Community-oriented health services in low resource settings

The global gap between the ‘haves and the have-nots’ and the contrasting issues of under-nutrition among the poor, and over-nutrition among the wealthy, have been recognised for more than a decade (WHO, 2002). Health and health needs differ markedly between high and low-resource settings and whilst most health risks cluster around the poor or most disadvantaged, no risk occurs in isolation and each may have one or more causes. Health care systems have the potential to reduce health risks and achieve ‘good’ outcomes and efficiency when their four core functions (financing, resource generation, service delivery and stewardship) are organised and carried out in a systematic manner. Although healthcare spending (as a percentage of gross domestic product (GDP), varies widely across the world, merely allocating more funds/resources to health care by a country does not mean the health care system will be more effective or efficient. As an example total expenditure on health (as a percentage of GDP) in the United States is 17.7% and in Japan 9.6%, however health status (reflected by chronic disease rates and life expectancy) is better for those living in Japan than those in the United States (OECD, 2013).