Globalization, Health Sector Reform, Gender and ... - Ford Foundation

comparing the different countries where HSR is being implementedreveal that health policies and strategies vary considerably(DGIS, 1999). The reasons and timing of launching sectorreform—as well as procedures and mechanisms for policy development,planning and implementation of health programs—alsovary from country to country.Common health problems and challenges in low- and middleincomecountries may demand similar health strategies and interventions,but the specific characteristics and dynamics of acountry’s health system are likely to generate differences in theimplementation of the reforms. In any case, if health reforms areto succeed, they require the leadership and participation of boththe national governments and the wider civil society in the developmentof broad health policy framework and specific reformplans. Stakeholder participation is now widely recognized as acritical condition for success.Development agenciesare still strugglingto turn rhetoricalcommitments to genderequity and equalityinto concrete sectorprogram inititiativesand to integrate genderconcerns into healthreform programs.A crucial aspect of HSR is capacity building in poorly-equippedMinistries of Health so that governments will have an effectivebudgetary and institutional framework. Governments’ financingmechanisms must be developed in order to make changes sustainablewhen external sources of funding are no longer available.HSR programs and objectives tend to be quite ambitious. Increasedcoverage at the level of basic health services serves a politicalpurpose but rarely is matched with realistic considerations of thefinancial and human resources needed to provide such services.In theory, the integration of vertical programs should improve efficiency:however, integrating efficient vertical programs into inefficientgeneral services may jeopardize the quality of some ofthe newly-integrated services.Despite considerable rhetoric, there has been relatively little investmentby governments and international institutions in primaryand preventive sexual and reproductive health interventions otherthan contraceptive delivery (Population Council, 1998). In a contextof extremely under-funded health systems in which a morefunctional service delivery is very difficult to attain, family planningresources tend to be greater than maternal and child health(MCH) resources, yet the burden of care has been on the MCHworkers.All sector reform programs acknowledge sexual and reproductivehealth as a priority policy. However, when institutional changesor budgetary allocations are made, sexual and reproductive healthand gender issues are set aside in favor of other, competing prioritiesresulting from an overburdened health system, pressure from39