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The remaining 14% is covered by other not-for-profit agencies or has no specific coverage. The system's duality has led to increasing inequalities prompting the Chilean government to introduce major reforms in health care provision. Chile's health care system is funded by a universal income tax deduction equal to 7% of every worker's wage.
Ministries of health in several sub-Saharan African countries, including Zambia, Uganda, and South African, were reported to have begun planning health system reform including hospital accreditation before 2002. However, most hospitals in Africa are administered by local health ministries or missionary organizations without accreditation programs.
The universal health care system was adopted in Brazil in 1988 after the end of the military dictatorship. However, universal health care was available many years before, in some cities, once the 27th amendment to the 1969 Constitution imposed the duty of applying 6% of their income in healthcare on the municipalities. [162]
However, by the early 1990s, the strain of providing free health care for all became evident in the face of rising health care costs and a struggling economy. Early 1990s the government adopted health sector reforms that changed the financing system from free services to mixed financing mechanisms including cost sharing policies.
The five control knobs for health-sector reform. In "Getting Health Reform Right: A Guide to Improving Performance and Equity," [2] Marc Roberts, William Hsiao, Peter Berman, and Michael Reich of the Harvard T.H. Chan School of Public Health aim to provide decision-makers with tools and frameworks for health care system reform.
Urban centres are well served, and contain most hospitals, clinics, and pharmacies in the country. Rural areas often have no modern health care. Patients in these areas either rely on traditional African medicine, or travel great distances for health care. In 2005, Ghana spent 4% of GDP on health care, or US$30 per capita.
When South Africa freed itself of apartheid, the new health care policy has emphasised public health care, which is founded with primary health care. The National Strategic Plan therefore promotes distribution of anti-retroviral therapy through the public sector, and more specifically, primary health care. [10]
The shortage of health workers in Malawi is an obstacle to utilizing Global Health Initiatives (GHI) funds effectively. [16] Increasing health services such as HIV/AIDs treatment commonly prompt an increase in the number of minimally trained health care workers and a modest increase in clinical staff members. [16]