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    Sustaining primary health care.

    LaFond A

    London, England, Earthscan Publications, 1995. 218 p.

    This book reports the findings of a 3-year research project conducted by Save the Children Fund UK, which used a variety of case studies to document and analyze how health systems in low-income countries develop in response to internal and external influences and how these influences affect the sustainability of the health systems. After an introduction that defines sustainability as "the capacity of the health system to function effectively over time with minimum external input," chapter 1 considers the sustainability problem by looking at the donor's dilemma and at definitions and measures of sustainability, providing a conceptual framework that emphasizes the quality of the process of health system development, and noting contradictions that occur in the development process, such as those that exist between immediate needs and capacity building, between dependency and self-reliance, and between the goals of effectiveness and continuity/self-reliance. Chapter 2 describes the contextual hostility created by economic conditions, the international aid system, the local political climate, and the health care market. This chapter also includes a note on the history of legacies and investment trends. Chapter 3 explores the quality of investment through an exploration of the role of government, the constraints faced by donors as investors, and the investment dynamic that emerges from the interaction between governments and donors. The final chapter links investment and sustainability by addressing the contradictions between investment practice and sustainability and considering strategies for securing sustainability. It is concluded that the two basic requirements for health system sustainability are a renewable resource base and an institutional capacity for effective and efficient resource use.
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