**PHN 1992 Sector Review**

8 population, health and nutrition and eight focused on the social sectors or poverty alleviation, but paid specific attention to the PHN sector.

2.17 In FY92, five country-specific health sector reports were published in grey cover (Nigeria: Health Care Cost, Financing and Utilization; Poland: Health System Reforms - Meeting the Challenge; Romania: Accelerating the T'ansition - Human Resource Strategies for the 1990s; Bra2il: Women's Reproductive Health; and Yemen: Human Development - Societal Needs and Human Capital Response). In this section, these reports are examined to assess their usefulness for devising policies and programs to address poverty alleviation and the quality of PHN services in developing countries (A review of population sector work is provided in paras. 2.412.42).

2.18 A first step in making use of limited resources to alleviate poverty is to identify the poor and vulnerable groups. The strongest reports classified the poor by gender, geographic area, income, nutritional level, and educational level, among other indicators. However, several reports did not provide data on who the poor are and where they reside. The Romania Human Resources Strategies Report did make the case that the country should conduct an assessment of the needs of poor and vulnerable groups in the country. The identification of poor and vulnerable groups and the assessment of their needs and demand for basic health services is an essential component of general health sector work. Chapter V of this report stresses this message and offers guidance in this regard.

2.19 A key barrier to poverty alleviation mentioned in most reports is the misallocation of health resources. Many countries spend the majority of their health resources on costly curative care, and, consequently, most reports stressed the importance of redirecting funds from curative care to primary health care activities for the general population. The Brazil Women's Reproductive Health Report goes a step further by recommending that women, in particular, be targeted to benefit from basic health services, since they currently benefit from a disproportionately smaller share of available health resources. However, several reports also make the point that in order to reach the poor and vulnerable groups, reallocation of public health expenditures will not be enough; actual spending must increase if needs are to be met.

2.20 While increasing resources for public health services is important for poverty alleviation, the best reports stressed that countries need to find a way to pay for this increase. The Poland Health Systems Reform Report emphasizes the need to diversify sources of funding. Several reports recommend giving greater support and encouragement to the private sector (including NGOs) to deliver health services. Increased government recognition of the private sector is important since private sector providers offer a complement of services to those provided by the government thus expanding service availability overall; and the quality of private services is often relatively high. The Nigeria Health Care Cost, Financing and Utilization Report emphasizes the need to encourage the "complementary role" of the private sector to provide services, especially to higher income groups. This report suggests that in order to ensure that access and quality are maintained or improved, the government may need to provide incentives to the health sector and regulate it through education programs targeted to providers. The Romania Human Resource Strategies Report suggests that granting more autonomy to private sector providers may be an effective incentive for encouraging their growth.

2.21 A number of reports recommend decentralization as a way to increase access to and quality of health services; however, several reports warn that there should be simultaneous efforts to improve management and financing at decentralized levels. In the Republic of Yemen Human Development Report, training of female health workers in rural areas is recommended as a means to improve the access to and quality of health care, especially for women.