The new policies for rural health: institutional, social and financial challenges to large-scale implementation.

Abstract

Rural development activities are frequently more important than isolated health care interventions in maximizing improvements in rural health status. In addition, integrated socio-economic development of rural areas ensures availability of local resources to finance health schemes, encourages community involvement in development and reforms and strengthens management capacity for health programme implementation and development. Public health services provide in turn an entry point for directly productive development activities. In designing, implementing and operating health components of rural development projects in developing countries, the most serious obstacles are almost invariably the following: (i) how to strengthen the managerial capacity of the health administration from the national to the local level and how to execute integrated programmes through decentralized and uncoordinated agencies; (ii) how to ensure adequate recurrent cost financing and contribution of beneficiaries to operating cost; and (iii) how to achieve active involvement of rural communities in decision-making and services delivery when projects are large and planned and executed by government authorities. In discussing these issues the paper will cite the World Bank’s experiences in a number of African, Asian and Latin American countries.