17
Figure 10: Trend in suspected malaria cases tested (%) in Malaysia
Source: WHO 2017d.
However, not every country has been able to achieve reforms that ensure access to healthcare for all.
This indicates that, while these principles have worked, they are also dependant on certain structural
factors. Alike other development issues, health is influenced by macro issues like the socio-political
system of the country. The socio-political nature of the health system can affect health systems
primarily in two ways, philosophically and organically. Philosophical impact of a system is reflected in
the recognition of people and their health right. One of the examples of how system’s willingness can
overcome resource constraints is Thailand. In spite of their reliance on out-of-pocket expenditure for
health and related resource scarcity, the country has been successful in securing the health-related
interest of the marginalized and vulnerable by devising a system of community-based risk pooling,
health insurance.
Organic barriers are very much related to the supply side. It is the much-discussed accountability
factor that often determines the effective implementation of any health system innovation. Examples
include shortage of healthcare staff due to absenteeism or informal pay to avail healthcare etc. The
good news is, if the socio-political philosophy is pro-poor, the reform principles can address such
organic issues. However, that also depends on proper stewardship and leadership by the government
and other development partners. Based on the global experience what works to enable a political
system towards a pro-poor approach is to invest in a critical platform constituted by civil society,
development partners and government to ensure evidence-based policy formulation and
implementation. This also contributes to foster effective governance by making all the stakeholders
accountable towards ensuring access to healthcare especially by the vulnerable groups.