Gesundheit im Umbruch

Some Key Resources and Basic Reading

Health Care Systems in Transition


The European Observatory on Health Care Systems

The observatory supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe. The Observatory is a partnership between WHO Regional Office for Europe, the Governments of Greece, Norway and Spain, the European Investment Bank, Open Society Institute, World Bank, London School of Economics and London School of Hygiene & Tropical Medicine.


European Health Report 2002

”Although overall levels of health in the European Region are among the highest in the world, the report points to major inequalities between and within countries. Most striking is the widening gap in life expectancy and healthy life expectancy between western and eastern European countries, with a particularly marked decline in the NIS due largely to premature mortality among adult males. Important inequalities in health status result from the dramatic increase in the incidence of communicable diseases such as HIV/AIDS and tuberculosis in eastern European countries, largely related to the deterioration in the socioeconomic situation, and the persistence of malaria in some areas in the south-eastern part of the Region.”;


The World Health Report 2000

Health Systems: Improving Performance

“The World Health Report 2000 is an expert analysis of the increasingly important influence of health systems in the daily lives of people worldwide. Health systems provide the critical interface between life-saving, life-enhancing interventions and the people who need them. If health systems are weak, the power of these interventions is likewise weakened, or even lost. Health systems thus deserve the highest priority in any efforts to improve health or ensure that resources are wisely used.”


Health Care Systems in Transition profiles (HiTs)

“HiTs are country profiles that provide an analytical description of each health care system and of reform initiatives in progress or under development. HiT's aim to provide relevant comparative information to support policy-makers and analysts in the development of health care systems and reforms in the countries of Europe and beyond. The HiT profiles are building blocks that can be used to learn in detail about different approaches to the financing, organization and delivery of health care services; to describe accurately the process, content and implementation of health care reform programmes; to highlight common challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in countries of the WHO European Region.”


Ten years of health sector reform in CEE and NIS

“The decade since the break up of the Soviet bloc has brought enormous political and socio-economic change. The health sector has not been spared the effects of transition and the countries emerging from the process have each engaged in varying degrees of health system reform. It is at last possible to reach some judgement about how this process has unfolded, and to identify successes and failures, and to understand better the scale and nature of the remaining challenges. It is now timely to take stock of these experiences and to draw lessons for the future development of health systems in this complex and dynamic region.”
Josep Figueras, Martin McKee, Suszy Lessof, Ten years of health sector reform in CEE and NIS: An Overview. A background paper prepared for USAID Conference,Washington, DC, 29–31 July 2002 (draft). First of a series of six commissioned papers discussing the key issues for health systems in transistion. Download:, Conference website: Conference reader available in early 2003.


Health as Citizenship

“Hannah Arendt developed three dimensions of being fully human: family life, work life and public life, the vita activa. Within these arenas, what connects us as human beings is trust, reciprocity and mutuality, dimensions of what increasingly is being called the social capital of societies. Discussing these issues in terms of health presents several difficulties in former closed socialist societies that are now open to the free market and to increasing individualization. It highlights crucial policy conflicts between what is considered a public and collective good and what is considered a private responsibility. As a principle, the mobilization of citizens and communities for better health embodies both the dimensions of democratization (including joint decision-making and accountability) and of individualization. In the countries of central and eastern Europe, it was (and is being) experienced in all its ambivalence and ambiguity as many countries moved from a collective to an individualistic understanding of health. This is reinforced by moves (and strong pressures from major donors) to reshape the health system and shift responsibilities from the state to other levels of governance, to the private sector and to individuals and families.
Any analysis of this process must take into account the political and social contexts within which participatory and collaborative strategies for health are proposed. For citizens, it includes the ambiguity of gaining a concept of individual human rights or patients’ rights yet perhaps losing the collective right to health as a public good and, in the context of the transition, losing access to services. For health professionals, the changes could be seen as a major loss of authority, both towards the general population and towards other sectors with whom they were now called on to cooperate. Nothing had prepared them to work in this new manner. For politicians, it meant accepting voices outside the formal political system, a more open democratic process than that represented by political parties.”
Ilona Kickbusch, Mobilizing citizens and communities for better health: The civil society context in central and eastern Europe. A background paper prepared for USAID Conference,Washington, DC, 29-31 July 2002 (draft). Download:, Conference reader available in early 2003.


Health care in central Asia

“Central Asia remains one of the least known parts of the former Soviet Union. The five central Asian countries have faced enormous challenges over the last decade in reforming their health care systems, including adverse macro-economic conditions and political instability. Common strategies have involved devolving the ownership of health services, seeking sources of revenue additional to shrinking state taxes, "down-sizing" their excessive hospital systems, introducing general practitioners into primary care services, and enhancing the training of health professionals. This book draws on a decade of experience of what has worked and what has not.”
Martin Mckee, Jane Falkingham and Judith Healy (ed.), Health care in central Asia, Buckingham 2002 (Open University Press). Download (pdf) from:


Deepening democracy in a fragmented world
Human Development Report 2002

”Politics matter for human development. Reducing poverty depends as much on whether poor people have political power as on their opportunities for economic progress. Democracy has proven to be the system of governance most capable of mediating and preventing conflict and of securing and sustaining well-being. By expanding people's choices about how and by whom they are governed, democracy brings principles of participation and accountability to the process of human development.”