Equity impacts of neoliberal reforms: what should the policy responses be?

The final article in this special section draws together the lessons learned from the ALPS analyses and considers a range of potential policy responses. The country case studies highlight that health systems in many low- and middle-income countries are failing not only the poor but also other income groups, who are faced with wide-ranging barriers to accessing the health care they need. A key policy intervention to address these health system failures is that of challenging the status quo in relation to the public-private health care mix. There is an urgent need to strengthen public health services that have been systematically neglected over the past few decades while also regulating the worst excesses of the private health sector. Promoting a greater reliance on financing mechanisms that are progressive and that strengthen cross-subsidies in the overall health system is critical, as is ensuring that available financial and human resources are equitably allocated among geographic areas and groups. Finally, health system interventions of this nature should be supported by broader poverty-reduction strategies. Such interventions to fundamentally change ailing health systems are essential to break the vicious cycle of poverty, ill-health, and (further) impoverishment.