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[Unpublished] 1984. v, 25 p.This meeting was sponsored by the World Health Organization (WHO) with Dr. Wayne S. Stinson participating at WHOs request. The objectives of the informal consultation were: 1) to strengthen national capabilities for undertaking the costing of preimary health care and for the utilization of results for development and management; 2) to exchange experiences on the costing of PHC in different countries; 3) to discuss methodologies used for data collection at the PHC center; and 4) to make recommendations for future work. This consultation is one in a series of costing and financing meetings held by WHO since 1970. The most recent meeting prior to 1983 was an interregional workshop on the cost and financing of primary health care, held in Geneva in December 1980. Papers distributed at that meeting (which have not yet been published) suggest a need for greater understanding of costing principles and technical refinement of methodologies. Judging by the papers presented at the Nazareth workshop, costing efforts have greatly improved since 1980. Representatives from the following countries participated in the Nazareth workshop: Argentina, Botswana, Columbia, