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[Unpublished] 1993 Dec. xii, 217,  p. (Report No. 12577-AFR)The World Bank has recommended a blueprint for health improvement in sub-Saharan Africa. African countries and their external partners need to reconsider current health strategies. The underlying message is that many African countries can achieve great improvements in health despite financial pressure. The document focuses on the significance of enhancing the ability of households and communities to identify and respond to health problems. Promotion of poverty-centered development strategies, more educational opportunities for females, strengthening of community monitoring and supervision of health services, and provision of information on health conditions and services to the public are also important. Community-based action is vital. The report greatly encourages African governments to reform their health care systems. It advocates basic packages of health services available to everyone through health centers and first referral hospitals. Health care system reform also includes improving management of health care inputs (e.g., drugs) and new partnerships between public agencies and nongovernmental health care providers. Ministries of Health should concentrate more on policy formulation and public health activities, encourage private voluntary organizations, and establish an environment conducive to the private sector. African countries need more efficient allocation and management of public financial resources for health to boost their effect on critical health indicators (e.g., child mortality). Public resources should also be reallocated from less productive activities to health activities. More commitment from governments and domestic sources and an increase of external assistance are needed for low income African countries. The first action step should be a national agenda for health followed by action planning and setting goals to measure progress.
A fundamental shift in the approach to international health by WHO, UNICEF and the World Bank: instances of the practice of "intellectual fascism" and totalitarianism in some Asian countries.
INTERNATIONAL JOURNAL OF HEALTH SERVICES; PLANNING, ADMINISTRATION, EVALUATION.. 1999; 29(2):227-59.This article comments on the practice of "intellectual fascism" and totalitarianism in some Asian countries. It demonstrates how the imposition of an enormous, high-priority, prefabricated health service agenda by the rich countries on the poor ones has destroyed the promising growth of people-oriented health services in countries such as India. In order to protect their political and social interests, the rich countries "invented" Selective Primary Health Care and used the WHO, the UN Children's Fund (UNICEF), the World Bank (WB), and other agencies to initiate global programs on immunization, AIDS, and tuberculosis. These programs were proven to be defective in concept, design, and implementation. There are five major areas of the principles and practice of international public health that have been distorted by the WHO, UNICEF, and WB: 1) the "public health" practiced by exponents of the international initiatives is starkly ahistorical; 2) the scientific term "epidemiology", which forms the foundation of public health practice, has been grossly misused by a new breed of experts; 3) suppression of information, use of doctored information, spread of misinformation and disinformation, and lack of effective evaluation/surveillance result when programs are designed to serve power managers, required by their paymasters to satiate the greed of the marketplace; 4) directors-general of two top public health institutions in India found high positions in WHO after supporting the WHO/WB Global Programme for Tuberculosis despite its serious flaws; and 5) those who are expected to be the conscience keepers of ethics and morality in public health practice -- public health school teachers, key public health administrators, nongovernmental organizations, political leaders--are even the worst offenders in inflicting humiliations among people.
WIPHN NEWS. 1994 Winter; 17:1.The World Bank has assumed first place in world health assistance and states that one reason for lending in health is that its presence in the health sector enables it to pressure governments to control population growth. The Bank believes that rapid population growth slows development, and to achieve its goal of lower birth rates in low-income countries, it recommends that governments provide an essential "clinical" package, which consists of perinatal and delivery care, family planning services, management of the sick child, treatment of tuberculosis, and case management of sexually transmitted diseases. "Clinical" in this context means services provided in a health clinic by nurses and midwives, not physicians. Sick children are the main beneficiaries of the package because it is assumed that families will limit the number of births only after child mortality falls. The treatment of tuberculosis is included to save the lives of children. The Bank has predicted that the AIDS epidemic will not result in negative population growth in Africa and has emphasized family planning services in the essential package. The World Bank seems to have made family planning the new, reductionist version of primary health care.
[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. 27,  p.In the mid 1980s, USAID started nonproject assistance, mainly in the economic sectors, to African countries. The countries received nonproject assistance after they fulfilled conditions which influence institutional and/or policy reforms. The longest running health sector reform program in Africa was in Niger and was slated to receive portions of the funds after fulfilling 6 specific predetermined reform activities. Yet, between 1986 and 1991, Niger had implemented only 2 of them. It did accomplish the population/family planning reforms: expansion of family planning services, a national population policy, analyses and implementation of improvements in the pricing and distribution of contraceptives, and legalization of use and distribution of contraceptives. Continuing economic deterioration during the 1980s and political upheavals after 1989 somewhat explained why the other reform activities were not implemented. Other equally important factors were a very complex sector grant design (more than 20 reforms in 6 policy/institutional areas) with little incentive to realize the reforms, insufficient number of staff (limited to senior personnel) to implement the reforms, and just 1 USAID staff to monitor and facilitate activities. The nonproject assistance for the primary health care (PHC) system in Nigeria had a simpler design than that in Niger. The reform goals were shifting responsibility for PHC from curative care to preventive health services. After USAID and the Nigerian government signed an agreement, they included policy reforms promoting privatization of health services. Only 1 reform was implemented. Factors which could lead to success of nonproject assistance include host government needs to perceive it owns the objectives and building financial and institutional sustainability. In conclusion, nonproject assistance can be effective when implementing policy reforms that the host government has already adopted.
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.
In: Family planning within primary health care, edited by F. Curtis Swezy and Cynthia P. Green. Washington, D.C., National Council for International Health, 1987. 112-4.The World Bank's appreciation of the unique role of NGOs in working beyond the effective reach of government systems in reaching underserved populations and communities has come with its increasing involvement in social sector development. NGO understanding of the needs of communities, underserved populations, and special subgroups constitutes a strong basis for designing and implementing actions to promote social and behavioral change. NGOs can complement the skills available within governments to put their people-oriented policies into meaningful effect. This NGO support may be sine qua non for the success of such policies, and of the programs and projects the Bank supports in the social sectors. The Bank is still developing ways to encourage NGO participation in such programs and projects. Staff in the Population, Health and Nutrition Department of the Bank are directing much more effort now to working with NGOs in family health and population work, particularly in subSaharan Africa where the greatest current challenge exists. At the international level, in order to promote policy dialogue with an operational perspective between the Bank and the NGO community, a Bank/NGO committee has been established. Composed of NGO representatives from both donor and recipient countries and Bank staff, it meets regularly and has proven helpful in identifying mutual interests and common objectives in a number of important areas, including food security. The committee does not replace collaborative mechanisms at the country level, but it has been successful in inspiring both the Bank and NGPs to pursue collaboration more assiduously at the country and sectoral levels.