Abstract
Health policy making in developing countries is increasingly being envisaged as a stewardship process concerned with attaining trust and legitimacy between a government and its people towards the improvement of the welfare of populations. Health policy today involves multiple actors and an increased role by global and international agencies. Increased investment in the context of the Millennium Development Goals is also placing greater attention on good national and international governance. Particular attention is being paid to governance of the new breed of vertical programmes. This approach has demonstrated benefits for the specific diseases being tackled, yet it threatens other programmes and the capacity of local authorities to meet broad health needs. Developing country governments should set clear priorities on the basis of health needs and infrastructure capacity as well as on sound ethical guidance that help achieve maximum improvement in health in return for minimum expenditure.
Comprehensive national health accounts is an important policy tool to track health spending from all sources. Performance assessment can support policy making in monitoring and evaluating attainment of critical outcomes and the efficiency of the health system in a way that allows comparison over time and across systems. Particular attention is being given to financing healthcare for the more than 1.3 billion rural poor and informal sector workers in developing countries without financial protection against the catastrophic costs of healthcare. Success with these and other innovations will depend on solving the multiple challenges facing the health workforce. Relying on public–private mix of services to address health infrastructure faces the question of the capacity by government to develop contracts, set prices, and monitor and supervise private providers.
It is not always easy to reconcile efficiency and equity in health policy. Equity should be a primary concern for sustainable policy making, and tools are available to trace the extent to which investments at national levels benefit the poor and needy. In many respects, health policy in developing countries is all about the encouragement of innovation and the scalingup of lifesaving technologies and systems. Access to knowledge and technology has accounted for a high proportion in the decline in mortality rates. New strategies for organizing health research systems can contribute to make evidencebased policy a reality in developing countries.