Better health through better use of resources: editorial

World Health • SOth Year, No. 5, September-October 1997 3 Editorial Better health through better use of resources I n recent years there has been a shift from publicly financed and organized health systems to more mixed arrangements, with an increas- ing role played by private profit- making and other organizations. This shift has produced a great variety of cost-sharing mechanisms. As a result, in some countries the govern- ment may be reducing its role in financing and increasing its role in regulating the health-related activi- ties of its various partners. Thus, institutional arrangements are changing. We should learn as much as we can about them, but we should also propose mechanisms and programmes to help ensure that these arrangements move us towards the goal of health for all. In particular, three operating principles should be kept in mind. Firstly, we should promote the economical use of resources, whether they come from the public or the private purse. This does not necessar- ily mean spending less. It means making an investment in health. Setting up an efficient administra- tion, for instance, that avoids dupli- cation and coordinates both publicly and privately funded health services, may require a substantial initial investment. Well-tried cost-saving methods are available, and the need to use them cannot be overempha- sized. Generic essential drugs, low- cost but effective therapies, and disease prevention activities all help to reduce the cost of curative care. To be beneficial, however, cost reduc- tion efforts must take fully into account the need for basic services of an acceptable quality. Secondly, finding the right com- bination of local and central adminis- trative responsibility can make a major contribution to improving health status. Assigning more re- sponsibility to the local level will often make services more flexible and adaptable to changing needs. At the same time, responsibility for coordination and management of the overall health system, including its financing, has to be maintained at the central level. Thirdly, the health sector should play a very active role in reducing the huge disparities in access to health services that exist today. Even in high-income countries with rela- tively good health status, many of the rural people and the poor have little or no access to the basic necessities for health. In lower-income countries this means that the vast majority of the population is underserved. Disparity is also growing in many of the world 's cities, where rising stan- dards of living for some are accom- panied by rapid growth in the population of shanty town dwellers with no access to services. Mechanisms and financing methods exist that can make access to health care more equitable, and health authorities must insist that they be used. The articles in this issue of World Health provide useful information and ideas on how to tackle the many challenges we are still facing. Each situation is different, and the compet- ing needs are often difficult to under- stand and even more difficult to meet. However, in all of them one imperative is clear: to achieve better health through better use of resources. • Dr Hiroshi Naka;ima, Director-General of WHO. Photo WHO/H Anenden Hiroshi Nakaiima, M.D., Ph.D.