| Composition of pluralistic health
systems: how much can we learn from
household surveys? An exploration in
Cambodia |
| Authors: |
Bruno Meessen, Maryam Bigdeli, Kannarath Chheng, Kristof Decoster, Por Ir, Chean Men |
| Source: |
Health Policy and Planning, 2011;26:i30–i44; doi:10.1093/heapol/czr026 |
| Topic(s): |
Adult health
Service utilization
|
| Country: |
Asia
Cambodia
|
| Published: |
FEB 2011 |
| Abstract: |
In spite of all efforts to build national health services, health systems of many
low-income countries are today highly pluralistic. Households use a vast range
of public and private health care providers, many of whom are not controlled
by national health authorities. Experts have called on Ministries of Health
to re-establish themselves as stewards of the entire health system. Modern
stewardship will require national and decentralized health authorities to have an
overall view of their pluralistic health system, especially of the components
outside the public sector. Little guidance has been provided so far on how to
develop such a view. In this paper, we explore whether household surveys could
be a source of information. The study builds on secondary data analysis of a
household survey carried out in three health districts in rural Cambodia and of
two national surveys. Cambodia is indeed an interesting case, as massive efforts
by donors in favour of the public sector go hand in hand with a dominant role
of the private sector in the provision of health care services. The study confirms
that the health care sector in Cambodia is now highly pluralistic, and that the
great majority of health seeking behaviour takes place outside the public health
system. Our analysis of the survey also shows that the disaffection of the
population with public health facilities varies across places, socio-economic
groups and health problems. We illustrate how such knowledge could allow
stewards to better identify challenges for existing or future health policies.
We argue that a whole research programme on the composition of pluralistic
health systems still needs to be developed. We identify some challenges and
opportunities.
Keywords Household surveys, Demographic and Health Surveys, private sector, public
sector, stewardship |
| Web: |
http://heapol.oxfordjournals.org/content/26/suppl_1/i30.full.pdf+html |
|