Health sector reforms: implications for sexual and reproductive health services.

These reforms have also been affected by changes in national and international allocation of resources to the health sector, the attribution of responsibility for health, and the increasing commodification of health in almost all countries [2]. Policy changes, some progressive, others retrogressive, wide-ranging biomedical and social research, and efforts to improve sexual and reproductive health service delivery in the face of cutbacks, have been taking place at the same time. Although the reforms have been to health systems as a whole and will have influenced the extent to which countries have been able to implement the ICPD Programme of Action, there is only limited evidence available on this to date and little interaction between the institutions and individuals involved. Moreover, there has been limited capacity to generate evidence on the impact of reforms on sexual and reproductive health services, not only to ensure that ICPD goals are reached. In February 2002, RHM organised a multi-disciplinary meeting at the Bellagio Study and Conference Centre, Bellagio, Italy, attended by 25 people from all world regions, whose purpose was to examine the implications of health sector reforms for sexual and reproductive health services, with a focus on low-income countries. That meeting, which included participants with expertise in health sector reforms and participants with expertise in sexual and reproductive health issues, confirmed just how important it is for more dialogue to take place on these issues. Some of the papers included in this journal issue were presented at the meeting and substantially revised in light of the insights gained there. Others were submitted and reviewed in the usual way. A further group of papers presented at the meeting will be included in the May 2003 issue of the journal, which will focus on the integration of sexual and reproductive health services as a health sector priority. This editorial summarises some of the insights that emerged during the meeting, which are linked to each of the papers in this journal issue.