Health policy in poor countries : weak links in the chain

The authors show how the recent empirical and theoretical literature on health policy sheds light on the disappointing experience with the implementation of primary health care. They emphasize the evidence on two weak links between government spending on health and improvements in health status. First, the capability of developing country governments to provide effective services varies widely -- so health spending, even on the"right"services, may lead to little actual provision of services. Second, the net impact of government provision of health services depends on the severity of market failures. Evidence suggests these are the least severe for relatively inexpensive curative services, which often absorb the bulk of primary health care budgets. Government policy in health can more usefully focus directly on mitigating market failures in traditional public health activities and, in more developed settings, failures in the markets for risk mitigation. Addressing poverty requires consideration of a much broader set of policies which may -- or may not -- include provision of health services.