BMJ  2004;329:1175-1176 (13 November), doi:10.1136/bmj.329.7475.1175

Commentary

the devil is in the detail

Martin McKee, professor of European public health1, Barbara McPake, senior lecturer in health economics2

1 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1E 7HT, 2 Health Systems Development Programme, London School of Hygiene and Tropical Medicine

Correspondence to: M McKee Martin.McKee@lshtm.ac.uk

The first 150 words of the full text of this article appear below.

Okuonzi argues that the introduction of market reforms, into the Ugandan health system has been a failure.1 However, health systems are extremely complex and, as the debate about the British internal market shows, attribution of cause and effect is far from easy. The situation in Uganda is equally complex, with reforms taking place against a background of regional conflict, growing inequalities, and changes in other sectors. Furthermore, while Okuonzi focuses on hospitals, it is equally important to look at primary care, which the Ugandan reforms have sought to strengthen.

Can we gain insights about market reforms from other low and middle income countries? It is important to distinguish between reforms directed at funding and those directed at delivery of care. Many policies aimed at funding, such as user fees, increase the economic burden on families. This can deter them from seeking necessary care and increases the risk of impoverishment from . . . [Full text of this article]

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Relevant Article

Learning from failed health reform in Uganda
Sam Agatre Okuonzi
BMJ 2004 329: 1173-1175. [Extract] [Full Text] [PDF]

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Rapid Responses:

Read all Rapid Responses

evidence needed on ideologies
Colin HW Bullough
bmj.com, 29 Nov 2004 [Full text]
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