Health Sector Reforms: Implications for Sexual and Reproductive Health Services

Since the mid-1980s long before the International Conference on Population and Development (ICPD) in Cairo in 1994 fundamental changes have been taking place in the financing management and structure of health care provision described at length in the 1993 World Bank Report. These changes include reforms in: mechanisms for health financing priority setting and accountability the structure of national health systems and the role of the state in health service provision. These reforms have also been affected by changes in national and international allocation of resources to the health sector the attribution of responsibility for health and the increasing commodification of health in almost all countries. Policy changes some progressive others retrogressive wide-ranging biomedical and social research and efforts to improve sexual and reproductive health service delivery in the face of cutbacks have been taking place at the same time. Although the reforms have been to health systems as a whole and will have influenced the extent to which countries have been able to implement the ICPD Programme of Action there is only limited evidence available on this to date and little interaction between the institutions and individuals involved. Moreover there has been limited capacity to generate evidence on the impact of reforms on sexual and reproductive health services not only to ensure that ICPD goals are reached. (excerpt)