Cooperation between Chili and France in management training in the Chilean public health sector

: This short paper is not by an economist. It is by a public health doctor who has spent the last ten years working with development agencies and governments to strengthen public health systems in poor and middle-income countries. It is becoming increasingly obvious that while this still needs to be done, the focus of attention must shift to private expenditure and private providers. In most poor and middle income counties--even the most aid dependant--by far the biggest source of finance in the health sector is out of pocket expenditure and the poor in many of these countries spend disproportionately more than the rich as a % of household income on health care. This expenditure is primarily in the private sector or on unofficial user fees in the public sector. This expenditure does not protect the poor from the economic costs of catastrophic illness nor do they appear to get good value for treatment in the primary care setting. This paper is not a detailed synthesis of current knowledge but an overview for those who are not specialists in this area. It gives references to key publications, which have done that synthesis, and draws from them.