Explanations of Performance and Reform Responses

Abstract

This chapter provides an overview of health sector reform in the five study countries. The policy context, content and process are each analysed (Walt and Gilson 1994). New Institutional Economics emphasises that most institutional change is incremental and slow and hence the historical structure of institutions will affect the speed and success of reform. Accordingly, the following section on context explores in some detail the historical development of the health system in the study countries. The contextual section also addresses macro-economic and social issues, describing trends in economic and social indicators and the design and implementation of structural adjustment programmes. Consideration of these broader contextual issues helps explain the health system performance described in the previous chapter.