This in-depth study of health insurance schemes in Zaire recommends developing more pilot insurance systems in areas where health systems already function - and strengthening existing systems through training, exchange visits, information systems, and technical assistance. Implementing a nationwide health insurance system is not likely to be as successful as decentralized, locally managed plans.

World Bank Discussion Paper No. 385. Since the advent of reform in 1992, the Russian authorities have made substantial strides toward creating a market economy through privatization. Recently, Russian authorities have established an institutional framework for a case-by-case approach that ensures transparency and competition through the use of independent financial and other advisers. This paper contains the principal presentations made at a World Bank workshop on the lessons of international experience in case-by-case privatization.

This report describes and evaluates the ways in which user-fees are currently implemented to finance public health services in Sub- Saharan Africa. It presents the main issues that arise in assessing cost recovery through user fees and evaluates experiences to date. The authors highlight variety of practices encountered in different countries, the too common failure to structure charges so as to promote efficient use, and the lack of effective exemption structures for protecting the poor. The study thoroughly reviews standard cost recovery models and describes an initiative launched in Bamako, Mali, in 1987. Issues, experience, and conclusions are drawn from a sample of 38 countries.

Spanish edition. World Bank Technical Paper No. 345S. This report examines specific policies for achieving sustainable development of the mining industry in the countries of Latin America and the Caribbean. The report highlights the importance of the mining sector to national economies of the region and discusses World Bank assistance in formulating policy. Also available in English: (ISBN 0-8213-3816-1) Stock no. 13816.

Analyses 82 health insurance schemes in terms of their membership and coverage, financing, administration and fund management, how providers were paid and the mechanisms for providing health care.

Drawing on various disciplinary perspectives, this book re-focuses the debate on what makes a good health system, with a view to clarifying the uses of social science research in thinking about health care issues in Africa. The explosion of the HIV/AIDS pandemic, the persistence of malaria as a major killer, and the resurgence of diseases like tuberculosis which were previously under control, have brought about changes in the health system, with implications for its governance, especially in view of the diminished capacity of the public health facilities to cope with a complex range of expanded needs. Government responsibilities and objectives in the health sector have been redefined, with private sector entities (both for profit and not-for profit) playing an increasingly visible role in health care provisions. The reasons for collaborative patterns vary, but chronic under-funding of publicly financed health services is often an important factor. Processes of decentralisation and health sector reforms have had mixed effects on health care system performance; while private health insurance markets and private clinics are pointers to a growing stratification of the health market, in line with the intensified income and social differentiation that has occurred over the last two decades.These developments call for health sector reforms.