Health sector reform in comparative perspective: An unending quest

Given the problematic nature of attempts to reform national delivery systems for health care, the paper reviews the logic of New Public Management in the health sector. After a background on approaches to building capacity within three generations of public sector reforms, it examines the reforms applied to the delivery of health services and suggests strategies for reform that take capacity into account. In particular, based on field reserach in India, Brazil and South Africa, it considers public-private partnerships that are often advocated in order to alleviate deficiencies in public health systems as well as to reduce financial stress on both governments and those who seek services from a largely unregulated private market. It concludes with a discussion of the role of governance in health policy and development.