The World Health Report 2000 Where particular practices and procedures are known to be harmful, the health ministry has a clear responsibility to combat them with public information and legal measures Phar- maceutical sales by unregistered sellers, the dangers of excessive antibiotic prescription and of non-compliance with recommended dosages should all be objects of public stew- ers in question and local health authorities Contrary to what might be expected, the share of private health financing tends to be larger in countries where income levels are lower But poorer countries seldom have clear lines of policy towards the private sector. They thus have major steps to take in recognizing and communicating with the different groups of private providers, the better to influence and regulate them. The private sector has the potential to play a positive role in improving the performance of the health system. But for this to happen, governments must fulfil the core public func- tion of stewardship. Proper incentives and adequate information are two powerful tools to improve performance To move towards higher quality care, more and better information is commonly re quired on existing provision, on the interventions offered and on major constraints on serv ce implementation. Local and national risk factors need to be understood. Information on numbers and types of providers is a basic -and often incompletely fulfilled-requirement An understanding of provider market structure and utilization patterns is also needed, so that policy-makers know why this array of provision exists, as well as where it is growing An explicit, public process of priority setting should be undertaken to identify the co tents of a benefit package which should be available to all, and which should reflect local disease priorities and cost effectiveness, among other criteria. Supporting mechanisms clinical protocols, registration, training, licensing and accreditation processes-need to be ought up to date and used. There is a need for a regulatory strategy which distinguishes between the components of the private sector and includes the promotion of self-regula Consumers need to be betterinformed about what is good and bad for their health, why not all of their expectations can be met, and that they have rights which all providers should spect. Aligning organizational structures and incentives with the overall objectives of olicy is a task for stewardship, not just for service providers. monitoring is needed to assess behavioural change associated with decentralizing au ority over resources and services, and the effects of different types of contractual relation ships with public and private providers. Striking a balance between tight control and the independence needed to motivate providers is a delicate task, for which local solutions must be found. Experimentation and adaptation will be necessary in most settings. A sup orting process for exchanging information will be necessary to create a virtual network from a large set of semi-autonomous providers FINDING A BETTER BALANCE The report says serious imbalances exist in many countries in terms of human and physical resources, technology and pharmaceuticals. Many countries have too few qualified healt personnel, others have too many. Health system staff in many low-income nations are equipment. One result is a"brain drain "of talented but demoralized professionals who either go abroad or move into private practice. Here again, the poor are most affectedxvi The World Health Report 2000 Where particular practices and procedures are known to be harmful, the health ministry has a clear responsibility to combat them with public information and legal measures. Phar￾maceutical sales by unregistered sellers, the dangers of excessive antibiotic prescription and of non-compliance with recommended dosages should all be objects of public stew￾ardship, with active support from information campaigns targeted at patients, the provid￾ers in question and local health authorities. Contrary to what might be expected, the share of private health financing tends to be larger in countries where income levels are lower. But poorer countries seldom have clear lines of policy towards the private sector. They thus have major steps to take in recognizing and communicating with the different groups of private providers, the better to influence and regulate them. The private sector has the potential to play a positive role in improving the performance of the health system. But for this to happen, governments must fulfil the core public func￾tion of stewardship. Proper incentives and adequate information are two powerful tools to improve performance. To move towards higher quality care, more and better information is commonly re￾quired on existing provision, on the interventions offered and on major constraints on serv￾ice implementation. Local and national risk factors need to be understood. Information on numbers and types of providers is a basic – and often incompletely fulfilled – requirement. An understanding of provider market structure and utilization patterns is also needed, so that policy-makers know why this array of provision exists, as well as where it is growing. An explicit, public process of priority setting should be undertaken to identify the con￾tents of a benefit package which should be available to all, and which should reflect local disease priorities and cost effectiveness, among other criteria. Supporting mechanisms – clinical protocols, registration, training, licensing and accreditation processes – need to be brought up to date and used. There is a need for a regulatory strategy which distinguishes between the components of the private sector and includes the promotion of self-regula￾tion. Consumers need to be better informed about what is good and bad for their health, why not all of their expectations can be met, and that they have rights which all providers should respect. Aligning organizational structures and incentives with the overall objectives of policy is a task for stewardship, not just for service providers. Monitoring is needed to assess behavioural change associated with decentralizing au￾thority over resources and services, and the effects of different types of contractual relation￾ships with public and private providers. Striking a balance between tight control and the independence needed to motivate providers is a delicate task, for which local solutions must be found. Experimentation and adaptation will be necessary in most settings. A sup￾porting process for exchanging information will be necessary to create a ‘virtual network’ from a large set of semi-autonomous providers. FINDING A BETTER BALANCE The report says serious imbalances exist in many countries in terms of human and physical resources, technology and pharmaceuticals. Many countries have too few qualified health personnel, others have too many. Health system staff in many low-income nations are inadequately trained, poorly-paid and work in obsolete facilities with chronic shortages of equipment. One result is a “brain drain” of talented but demoralized professionals who either go abroad or move into private practice. Here again, the poor are most affected