Strategies for achieving health financing reform in Africa

African ministries of health have been discussing and adopting far-reaching health sector policy reforms since the 1980s. Experience has shown that a broad array of institutional reforms and management processes - such as civil service reform, decentralization, strengthened management capacity, building political consensus on priorities, overcoming bureaucratic constraints - is needed to complement and support the more technical, economic and financing policy solutions to adopting and implementing these reforms. This article identifies some of the main obstacles that African countries face in designing, adopting, and implementing health financing reform and the strategies they have used to overcome these obstacles. It also draws lessons learned about resolving specific design and implementation issues to avoid common pitfalls and to create conditions for success. Copyright (C) 1996 Elsevier Science Ltd