The impact of health system reform on remote health in Cambodia and the Philippines.
Remoteness is commonly conceived of in the Western health context in terms of geographical or social isolation. These features of remoteness also apply to the developing nation context. However, the international context has additional dimensions of remoteness that impact significantly on health outcomes. These are the economic, social and political realities of poverty and insecurity in remote populations. Based on the experiences of implementation of health development projects in Cambodia and The Philippines in the 1990's, this paper describes the character of poverty and insecurity and it's impact on health outcomes. It also describes recent health sector reforms of decentralisation and devolution, and discusses the degree to which these reforms have responded to the health needs of remote populations.


CONCLUSIONS
Poverty and insecurity are dominant factors in reducing access to essential health services and hence impact negatively on health outcomes, particularly for women and children. Recent health sector reforms have not as yet demonstrated tangible benefits for the health of remote populations.
Grundy
J J
JJ
Centre for Remote Health, Alice springs, Northern Territory, Australia. john.grundy@flinders.edu.au