Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening.

Dina Balabanova ORCID logo; Anne Mills ORCID logo; Lesong Conteh; Baktygul Akkazieva; Hailom Banteyerga; Umakant Dash; Lucy Gilson ORCID logo; Andrew Harmer; Ainura Ibraimova; Ziaul Islam; +12 more... Aklilu Kidanu; Tracey P Koehlmoos; Supon Limwattananon; VR Muraleedharan; Gulgun Murzalieva; Benjamin Palafox ORCID logo; Warisa Panichkriangkrai; Walaiporn Patcharanarumol; Loveday Penn-Kekana ORCID logo; Timothy Powell-Jackson ORCID logo; Viroj Tangcharoensathien; Martin McKee ORCID logo; (2013) Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening. Lancet, 381 (9883). pp. 2118-2133. ISSN 0140-6736 DOI: 10.1016/S0140-6736(12)62000-5
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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.

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