The spread of market relationships has advanced so far in many countries that official policies often have limited relevance to the realities that poor people face when coping with health problems. This article in the Global Forum for Heath Update proposes an approach which explores the operation of health markets in order to help explain how health systems are changing. The authors identify potential opportunities for intervention and innovation, and guide the design of monitoring systems that can track and learn from both the intended and unintended consequences of such innovations. Different types of emerging innovations are examined with a specific focus on two in Nigeria and Bangladesh. Given the pervasiveness of markets for health-related goods and services and the great degree to which the poor obtain medical care in these markets, the authors argue that it is time for health policymakers to take action to improve their performance, based on a systematic understanding of how these markets operate. In doing so, they need to take a number of things into account. The authors argue that this includes attempts to achieve long-lasting change through the efforts of a single organisation or a particularly innovative individual which tend to be unsuccessful. The article also warns that it is important to understand and address market systems as a whole in order to achieve sustainable change. Interventions intended to benefit the poor need to acknowledge and take into account the influence of power and conflicts of interest on their outcome and this should be anticipated in a detailed stakeholder analysis.
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