Inefficiency

Many countries, for want of funds, have rationed health care by limiting overall budgets rather than directing resources to specific illnesses or diseases. Unless the performance or the efficiency of the health system improves, even extra funds could be wasted. One possible approach, where funds are inadequate, could be to ration funds based on essential interventions. The smallpox and malaria eradication campaigns of the 1960s started a trend towards donor-driven, disease- specific vertical programmes. Since the 1980s, with the launch of structural adjustment programmes, donor countries have favoured extending assistance to programmes which are focused on disease eradication. It is argued that with such approaches, public health care efforts outside of such vertical structures may suffer. Also, even vertical programmes dependent on external funding would be threatened if donor funds disappear. Vertical programmes may be affordable and prudent only for diseases that offer a reasonable possibility of eradication in a foreseeable period.
A more preferable path is that of disease-specific programmes integrated with overall health structures. Maternal and child health services also need to be suitably integrated. In many countries, primary health care has focused on family planning to the exclusion of maternal and child health services. To avert more maternal deaths, care during pregnancy and especially during childbirth must be linked to reliable systems that ensure the availability of advanced treatment in cases of obstetrical emergencies (HDR, 2003, p-102).