Table 1 Effect of rising petroleum prices on the functioning of health systems in LMICs

1. Health infrastructure, supplies, & equipment

• Increased cost of petroleum-based medical supplies and equipment (e.g. rubber gloves, syringes, pharmaceuticals)

• Increased cost of transporting construction materials, equipment, and other commodities to remote parts of the health system

2. Transportation and referral system

• Disruptions to medical supply chains

• Increased fuel costs for transporting health workers and administrators

• Challenges to referral systems as patient transportation becomes more costly

3. Energy for health services

• Disruption to fossil fuel-dependent health facility operations (e.g. heating/cooling, powering medical equipment, lighting)

4. Human resources policy

• Personnel shortages in rural areas and increased absenteeism

• Increased costs of supervisory visits to remote areas

5. Health systems organization

• Centralized health systems increasingly inaccessible to rural or remote populations

• Less effective administrative and personnel supervision in peripheral areas