While many constraints facing the health sector can be relaxed through the injection of new health sector resources, a lack of money is not the only problem facing the health sector in low and middle income countries. Poor countries differ according to the type and level of constraints they face. We argue that it is important to understand the full range of constraints that influence the use and provision of health services in specific settings when making strategic choices about how to scale-up key interventions to improve the health of poor people. This paper presents a conceptual framework for understanding constraints which is based on the level at which a constraint operates, the nature of the constraint, and its amenability to buy-out in the short term. Cross-sectional data is used to identify proxy measures of these constraints in order to categorise countries according to the type and level of constraint they face. An overall index of constraints is created, which includes variables reflecting demand, health system strength, and environmental characteristics including both governance and geography. Measures of government commitment to the health sector, and the distribution of key health sector inputs are explored but excluded from the index. A typology of countries according to the constraints they face can feed into the estimates of the cost of scaling up interventions, the choices of how to delivery priority interventions, and, potentially, of which countries should be the focus of early efforts.
Hanson, K.; Ranson, K.; Oliveira-Cruz, V.; Mills, A. Constraints to scaling up health interventions: A conceptual framework and empirical analysis. Commission on Macroeconomics and Health (CMH), Geneva, Switzerland (2001) 106 pp. [CMH Working Paper Series, Paper No. WG5 : 13]