Inequalities in Health System……


Stronger health systems are key to achieving improved health outcomes!! Health systems in the developing countries are too fragile and fragmented to deliver the volume and quality of services to those in need. Critical shortfalls are health workforce, lack of donor coordination and weak information system. Access to health services in many developing countries and in some developed countries is very uneven, and large segments of the rural population are not reached. Health facilities and personnel are mostly concentrated in urban areas, and within the urban population the services are oriented to the middle-income and higher-income groups. Political considerations may override all other priorities, and little progress can be expected unless there is a political commitment to apply resources where the need is greatest.

There is a shortage of skilled health personnel, particularly in the poorer countries. National averages for Physicians : Population ratios are reported to be 1:17,000 in the least developed countries and 1:2700 in other developing countries, as compared with 1:520 in developed countries. The pyramid of health manpower is inverted, particularly in the least developed countries. Instead of a broad base of inexpensively trained, less skilled personnel working at the community level, priority has been given to expensive training programs for ” conventional” doctors, who expect sophisticated facilities and equipment and facilities, gravitate to practice in the cities, and have a propensity to emigrate. To achieve effective coverage of the population, large number of less skilled personnel need to be trained, and these health workers need to be part of a system that will provide supervision, drugs, supplies and support services necessary for their practice.

A second obstacle is the lack of appropriate technology in health system and to cope with the serious endemic diseases prevalent in the developing world. Most of the technologies that are being transferred from the developed world are expensive, and the equipment is often difficult to maintain. Another obstacle is the Pharmaceutical Policies. The most widely used technologies in healthcare are drugs and vaccines. Shortage of supplies and failure to provide for the timely distribution of drugs and vaccines are serious problems that must be overcome for an effective health program.



Developing countries face the challenge of coping with a heavy burdens of illness that differs markedly in subgroups of the population at different stages of development due to improper or insufficient health system. The main cause is the political will to allocate the necessary resources for the health program and the management capability to organize and operate a system of services for the rural and sub-urban populations that use multi-purpose community health workers. Pharmaceutical are of special importance, since the timely supply of essential drugs is critical to the quality of healthcare and the credibility of community health workers. The dangers of excessive use or inappropriate choice of drugs necessitate the introduction of policies on procurement, prescription, pricing and quality control to avoid health hazards and excessive costs. Greater efforts are required to mobilize resources for health from other sources, particularly the private sector, and to ensure that they are used in the most cost-effective manner!!!


1. Cochrane AL. Effectiveness and efficiency: random reflections in health services.
2. Yudkin JS. The economics of pharmaceutical policy in Ghana.
3. Idem. A new look at development cooperation for health.

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