Working Paper

Pluralism and Marketisation in the Health Sector: Meeting Health Needs in Contexts of Social Change in Low and Middle Income Countries

Published on 1 January 2001

This paper is part of a broader attempt to identify the key producers of social goods and how social policy interventions can support them. In this paper, we focus on the health sector in order to:

  • Examine the changing roles of health care providers and the management of health expertise in the context of pluralism and increasing marketisation of health goods and services
  • Explore how pluralism of provisioning and increasing markets for health goods have affected the ways households meet their health needs
  • Stimulate a reassessment of what governments should or could do to enable delivery of competent health care under conditions of pluralism and marketisation.

We argue that over the last few decades there have been profound changes in the ways health goods are being produced and consumed in low income and transitional countries. We outline the main categories of change in the health sector in terms of socio-economic changes, changes in health provision, knowledge and technologies, and political changes.

We examine the changing roles and functions of providers, asking what services health workers provide, what is the structure of rewards and incentives for health providers and how current arrangements affect transactions costs and quality of services. We go on to consider how households, particularly poor ones, manage health provisioning in a pluralistic environment where health goods and services have become increasingly marketised. We ask how the balance between different sorts of provision has changed and whether there has been an expansion of the productive and reproductive functions of households.

We then explore the roles of governments and other institutions in contexts of pluralism and marketisation. We look at the implications for financing of health services, the management of expert knowledge, and the skill needs of practitioners. We focus particularly on shifts in the location of specialised knowledge, such as the growing role of shops, pharmacies and sellers of medical techniques, and on strategies for disseminating health-related knowledge. We note the possible role of IT and expert systems for transforming chaotic markets in health care and health knowledge.


Gerald Bloom

Research Fellow

Hilary Standing

Emeritus Fellow

Publication details

published by
Bloom, G. and Standing, H.
IDS Working Paper, issue 136
1 85864 361 9


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