Education And Debate

the devil is in the detail

BMJ 2004; 329 doi: (Published 11 November 2004) Cite this as: BMJ 2004;329:1175
  1. Martin McKee (, professor of European public health1,
  2. Barbara McPake, senior lecturer in health economics2
  1. 1 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2 Health Systems Development Programme, London School of Hygiene and Tropical Medicine
  1. Correspondence to: M McKee

    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 …

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