REFORM AND CHANGING ROLES
• Health sector reform should shape the mix of public-private, and central-local participation in health care so as to achieve maximum benefit for all.
• Increasing the importance of the private sector or of competitive mechanisms within the public sector are options which can be undertaken within a reform process as part of a comprehensive effort to improve equity, quality, and efficiency in health systems.
• Concerns about equity and as well as the information imbalance, failure of competition, and externalities in the pharmaceutical sector argue strongly for essential state roles in policy-making, regulating, assuring quality and access, and promoting rational drug use.
• Public and private sectors should compete fairly, on equal grounds and the structures and procedures for business for both sectors should be transparent.
• Public-private roles in the pharmaceutical sector should be considered within the context of a national drug policy which aims to ensure access to and rational use of drugs which are safe, effective, and of high quality.
• A strong or increasing role of the private sector changes but does not reduce the responsibility of the government to oversee equity of access and quality of health services.
DECENTRALIZATION WITHIN THE PHARMACEUTICAL SECTOR
• Some responsibilities and activities within the sector may benefit from a decentralized approach, but certain essential functions (development of a national drug policy, drug registration, and standards for quality control) should remain the responsibility of central authorities.