Health Systems in Low- and Middle-Income Countries: An economic and policy perspective

edited by Richard D. Smith and Kara Hanson . Published by Oxford University Press , Oxford UK 2012 . ISN 978019956676 : 288 pages ; RRP $ 62.95

Reviewed by Simon Barraclough

School of Public Health and Human Biosciences, La Trobe University, Victoria

Health systems pose a complex subject for analysis. Their nature and performance are shaped by a myriad of forces such as individual and societal values, the economic capacity of nations, human resources, management, policy and technologies. The wider context must also be considered and is increasingly affected by global factors.

This book is a timely addition to the literature on health system economics and policy in middle and low-income countries. The authors have considerable expertise in both research and project development. Much of their previous published work is drawn upon in this volume of edited chapters, which provides both analytical and practical insights. For example, in the first chapter the reader is enjoined to consider the complexities of defining “system”, while several other chapters provide country-specific case studies illustrating a particular issue. Specialist chapters cover such topics as evaluation, financing, revenue pooling, human resources and pharmaceuticals. These are balanced with chapters exploring the wider context of the economics and public policy of health systems, and include such topics as international trade, foreign aid assistance and the social determinants of health.

A commendable aspect of this book is its engagement with global factors. The inadequacies of a state-centred approach to health system development are made clear, and the need to embrace coalitions involving global non-state actors is reinforced. The book concludes with a chapter written by the editors considering what they regard as the “missing pillar” of healthy system development: global health diplomacy. The reader is reminded of the need to advocate as a key health sector competency, that is, the “negotiation to secure collaboration and coalition building, across sectors, in order to influence the determinants of health and health service utilization and connect policy…” (p.268). Given that the “policy space” of such governance has rapidly expanded beyond the nation state, the imperative of “global health diplomacy” is clear.

This book will be valuable both to teachers and students of health systems, as well as those seeking an introduction for research purposes. Most chapters impart “policy wisdom” which will benefit those seeking to introduce or reform policy in their own countries. Such wisdom is presented in a non-doctrinaire way, inviting the reader to consider relevant factors and not simply follow a ‘how to do it’ formula. In some places the authors have perhaps sought to place too much content into their discussion, briefly identifying points and leaving the reader to follow them up from the references. In such cases, the chapters provide a useful point of entry, rather than conventional text book coverage of topics.

Although the facts and figures presented in the book will become dated (it is perhaps regrettable that the manuscript was completed in August 2010 but not published until 2012) the perennial problems and issues, as well as the conceptual thinking presented in treating them, will ensure a continuing relevance for this work. On a pedantic note: in places in this book the title of the World Health Organization is misspelt, which is surprising, since this body uses British spelling conventions and Oxford University Press dictionaries indicate a first preference for “organization”.