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Lancet. 1993 Aug 14; 342(8868):440.The World Bank's world development report is an appraisal of the main health problems and strategies for health promotion and disease control, as described in a July 10 editorial. It contains issues such as poor peoples' access to basic health care, implying that such access is a fundamental human right. The World Bank has softened some of its ideologically-driven policies in favor of more pragmatic approaches. Past advocacy of provision of health services by profit-making professionals has been toned down, possibly in view of findings that privatization is no panacea. However, the report pays little attention to the historical and social contexts that bolster or block the effectiveness of pubic health measures. HIV/AIDS control is very much a matter of socioeconomic development, which includes education , income, and welfare. Sociocultural, and also legal, empowerment and the respect for human rights are crucial. But the World Bank pushes mainly technocratic answers and neglects social movements, which have successfully widened access to resources that promote better health for everyone. It is also short on the history of the interaction between donors and developing countries. Structural adjustment programs imposed by the World Bank have compelled recipients to cut their health services. Donors now emphasize the importance of protecting sectors such as health care and education. However, structures have fallen apart; health planners, managers, and grassroots workers have lost their jobs. The report proposes a package of interventions but fails to recognize that many poor countries are unable to provide even a minimal service. Half the population of sub-Saharan Africa is expected to be below the poverty line by the year 2000, and unequal trade with developed countries continues with a crushing debt burden. The views of this report should be adopted by the macro-economic branches of the World Bank.
Development. 1989; (4):77-82.Contemporary multilateral loan agreements to developing nations, unlike previous project and program aid, have often been contingent upon the effective implementation of structural adjustment programs of market liberalization and macroeconomic policy redirection. These programs herald such reform as necessary steps on the road to economic growth and development. Price decontrol and policy change may also, however, generate the more immediate and undesirable effects of exacerbated urban sector bias and plummeting income and quality of life in the general population. This paper considers the resultant changes expected in the political arena, product and input pricing, small business promotion and formation, export crop production, interest rate policy reform and financial market deregulation, exchange rate and public sector expenditure, and the labor market, and their effect upon women's economic position. The author notes, however, that women are not affected uniformly by these changes and sectoral disruptions, but that some women will suffer more than others. To develop policy to effectively meet the needs of these target groups, more subpopulation specificity is required. Approaches useful in identifying vulnerable women in particular societies are explored. Once identified, these women, especially those who head poor households, should be afforded protection against the turbulence and short- to medium-term economic decline associated with adjustment.
[Unpublished] 1989. Presented at the Conference on Global Environment and Human Response toward Sustainable Development, Tokyo, Japan, September 11, 1989. 11 p.With the installation of Barner B. Conable as President of the World Bank, the Bank began to incorporate the environmental effects of development projects into its loan decisions. It has also augmented loans for environmental, population, and forestry projects. In 1988, >100 projects with important environmental elements (35% of all Bank and IDA projects) were approved, the majority of which were in agriculture. The Bank has expected the percentage of such projects to increase annually. Further, to assist the countries and the Bank in considering environmental concerns in the beginning stage of designing development projects, the Bank has developed Environmental Assessment Guidelines. The Bank has taken on a formidable task, however, since its primary purpose is to reduce poverty which often conflicts with protecting the environment. Its leadership believes that the 2 goals are not necessarily mutually exclusive, and, if they are to be achieved, the problems must be clearly defined and all the countries of the world must work towards solutions to benefit the global community. Additionally, the Bank has begun to encourage developing countries to switch to cleaner fuels, processes, and systems to curtail global warming. It also monitors research on carbon dioxide, methane, and chlorofluorocarbon emissions, all of which contribute to the greenhouse effect, and on climatic change. The Bank has recognized, however, that improvement in the environment cannot occur fast enough, at the rate the earth's population is increasing. Therefore it continues to fund family planning and health projects.
Social Science and Medicine. 1985; 21(1):41-53.This paper explores the emergence of an international fad aiding and monitoring community participation efforts and projects its future outcome based on lessons from previous experiences in other than the health sector. The analysis suggests that the promotion of community participation was based in all cases on 2 false assumptions. 1) The value system of the peasantry and of the poor urban dwellers had been misunderstood by academicians and experts, particularly by US social scientists, who believed that the traditional values of the poor were the main obstacle for social development and for health improvement. However, the precolumbian forms of organization that traditional societies had been able to maintain throughout the centuries were not only compatible with development but had many of the characteristics of modernity: the tequio guelagetza minga and even the cargo system stress collective work, cooperation, communal land ownership and egalitarianism. 2) Another misjudgement was the claim that the peasantry was disorganized and incapable of effective collective action. In Latin America historical facts do not support this contention. A few examples from more recent history show the responsiveness and organizational capabilities of rural populations. The Peasant Leagues in Northeastern Brazil under the leadership of Juliao is perhaps 1 of the best known example. The question is thus raised as to why international and foreign assistance continues to pressure and finance programs for community organization and/or participation. It is suggested that the experience in Latin America (except perhaps Cuba and Nicaragua) indicates that community participation has produced additional exploitation of the poor by extracting free labor, that it has contributed to the cultural deprivation of the poor, and has contributed to political violence by the ousting and suppression of leaders and the destruction of grassroots organizations. Information presented on community participation in health programs in Latin America illustrates that they have followed closely the ideology and steps of community participation in other sectors. A country by country examination indicates that health participation programs in Latin America in spite of promotional efforts by international agencies, have not succeeded. The real international motivation for participation programs was the need to legitimeize political systems compatible with US political values. Through symbolic participation, international agencies had in mind the legitimation of low quality care for the poor, also known as primary health care and the generation of much needed support from the masses for the liberal democracies and authoritatrian regimes of the region. Primary health care delivery can be successful without community participation, in contradiction to what international agencies and governments maintain.
