title: Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening.
abstract: In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. dina.balabanova@lshtm.ac.uk
authors.forename: Dina
authors.initials: D
authors.lastname: Balabanova
authors.forename: Anne
authors.initials: A
authors.lastname: Mills
authors.forename: Lesong
authors.initials: L
authors.lastname: Conteh
authors.forename: Baktygul
authors.initials: B
authors.lastname: Akkazieva
authors.forename: Hailom
authors.initials: H
authors.lastname: Banteyerga
authors.forename: Umakant
authors.initials: U
authors.lastname: Dash
authors.forename: Lucy
authors.initials: L
authors.lastname: Gilson
authors.forename: Andrew
authors.initials: A
authors.lastname: Harmer
authors.forename: Ainura
authors.initials: A
authors.lastname: Ibraimova
authors.forename: Ziaul
authors.initials: Z
authors.lastname: Islam
authors.forename: Aklilu
authors.initials: A
authors.lastname: Kidanu
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Koehlmoos
authors.forename: Supon
authors.initials: S
authors.lastname: Limwattananon
authors.forename: V R
authors.initials: VR
authors.lastname: Muraleedharan
authors.forename: Gulgun
authors.initials: G
authors.lastname: Murzalieva
authors.forename: Benjamin
authors.initials: B
authors.lastname: Palafox
authors.forename: Warisa
authors.initials: W
authors.lastname: Panichkriangkrai
authors.forename: Walaiporn
authors.initials: W
authors.lastname: Patcharanarumol
authors.forename: Loveday
authors.initials: L
authors.lastname: Penn-Kekana
authors.forename: Timothy
authors.initials: T
authors.lastname: Powell-Jackson
authors.forename: Viroj
authors.initials: V
authors.lastname: Tangcharoensathien
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D001459:Bangladesh; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D006076:Government; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007194:India; D007707:Kyrgyzstan; D008297:Male; D009936:Organizational Innovation; D011203:Poverty; D013785:Thailand