Health Policy in Poor Countries : Weak Links in the Chain

There is an apparent consensus that the correct health policy in developing countries is public provision of a mix of preventive and simple curative services through low level health workers and facilities. But the strength of this consensus on the primary health care paradigm is in sharp contrast to either the strength of its analytical foundations or its mixed record in practice.Filmer, Hammer, and Pritchett show how the recent empirical and theoretical literature on health policy sheds light on the disappointing experience with the implementation of primary health care. They emphasize the evidence on two weak links between government spending on health and improvements in health status. First, the capability of developing country governments to provide effective services varies widely-so health spending, even on the right services, may lead to little actual provision of services. Second, the net impact of government provision of health services depends on the severity of market failures. Evidence suggests these are the least severe for relatively inexpensive curative services, which often absorb the bulk of primary health care budgets. Government policy in health can more usefully focus directly on mitigating market failures in traditional public health activities and, in more developed settings, failures in the markets for risk mitigation. Addressing poverty requires consideration of a much broader set of policies which may-or may not-include provision of health services.This paper - a product of Poverty and Human Resources, Development Research Group - is part of a larger effort in the group to investigate efficacy in the social sectors. The study was funded by the Bank's Research Support Budget under the research project Primary Health Care: A Critical Examination (RPO 680-29). The authors may be contacted at dfilmer@worldbank.org or jhammer@worldbank.org