Problems to solve.

In the vast majority of low-income countries health system performance is way off the mark. Many of the individuals who could benefit most from preventive and therapeutic health services do not receive them and when they do the quality of the services is low. The most obvious reason for the deficiencies is limited resources. On average low-income countries -- those with a gross national income of less than $1095 in 2009 dollars -- spend about 4.1 percent of gross domestic product from both public and private sources. At current levels of spending even adjusting for differences in the cost of labor and other inputs across countries it is impossible for basic services of acceptable quality to reach the majority of the population. Beyond this a range of systemic shortcomings is evident: quality control and supervision are absent supply chains are broken the transfer and use of information are weak managerial skills are in short supply in both public and private sectors and the absolute number of health workers at virtually all levels is lower than optimal by technical standards. To solve a problem one must identify it and understand its underlying causes. Here we highlight both a set of important problems and the reasons to believe -- at least on conceptual grounds -- that introducing financial and other material incentives can improve health sector performance. (Excerpts)