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Smallest-scale logistics

by Michael Keizer on February 26, 2009

Talking about health logistics, we tend to concentrate on heath systems logistics, i.e. the logistics of the health system. What we ignore is the logistics of daily life and its impact on health.

To give one example: obesity is linked to the way our communities are designed and how long we spend in our cars each day. More dramatic examples include how distance from a source of clean drinking water impact on water use, or how transport and in-house storage of that same drinking water can make all the difference between clean or contaminated water.

An even more direct link between smallest-scale logistics and health are the risks that many women and girls in developing countries (especially in refugee settings) run when collecting firewood. Here it is not even the logistics that impact on the product (firewood) and hence on health, but the logistic activity (collection) itself that endangers people’s life and health (although there is also an indirect link: the use of firewood as fuel causes air pollution).

UNHCR and the Women’s Refugee Commission recently started the Get Beyond Firewood initiative, which is trying to find safe alternatives for firewood. This is a good example of how improvement of the smallest-scale logistics can improve life and health of people in developing countries.


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Blindly optimistic or blindingly obvious?

by Michael Keizer on February 25, 2009

Oxfam recently released a report that basically claims that the only way to get health systems in developing countries on track is using a mainly public-sector approach. Of course,they hedge their position by including a disclaimer that “[t]he private sector can play a role in health care”,  but that is about the only nod they give to any merits of the private sector.

Obviously, not everybody agrees, and reactions have been swift and, at times, scathing; in fact, I have not been able to find any positive comments from non-Oxfam-related sources (but that might be due to the normal bias: it is always easier to be critical than to support somebody without appearing sycophantic).

The rational approach, of course, is: whatever works. Both Oxfam and its detractors seem to have been caught up in old-style ideology. The only rational response that I have seen up to now has come from CGD‘s April Harding: she points out that there might not be any convincing evidence for a blanket private-sector approach, but neither is there one for a similarly blanket public-sector one. Kudos to Harding.

I think it should be clear that every health system is unique, with its own setting, history, and constraints; and that consequently every system has its own optimum mix of public and private sector support. The art is to find that balance in each individual case, which is one of the central issues in public health economics. Blanket statements on which approach works best don’t do anybody any favour.

(Update 16 May 2009): See my recent post on pharmacies for more info on the public/private mix for health logistics.


Continue Reading 1 comment }Public health