Introduction to Health Systems & Reform 4(1)

Abstract

Reference Welcome to the first issue in 2018 of Health Systems & Reform, marking the start of our fourth year of publication. The topic of how to improve the performance of health systems in countries around the world remains high on the global policy agenda. The global meeting of the UHC Forum 2017 in Tokyo, in mid-December last year, illustrates the continuing high priority given to health systems issues. The articles published in this issue continue our efforts to identify critical topics for health systems and reform. First, the commentary on “fiscal space analysis” represents a hot topic in global health policy—the article was cited by Japan’s Minister of Finance Taro Aso in his Lancet article published just before the UHC Forum. The four research articles in this issue explore themes of deliberative democracy and prioritysetting at the community level in rural Arkansas, using burden of disease analysis and cost-effectiveness to decide on national health priorities in the Philippines, assessing the distributional cost-effectiveness and political feasibility of a tobacco tax in Armenia, and the implementation of breast cancer screening in Brazil’s primary health care centers. These articles reflect Health Systems & Reform’s commitment to research that examines the interaction of technical, ethical, and political analyses in health reform processes around the world. Following are my reflections on the articles. The commentary by H el ene Barroy and colleagues on “Assessing Fiscal Space for Health in the SDG Era: A Different Story” is notable for several reasons. First, the authors come from three key agencies in global health financing— the World Health Organization, the World Bank, and the Global Fund to Fight AIDS, Tuberculosis and Malaria—and the article received approval from all three institutions; no mean feat. Second, the article uses the World Bank’s framework on the five sources of fiscal space for health (“conducive macroeconomic conditions; reprioritization of health within the government budget; earmarked income and consumption taxes directed toward the health sector; better efficiency of existing health expenditure; and external aid”) to reflect on the lessons of doing such assessments in over 50 lowand middle-income countries. Perhaps not surprising, the authors found “high variability” in how the assessments Received 22 November 2017; accepted 22 November 2017. *Correspondence to: Michael R. Reich; Email: michael_reich@harvard.edu