How do countries regulate the health sector? Evidence from Tanzania and Zimbabwe

The health sectors in many low- and middle-income countries have been chara cterized in recent years by extensive private sector activity. This has bee n complemented by increasing public-private linkages, such as the contracti ng-out of selected services or facilities, development of new purchasing ar rangements, franchising and the introduction of vouchers. Increasingly, how ever, experience with the private sector has indicated a number of problems with the quality, price and distribution of private health services, and t hus led to a growing focus on the role of government in regulation. This paper presents the existing network of regulations governing private a ctivity in the health sectors of Tanzania and Zimbabwe, and their appropria teness in the context of emerging market realities. It draws on a comparati ve mapping exercise reviewing the complexity of the variables currently bei ng regulated, the level of the health system at which they apply, and the s pecific instruments being used. Findings indicate that much of the existing regulation occurs th rough legislation. There is still very much a focus o n the 'social' rather than 'economic' aspects of regulation within the heal th sector. Recent changes have attempted to address aspects of private heal th provision, but some very key gaps remain. In particular, current regulat ions in Tanzania and Zimbabwe: (1) focus on individual inputs rather than h ealth system organizations; (2) aim to control entry and quality rather tha n explicitly quantity, price or distribution; and (3) fail to address the m arket-level problems of anti-competitive practices and lack of patient righ ts. This highlights the need for additional measures to promote consumer protec tion and address the development of new private markets such as for health insurance or laboratory and other ancillary services.