Gerry Bloom and David Peters introduce the key concepts from their new book, Transforming Health Markets in Asia and Africa, at a recent launch event hosted by the Results for Development Institute for the DC Health systems Board.

1. www.futurehealthsystems.org
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2. Transforming health markets in Asia and Africa:
Improving quality and access for the poor
www.futurehealthsystems.org
Gerry Bloom, IDS
David Peters, JHSPH
Gina Lagomarsino, R4D
17 October 2012

3. The spread of health markets….
•Complex markets with a wide variety of
sellers of health-related goods and
services in terms of ownership, mission,
reputation and accountability
•Blurred boundaries between public and
private sectors and importance of market
relationships (informal payments, dual
practice, perverse incentives)
•Largely private production and
distribution of drugs and diagnostic tests
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4. .... faster than institutions to ensure they
perform well
•Lack of mechanisms to identify and reward quality
•Inadequate systems of accreditation, regulation and
accountability
•Often segmented systems with organised and regulated
services for the rich and unorganised markets for the poor
•Vicious circle of low trust, efficacy and efficiency
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5. Wide availability of drugs and medical advice
but……
Low quality
High costs
Inadequate Exacerbation
referral of inequality
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6. Building knowledge of health markets:
a scoping study
•Focus on outpatient services
•Review global knowledge
•Case studies in Bangladesh, Cambodia, China, India,
Nigeria
•Analytical framework combining a development and
public health approach (understanding of markets for
poor people and the special characteristics of health-
related goods and services)
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7. The health market systems approach

8. Actors, relationships and power
•Established role of informal providers as trusted sources
of advice and treatment (Bangladesh)
•Strong links to drug wholesalers (Bangladesh)
•The role of associations of informal providers
(Bangladesh, Nigeria)
•New ways of organising citizens to manage chronic
illness (Cambodia)
•The importance of the media and ICTs as a source of
information
•New kinds of relationships between governments and
market actors (China, India)
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9. From working with private providers to
engaging with health markets….
•Analyse local health market system
•Understand and support innovators
•Design interventions based on an understanding of the
likely responses of different actors
•Use a learning approach to build new kinds of
partnership and respond to unintended outcomes
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10. Improved
analytics
Greater More
role for segmented
ICTs markets
Dependence
on informal
providers
Need for
Increasing
trusted
information
local
asymmetry
institutions

11. People depend on informally
trained providers
Peters DH and Bloom G. 2012. Bring order to unregulated
health markets. Nature. 487: 163-165

12. Key Message 1: Marketized health care
needs better analytics
•Health care in LMICs are highly marketized and
pluralistic.
•There is a large gap between the public goals and the
messy reality.
•Better analytical and practical understanding of this
reality is needed.
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13. Key Message 2: Health systems are
segmented, but markets affect everyone
• Health systems are highly segmented, though market
transactions affect all socio-economic groups.
• Markets are segmented in complex ways that reflect:
• Users’ purchasing power (or lack of it)
• Cultural and social needs
• Understandings of health and disease
• Assessments of provider reputation
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14. Key Message 3: Markets need trusted
institutions emerging from local contexts
•Trust-based institutional arrangements to provide an
assurance of competence and effectiveness has lagged behind
the growth of markets.
•Path dependency of health systems means can’t just copy
OECD models – need to develop from the actors and emerging
informal and formal institutional arrangements in a country.
•They will reflect a country’s political economy, including the
role of government and factors affecting legitimacy of the
regime.
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15. Key Message 4: Information asymmetry harms
the poor, but lessons from other sectors offer
new opportunities
•Information asymmetry pervades health markets and
puts the poor at a disadvantage.
•Information asymmetry pervades all knowledge-based
market transactions, not only health.
•There is much to be learned from other markets’
approaches to reducing information asymmetries in ways
that benefit the poor.
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16. Key Message 5: Health ICTs can change
provider and public behavior to improve
access to health
•Recent developments in information and
communications technology (ICT) and knowledge
intermediaries are creating new opportunities for
structuring access to health knowledge and influencing
providers and the public.
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17. Questions for Gina
• How do findings compare with work of CHMI?
• What are the most promising opportunities for
intervening in health markets?
• What can we learn from other markets about reaching
the poor?
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18. From shortage of access to unruly markets
•We argue that shortage is no longer the main problem, but has
been replaced by issues with large, unruly markets. There are
problems with quality and accountability, but also
opportunities for expanding access.
•Is the diagnosis wrong?
•Will health markets “fix” themselves on their own? E.g. will
informal providers be crowded out as people get wealthier and
smarter?
•What is needed to change the thinking of governments,
development agencies, general public to address health
markets?
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19. Informal regulation
• Informal arrangements for regulation are emerging in
many health markets
• Are they effective?
•Can they be influenced to support public objectives?
•Are they sustainable?
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20. Model for transforming health markets: What
are the prospects?
•We propose public participation, iterative learning, good
technical management, and top-down institutional
support as a process for transforming health markets.
• Is this feasible, testable, compatible with how key
stakeholders operate in health markets?
• What are the opportunities for testing this? What are
the alternatives?
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21. 20%
Discount
Code:
MRJ81
http://bit.ly/THMiaa