It is widely acknowledged that inadequacies in public sector health systems can only be overcome by substantial structural and institutional reforms. In India, the need for reforms in the health sector has been highlighted and stressed upon in recent period. While there is a growing belief that public and private sectors in health can potentially gain from one another, there is also recognition that, given their respective strengths and weaknesses, neither the public sector nor the private sector alone can operate in the best interest of the health system. The current study attempts to analyse the impact of enabling environments measured by the economic freedom index in 20 Indian states on select healthcare outcomes, through a panel data model. The empirical results confirm that rise in economic freedom lowers maternal mortality and infant mortality, as the resulting conducive environment enables greater private sector participation. However, the crucial role to be played by the public sector is also underlined in no uncertain terms. The obtained results strongly indicate that the health scenario in India can improve only through closer co-ordination between the public and the private sectors.

The world remains off-track for the sustainable development goal (SDG) target 3.4, which calls for a one-third reduction in noncommunicable diseases (NCDs) mortality by 2030. This paper presents benefit–cost analyses of various NCD interventions in low-income (LICs) and lower–middle-income (LMCs) countries. We looked at 30 interventions recommended by the Disease Control Priorities Project, including six intersectoral policies (e.g., taxes) and 24 clinical services. We used a previously published model to estimate intervention costs and benefits through 2030, discounted at 8%. We focused on interventions with benefit–cost ratios (BCRs) > 15 and their contribution toward achieving the SDG target. We found that intersectoral policies often provided great value for money, with BCRs ranging from 40 (trans-fat bans) to 100 (tobacco excise taxes). However, seven clinical interventions (e.g., basic treatment of cardiovascular disease or breast cancer) also had BCRs > 15. The overall population impact of clinical interventions over the 2023–2030 period would be much higher than that of the intersectoral policies, which can take many years to reach their peak effects. Fully implementing the best-investment interventions would accelerate progress toward SDG 3.4 everywhere, but only one in 10 countries would achieve the target. This strategy would require an additional US$ 2.4 billion annually across all LICs and LMCs. We conclude that there are several cost-beneficial opportunities to tackle NCDs in LICs and LMCs. In countries with very limited resources, the best-investment interventions could begin to address the major NCD risk factors and build greater health system capacity, with benefits continuing to accrue beyond 2030.

Each year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low-income and lower-middle-income countries alone, translating to a welfare loss equivalent to $426 billion and $36 billion for neonatal and maternal deaths, respectively. The total loss was $462 billion or almost 6 % of these countries’ combined GDP. In the sustainable development goals pledge, the world promised to reduce maternal deaths to 0.07 % and neonatal mortality to below 1.2 %, saving about 200,000 women and 1.2 million children from dying annually. However, on the current trajectory, maternal mortality is expected to decline to only 0.16 % and neonatal deaths to only 1.5 % by 2030. This article analyses the most cost-effective way to reduce maternal and neonatal deaths – Increase coverage of basic emergency obstetric and newborn care from 68 to 90 % combined with increased family planning services in 55 low-income and lower-middle-income countries which account for around 90 % of the burden of maternal and neonatal mortality globally. The proposed package will require $3.2 billion per year more investment and will deliver benefits worth $278 billion per year in avoided deaths and higher economic growth. It will also yield a demographic dividend benefit equivalent to $25 billion annually. For every $1 invested, the social and economic benefits are estimated to be $87. The benefit-cost ratio is 87.

Millions of households are pushed into poverty every year because of high out-of-pocket (OOP) expenditure on health care. Globally, each year more than 150 million people face financial catastrophe and around 100 million suffer destitution due to OOP payments made for health care. More than 90 per cent of these people reside in low-income countries. In South Asia, impoverishment due to health payments is significant with at least 32 million people in India alone being pushed into poverty annually due to OOP expenditures on health care. In most health care systems in this region, the role of public spending on health and prepaid schemes, such as tax and social insurance, is limited as is the extent of financial risk protection. The problem is compounded by the large informal sector which is a major challenge to attaining universal health coverage in South Asian countries. Recent literature points to the role of public–private partnerships (PPP) in health care as a viable solution for ensuring equitable access to health care especially for the poor. This article seeks to review the major components of health care financing and reform including financial risk protection, resource generation and pooling, and PPPs in procurement and payment in South Asia. It identifies key lessons across the health financing systems of Asian countries that have attempted to reduce dependence on OOP expenditures, expanded health service delivery and increased pooled health financing mechanisms. It analyses the role and importance of PPPs in mitigating the impoverishing effects of OOP health expenditure in South Asia.

Undernutrition and micronutrient deficiencies are key drivers of infant and child mortality and are causes of impaired human potential for hundreds of millions of children every year. Investing in nutrition in the first 1,000 days from conception not only supports individual lifetime health, education, and productivity, but is also key to breaking the intergenerational cycle of malnutrition and enhance equitable development pathways for low- and middle-income countries. This paper provides a cost–benefit analysis of three nutrition interventions: 1) provision of preventive small-quantity lipid-based nutrient supplements (SQ-LNS) to children 6−23 months of age; 2) Complementary Feeding Promotion (CFP) for children 6−23 months of age; 3) provision of multiple micronutrient (MMN) and calcium (Ca) supplements to pregnant women. The benefit–cost ratios (BCRs) for MMN supplementation for pregnant women replacing iron and folic acid (37.5), as well as MMN and Ca combined (19-24), are the highest. The BCRs for CFP for children in the two highest socio-economic status (SES) quintiles and SQ-LNS for children in the three lowest SES quintiles are fairly similar at 16 and 14, respectively. The lowest BCR is for CFP for children in the three lowest SES quintiles due to the high cost of accomplishing behavioral change for improved complementary feeding in resource-poor households.