SUMMARYThis paper examines the recent trends in public hospital autonomy as an integral part of health systems reforms. It reviews literature produced on the subject across a range of developing countries and explores varying viewpoints, arguments, and rationale for hospital autonomy developed over the past two decades. It then leads onto a discussion of two experiences of autonomy reforms in Pakistan: the provinces of Punjab and NWFP. Derived from the lessons learned from these initiatives, a set of guidelines is suggested as sustainable frameworks for reviewing the current measures and for designing future autonomy initiatives in Pakistan.

This paper outlines the health context of the Kingdom of Saudi Arabia (KSA). It reviews health systems development in the KSA from 1925 through to contemporary New Health Insurance System (NHIS). It also examines the consistency of NHIS in view of the emerging challenges. This paper identifies the determinants and scope of contextual consistency. First, it indicates the need to evolve an indigenous, integrated, and comprehensive insurance system. Second, it highlights the access and equity gaps in service delivery across the rural and remote regions and suggests how to bring these under insurance coverage. Third, it suggests how inputs from both the public and private sectors should be harmonized - the "quality" of services in the private healthcare industry to be regulated by the state and international standards, its scope to be determined primarily by open-market dynamics and the public sector welfare-model to ensure "access" of all to essential health services. Fourth, it states the need to implement an evidence-based public health policy and bridge inherent gaps in policy design and personal-level lifestyles. Fifth, it points out the need to produce a viable infrastructure for health insurance. Because social research and critical reviews in the KSA health scenario are rare, this paper offers insights into the mainstream challenges of NHIS implementation and identifies the inherent weaknesses that need attention. It guides health policy makers, economists, planners, healthcare service managers, and even the insurance businesses, and points to key directions for similar research in future.

Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries. Design: Systematic literature review. Setting: Only research studies done in developing countries were included. Method: The review is restricted to English-language articles published between 1997 and 2007. It includes studies that reported randomized trials (controlled and uncontrolled) and surveys with some form of outcome measure, with or without process evaluation. The literature search was conducted on six electronic databases. Data were extracted and synthesized using a standard data extraction form. A narrative synthesis was carried out for the purpose of this review. The quality of the included trials was assessed by CRD guidelines and Crombie’s checklist. The applicability of research findings was evaluated by the RE-AIM model. Results: One randomized cluster trial and nine surveys were critically appraised. Three multi-faceted interventions were judged effective while another three were found ineffective. Two out of the three effective interventions used service provision and educational input. Two out of the three ineffective interventions also used service provision alongside other methods including screening and counselling. Findings of effective interventions were generalizable. Conclusion: The review suggests that eye health education and service provision lessen the barriers to service uptake and increase the uptake of eye care services. The role of counselling and screening services needs further review by large and good-quality studies.

Purpose -In recent years, effective leadership initiatives have been emphasized in the healthcare industry all over the world. This paper aims to examine contemporary healthcare development in the Kingdom of Saudi Arabia (KSA) and prescribe four essential policy dimensions to its leadership, depicting the imperative needs for direction, integration, revision, and evidence -the "DIRE needs" approach. Design/methodology/approach -The paper reviews literature on the contemporary KSA health system and provides guidelines for policy reforms vis-à -vis the emerging challenges. Findings -First, the paper offers a conceptual model to examine the ongoing and future health policy development of the KSA. It identifies four key policy dimensions -direction, integration, revision, and evidence and links these to the scope of broader health sector reforms. Second, it characterizes these dimensions as key initiatives for health resource capacity and infrastructural development, essentially the primary health care, which need to be taken up by KSA mainstream health services leadership. Third, it underlines the importance of integrating institutional research and information systems for evidence-based policy-making and practicable implementation. Fourth, it offers a social science research perspective to the need for multi-dimensional health policy reforms in the KSA. Research limitations/implications -This paper opens up KSA health leadership initiatives that may be viewed as the DIRE needs, to be mainstreamed in the domains of policy and strategic planning, research and development, and healthcare management practices. Originality/value -Social research in KSA health policy and planning is rare. This paper introduces a context-specific multi-dimensional model that provides critical insights into challenges and complexities that the Saudi health leadership must attend to. It defines a set of four essential benchmarking dimensions for guiding future policy reforms.