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Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
[Unpublished] 1986. Presented at the All-Africa Parliamentary Conference on Population and Development, Harare, Zimbabwe, May 12-16, 1986. 7 p.The Second African Conference on Population and Development, held early in 1984, marked a decisive stage in African thinking about population. During the 12 years between the 1972 and 1984 conferences, African nations learned in detail about their demographic situation and confronted the ever-increasing costs of development and their lack of physical and administrative infrastructure. In the midst of these and other concerns came the drought, which for over a decade in some parts of the continent has reduced rainfall, dried up rivers, lakes, and wells, and forced millions into flight. It is in this context that population became an African issue. African countries on the whole are not densely populated nor do they yet have very large concentrations in cities. Yet, population emerges as more than a matter of numbers, and there are features which give governments cause for concern. First, the population of most African countries, and of the continent as a whole, is growing rapidly and could double itself in under 25 years. Second, mortality among mothers and children is very high. Third, life expectancy generally is lower in African than in other developing countries. Fourth, urbanization is sufficiently rapid to put more than half of Africa in cities by 2020 and 1/3 of the urban population in giant cities of over 4 million people. The 1984 conference recognized these and other uncomfortable facts and their implications for the future, and agreed that attention to population was an essential part of African development strategy. Strategy is considered in terms of the 4 issues mentioned. First, high rates of growth are not in themselves a problem, but they mean a very high proportion of dependent children in the population. About 45% of Africa's population is under age 14 and will remain at this level until the early years of the 21st century. Meeting the needs of so many children and young adults taxes the ability of every African nation, regardless of how rapidly its economy may expand. Understanding this, a growing number of African leaders call for slower growth in order to achieve a balance in the future between population and the resources available for development. Reducing mortality requires innovation. Among the new approaches to health care are the use of traditional medicine and practitioners in conjunction with modern science and the mobilization of community groups for preventive care and self-help. Health care and better nutrition also are keys to improvement in life expectancy and call for ingenuity and innovation on the part of African governments and communities. Part of the solution to the impending urban crisis must be attention to the viability of the rural sector. The role of the UN Fund for Population Activities in addressing the identified issues is reviewed.
Lancet. 1986 Jan 25; 1(8474):223.This article summarizes the conclusions and recommendations of a joint UNICEF/WHO consultation on primary health care in urban areas. The meeting, which was held in Guayaquil, Ecuador, in October 1984, was attended by representatives from 9 countries: Brazil, Colombia, Ecuador, Ethiopia, Guatemala, India, Philippines, Republic of Korea, and Peru. 5 priorities were emphasized: the need for comprehensive rather than partial coverage, the use of simple 1st-line remedies such as oral rehydration, the reallocation of resources, intersectoral and interinstitutional collaboration, and the supporting responsibility of governments and international agencies. Community participation is an essential component of primary health care. Once the process of community development is launched, the balance within the existing health care system must be adjusted to prepare for the explosive tempo of urbanization. Cities, regions, and countries must move with sustained determination toward full primary health care coverage for the urban poor. Ongoing close collaboration between UNICEF and WHO is of great importance to the future of primary health care. Specifically, the consultation recommended: 1) consciousness raising activities to make governments, the world public, international organizations, and nongovernmental organizations aware of the scale of the need; 2) continuing support to projects and the informal network of people dedicated to the development of primary health care and the subsequent transformation of health systems; and 3) help with scaling up the health care system.