Community contributions towards health have risen …

As resources have become more scarce (and inequities have grown), mobilizing and allocating public and private resources for health has become an issue of central concern for the state, the private sector and civil society.

The costs of health services have risen at a time when household poverty has increased in many countries (Equinet Steering Committee, 2000; Simms, 2000). Market reforms have reduced tax-based spending on health relative to individual out-of-pocket spending. Inequity in health financing has increased, and collective forms of payment have been replaced by individual forms. Under-funded health services have looked to clients to 'take more responsibility' for their health, including contributing more funds towards health systems.

Solidarity and social networks have weakened as a result.