The proof of the reform is in the implementation

In 2000, TDR funded a series of studies to examine the opportunities and threats of health sector reform to the control of tropical diseases. This article is a cross-case analysis of ten of those studies, exploring the similarities in patterns across the countries covered: Colombia, China, Nigeria, the Philippines, Sudan, Tanzania and Uganda. The implementation experiences across countries were strikingly similar despite very different socio-economic and epidemiological situations. The reform implementation was neither complete nor clean and had in all the countries found some sort of least-energy equilibrium where the processes had stopped at a sub-optimal stage needing considerable renewed 'change-energy' to achieve its objectives. The role of the state had, in several cases, been reduced to a situation where it neither pursued the interest of the public nor protected the individual against harm caused by the behaviours of others. Whether one should follow a dedicated disease control programme or a systems approach is not a relevant question. Effective disease control cannot be implemented without strong and functioning health systems and health system performance cannot be improved without considering which purpose the system is to serve.