BY DR GERALD BLOOM, INSTITUTE OF DEVELOPMENT STUDIES
My presentation at the M4P Hub Conference reflects work by several members of the Future Health Systems Consortium on the implications of the rapid spread of markets for health-related goods and services. These markets are complex with a variety of sellers of health related goods in terms of ownership, mission, reputation and relationship to the regulatory system. Poor people frequently use providers in unorganised markets. Studies in Nigeria and Bangladesh found that more than half of people seeking treatment for malaria in the former used a patent medicine vendor and sixty-five percent of people who visited a health provider in a rural district in the latter went to an informal village doctor. In both cases there were serious problems with safety, effectiveness and cost. The behaviour of informal providers of drugs and health services is influenced by their source of knowledge (formal training, informal apprenticeships, advertising, marketing by drug wholesalers and so forth), financial incentives (including profits from selling drugs and commissions from drug wholesalers) and strategies to build and maintain their reputation. In both countries, interventions sought to convince informal providers to pay more attention to the quality of drugs and appropriateness of prescriptions through training and the involvement of trade associations and local government leaders in measures to monitor their performance and build their reputation. Governments and other stakeholders need to find effective ways to engage with pervasive health markets to protect the interests of the poor.
The following lessons should be taken into account:
- Interventions should be based on an analysis of the market system including the drug distribution network and the growing role of knowledge intermediaries, such as mobile telephone companies.
- Effective interventions are likely to involve partnerships between organisations with different agendas and different capacities.
- ustainable interventions need to include realistic business models for informal providers and for other intervention partners.
- Politics and interests strongly influence outcomes when going to scale and effective strategic leadership is needed.
Dr Bloom describes the response at the conference: “There was a lot of discussion about whether the special characteristics of the health sector mean that the M4P approach is not applicable to it. We discussed how unregulated markets for health-related goods and services can expose individuals to risk from dangerous or ineffective treatment and also lead to the emergence of diseases that are resistant to the available drugs. We also discussed the many ways that health markets are similar to markets in other sectors. We agreed that the design and implementation of interventions to improve the performance of health markets needs to combine expertise in health and health systems with expertise in engaging with markets. There was some discussion of the difficulties in combining these approaches. However, there was general agreement on both the magnitude of the health problems in many low income countries and the degree to which health markets have spread in them. We concluded that it is time for serious work to develop practical approaches for improving the performance of health markets in meeting the needs of the poor”.