Localization of health systems in low- and middle-income countries in response to long-term increases in energy prices | Globalization and Health

Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, etc. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors in low-and middle-income countries (LMICs) who already struggle to deliver services to remote parts of their catchment areas. 

The authors propose the concept of “localization”, as one element of response to these challenges. Localization assigns people at the local level a greater role in the production of goods and services, thereby decreasing reliance on fossil fuels and other external inputs. 

Effective localization will require changes to governance structures within the health sector in LMICs, empowering local communities to participate in their own health in ways that have remained elusive. 

Experiences with decentralization policies in the decades following Alma-Ata offer lessons on defining roles and responsibilities, building capacity at the local level, and designing appropriate policies to target inequities, all of which can guide health systems to adapt to a changing environmental and energy landscape.