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By Economic & Social Commission for Asia & the Pacific

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Additional resources for Achieving the Health Millennium Development Goals in Asia and the Pacific: Policies and Actions Within Health Systems and Beyond (Asia-Pacific MDG Study Series)

Example text

1. OBSTACLES WITHIN HEALTH SYSTEMS WHO defines health systems as “all the activities whose primary purpose is to promote, restore or maintain health” (WHO, 2000a). They would, therefore, include the “people, institutions and resources, arranged together in accordance with established policies, to improve the health of the population they serve, while responding to people’s legitimate expectations and protecting them against the cost of ill-health through a variety of activities whose primary intent is to improve health” (WHO, 2000b).

Deficiencies in access to essential and reliable medicines and vaccines Approximately one third of the world’s population does not have access to essential medicines that can save or prolong their lives. Structural problems limiting access to effective drugs include the following: • The low capacity of many health systems; • The lack of drugs and vaccines or the poor quality control of them; • Bottlenecks in the distribution and dispensing of medicines. A number of factors operating at the international level (covered in detail later in the study) also undermine investment in research, production and trade of medicines that are essential for the prevention and treatment of diseases affecting the poor.

Information asymmetries, an inelastic demand for services and difficulties in standardizing and monitoring the provision and procurement of services, all contribute to corruption. In several Asian countries health-care ranks as one of the most corrupt public services (Gupta and others, 2000; Utstein Group, 2005; Nissen, 2005; Kumar, 2003). 2. Vulnerabilities and corruption risks of health systems according to financing mechanisms Vulnerabilities Corruption risks PUBLIC Tax-based systems Directly financing of services Free/Subsidized services Diversion of public funds at Ministerial level Informal/Illegal payments Corruption in procurement Abuses undermining quality Health insurance Directly financing of services Excessive medical treatment Fraud in billing Diversion of funds Private insurance Separation between finance and provider.

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