In: Ghosh PK, ed. Third world development: a basic needs approach. Westport, Connecticut, Greenwood Press, 1984. 115-45. (International Development Resource Books No. 13)The basic needs approach is critically examined, and the appropriateness of donor agency support for the basic needs approach is questioned. The basic needs approach is plagued by operational problems. It is difficult 1) to define minimum basic need levels, especially if absolute standards are advocated; 2) to measure basic needs; and 3) to implement basic needs programs in such a way as to ensure that only the poorest segments of the population derive benefits and that the benefits remain in the hands of the poor. Basic needs advocates fail to deal with the question of economic growth. They assume that economic growth will continue and ignore the fact that there is a trade-off between satisfying basic needs and investing in growth. They also ignore the issue of trade-offs between fulfilling present and future basic needs. The basic needs approach implies a specific development pattern, and the longterm consequences of this implied development pattern are not sufficiently examined by advocates of the approach. The basic needs approach requires a development pattern that stresses rural development and labor intensive production instead of industrialization, capital intensive production, and growth of the modern sector. Ultimately, the development pattern advocated by this approach will result in an international division of labor between the developing and developed countries which will not improve international marketing conditions for the developing countries since developed countries will not be willing to substantially increase their importation of labor intensive products from the developing countries. Donor agencies need to adopt a cautious attitude toward funding and promoting the basic needs approach. Many developing countries strongly resent the basic needs approach. They feel that donors and the developed countries do not have the right to force them to focus their energies on eradicating poverty. They also fear that the approach is an attempt to reduce financial assistance. Donor agencies lack sufficient expertise to evaluate poverty-oriented programs and to assess the long range impact of many of these programs. In one country, a donor-supported basic needs program to increase agricultural productivity had the unexpected result of reducing the price of agricultural products. Another project aimed at improving living standards in a particular rural community unexpectedly increased property values and, ultimately, led to the migration of the former residents to an urban slum. Furthermore, donor agencies do not have the right to impose development strategies on aid recipients. Development strategies must be formulated by the recipients, and donors should support only those strategies which accord with the development goals of the recipient countries.
Washington, D.C., World Bank, 1980 Aug. 166 p.This report examines some of the difficulties and prospects faced by developing countries in continuing their social and economic development and tackling poverty for the next 5-10 years. The 1st part of the report is about the economic policy choices facing both developing and richer countries and about the implications of these choices for growth. The 2nd part of the report reviews other ways to reduce poverty such as focusing on human development (education and training, health and nutrition, and fertility reduction). Throughout the report economic projections for developing countries have been carried out, drawing on the World Bank's analysis of what determines country and regional growth. Oil-exporting countries will face greater economic growth; their average GNP per person could grow 3-3.5% in the 1980s. Oil-importing countries will develop slower or fall to 1.8%/year. Poverty in oil-importing developing countries could grow at about 2.4% GNP/person and by 1990 there would be 80 million fewer people in absolute poverty. Factors which will contribute to the economic problems of developing countries are trade (import/export), energy, and capital flow. The progress of developing countries depends on internal policies and initiatives concerning investment and production efficiency, human development and population. Not only can human development increase growth but it can help to reduce absolute poverty.
Chichester, England, John Wiley, 1982. 317 p.This textbook provides basic information on social policies aimes at improving the welfare of the populations in developing countried and assessing the effectiveness of the major social policies which have been applied to the problems of poverty in these countried. The book is an outgrowth of experience gained in teaching a course in social policy and planning at London School of Economics. The focus is on social policied rather than on social planning techniques, and the central theme is that state intervention and the implementation of social policies are a necessary prerequisite for improving the welfare of the inhabitants of 3rd World countried. The chapter defines underdevelopment. It stresses the need for governments to develop social policies in accordance with their needs and resources and to develop policies which will redistribute resources to the most seriously disadvantaged segments of their population. The 2nd chapter defines poverty, describes the basic inequalities in living standards and income which exist in 3rd World countries, and discuss the major theories which have been put forward to explain poverty. The next 5 chapters discuss the problems of population growth, rural and urban development, health, and housing. The various policied which have been formulated to deal with each of these problems are described and compared in regard to their effectiveness. The next chapter discusses social work and the problems associated with the development of social welfare services in developing countries. The final chapter deals with international issues and assesses. The value of bilateral and multilateral aid. Major assumptions underlying the presentation of the material are 1)poverty impedes development, 2)poverty will not disappear without government intervention, 3)economic development by itself cannot reduce poverty, 4)poverty is the result of social factors rather than the result of inadequacies on the part of poor indiciduals, 5)socialpolicies and programs formulated to deal with problems in the developed countries are inappropriate for application in developing countries; 6)social policies must reflect the needs of each country; and 7)social planning should be an interdisciplinary endeavor and should utilize knowledge derived from all the social sciences.