inclusion by Design? Rethinking Health Care Market Regulation in the Tanzanian Context," Journal of Development Studies, Taylor & Francis Journals, vol. 39(1), pages 1-20.
    2. Bloom, Gerald & Standing, Hilary & Lloyd, Robert, 2008. "Markets, information asymmetry and health care: Towards new social contracts," Social Science & Medicine, Elsevier, vol. 66(10), pages 2076-2087, May.
    3. World Bank & International Monetary Fund, 2005. "Global Monitoring Report 2005 : Millennium Development Goals— From Consensus to Momentum," World Bank Publications - Books, The World Bank Group, number 7325.
    4. Steven Simoens & Mike Villeneuve & Jeremy Hurst, 2005. "Tackling Nurse Shortages in OECD Countries," OECD Health Working Papers 19, OECD Publishing.
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    1. Andrew McNee, 2012. "Illuminating the local: can non-formal institutions be complementary to health system development in Papua New Guinea?," Development Policy Centre Discussion Papers 1215, Development Policy Centre, Crawford School of Public Policy, The Australian National University.
    2. Bloom, Gerald, 2011. "Building institutions for an effective health system: Lessons from China's experience with rural health reform," Social Science & Medicine, Elsevier, vol. 72(8), pages 1302-1309, April.
    3. Chandler, Clare I.R. & Chonya, Semkini & Mtei, Frank & Reyburn, Hugh & Whitty, Christopher J.M., 2009. "Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians," Social Science & Medicine, Elsevier, vol. 68(11), pages 2078-2088, June.

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