Author Archives: helenoko


The provision of health as we know now has come a long way. There have been changes in the concept and definition of health as well as the practice of medicine. Health concept and health systems differs in different parts of the world and this is influence by the political ideology of the nation [1]. This informs the health policies and practices [2]. The growth and development of health care services, systems and who benefits form it has come from many contributions: individuals, military services, missionary hospitals and the major player in health care, the government [1]. These agencies along with professional associations, various ministries in the federal and state governments with international agencies will continue to shape health care and bring reforms in the future [1].

The cost of health care services has grown and the insurance companies now play a major role as well as being driven by market forces and international corporations [1]. The future of the types of care available, who can access this care and who bears the cost is gradually being determined by the insurance companies and other nongovernmental agencies such as pharmaceutical companies and makers of medical supplies. Countries with socialist ideology who see health as a right of the citizens make effort to make health care available to all and the government paying for it. Example of this is the United Kingdom with its National Health scheme and Brazil [3]. The tax payers pay the bill. Canada on the other hand has mixed system with private/public partnership but all citizens are covered and have insurance. The United States of America has a great proportion of citizens’ uninsured, some are insured through their employers and others are self-insured. Any changes needed in the health system will take into consideration the financial cost of the innovation. The purchase of new medical equipment is not just a medical and administrative decision but the financial burden determines what the next purchase will be. Treatment regimens which was the prerogatives of doctors and health team is now determined by what the insurance companies are ready to pay for, or approve as a needed protocol.

The final cost is on the patient who cannot get what is the optimum care in the best system from the best care givers. Health reform will come from the active role of government, her policies, international bodies and associations of professional as well as other agencies in the health industry who will see a need for reform and guarantee that needed reforms are carried out without the interference and dictates of health insurance companies even when these are state owned [4].


1.            Reich, M.R., Reshaping the state from above, from within, from below: implications for public health. Social Science & Medicine, 2002. 54(11): p. 1669-1675.

2.            Lakin, J.M., The end of insurance? Mexico’s Seguro Popular, 2001–2007. Journal of Health Politics, Policy and Law, 2010. 35(3): p. 313-352.

3.            Arnquist, S., A. Ellner, and R. Weintraub, HIV/AIDS in Brazil: Delivering Prevention in a Decentralized Health System. Cases in Global Health Delivery, 2011. 018: p. 1-31.

4.            Glassman, A., et al., Political analysis of health reform in the Dominican Republic. Health Policy and Planning, 1999. 14(2): p. 115-126.



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Generating Political Priority: A lesson from Bangladesh. Helen Oko (hoo205)   

For any country to set up a health plan there are no set down rules and regulation to guide the policy making process. This is illustrated by the study done by Shiffman and Sultana as they studied how neonatal care became a national priority in Bangladesh and the process that it took to make this a reality (J. P. Shiffman & Sultana, 2013). In developing countries there are many competing needs for the limited resources that are available. It is not often that the countries have a process to follow for a health issue to become a national priority. The availability of national data, Inventory of resources available, literature review on proposals and the contribution of experts all play significant roles in setting the agenda with list of priorities for guidance and deliberation by the politicians. The statistics are great advocacy tools.

Allocating resources to all sectors of the government is something that is complex and requires the determination and commitment of some people who are ready to work hard to make this a reality. The World Health Organization (WHO) have recommended that countries set aside a least 5% of the national budget for health but this is not the case in many countries of the world especially the developing countries. The allocation to health will then be shared to all the different units and segments.

Making health a national priority as described by Shiffman has three major influences. The role of the international community and donor agencies is very important. The activities of local advocacy groups cannot be underestimated, and the political climate of the country at the time will contribute to making health or health program a national priority. The WHO sets out agenda that is recommended to the member nations to be followed (Jody R. Lori & Starke, 2012). This carries a lot of weight and influence. International donors have their projects and priorities and if the country wants to benefit from these agencies they would have to have the same priorities as the donor agencies who come not only with donations but with expertise that is most needed in most places. This is illustrated by the HIV/AIDS programs designed by the USA government and Bill and Melinda Gates Foundation along with other international bodies (J. Shiffman, 2008). AIDS program has become the priority of the nations that would want to benefit from them. The agenda is presented with ethical appeal on why a particular issue is just the right thing to be done at this time. These agencies have the money, the knowledge and expertise and the political cloud.

Individuals with political power and influence can take up a project and become the spokesperson for that project, create awareness and put pressure on the government to take up that particular issue. An example is cited by Shiffman of the former Director of UNICEF (James Grant) who took up child survival and he got it on the agenda (J. P. Shiffman & Sultana, 2013). He had such political influence that Bangladesh took it up immediately. The role of local health indicators is very important as well as high profile meetings in the city to call attention to particular issues. Influential policy makers could affect the decision making process from within.

Many factors come to play in generation political priority for health (J. R. Lori, Amable, Mertz, & Moriarty, 2012). The most important contribution comes from the International community and aid agencies and the political will of the politicians. There are pressures from all interested parties and sometimes the real need is given up for political gains.

Lori, J. R., Amable, E. E., Mertz, S. G., & Moriarty, K. (2012). Behavior change following implementation of home-based life-saving skills in Liberia, West Africa. J Midwifery Womens Health, 57(5), 495-501. doi: 10.1111/j.1542-2011.2012.00172.x

Lori, J. R., & Starke, A. E. (2012). A critical analysis of maternal morbidity and mortality in Liberia, West Africa. Midwifery, 28(1), 67-72.

Shiffman, J. (2008). Has donor prioritization of HIV/AIDS displaced aid for other health issues? Health Policy Plan, 23(2), 95-100. doi: 10.1093/heapol/czm045

Shiffman, J. P., & Sultana, S. M. B. A. M. (2013). Generating Political Priority for Neonatal Mortality Reduction in Bangladesh. Am J Public Health, 103(4), 623-631.

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by | October 3, 2013 · 3:29 am