Competing resource claims demand transparent decision- making processes

As noted earlier, the relations between the state, the private sector and civil society in making decisions about and managing public resources have become more important as the use of public funds has become a more contested issue.

There is evidence that health sector reforms have tended to benefit the wealthier and the more powerful more than other social groups. Without an open, participatory system with procedures and mechanisms for reaching collective resolution, the claims of medical interest groups, or urban elites, may be met at the cost of the poorer, less organized rural health workers, or the urban and rural poor (Van Rensburg & Fourie, 1994; Bennett et al., 1995). Rising demand by wealthier sectors for medical technology can potentially crowd out less effectively voiced demand by poorer sections for the health inputs they need. Given the relatively poor evidence base for some health policy reforms, it is important that mechanisms for information sharing and systems of procedural justice exist for adjudicating subjective claims within policy reforms (Kalumba, 1997; Lafond, 1995; Storey, 1989).