Health Reform in Latin America and Africa: decentralisation, participation and inequalities

As part of broader neoliberal economic policies most governments of Latin America and sub-Saharan Africa have implemented reforms of the formal health sector since the early 1980s. Driven both by the need for greater efficiency and calls for increases in patient choice and participation, these reforms have taken on different forms across the regions, but the main features have been decentralisation, increased user fees and the introduction of forms of health insurance. This paper considers the nature of these reforms, how the broad category of ‘neoliberal health sector reform’ has played out in different places and the impact of these reforms across socioeconomic groups.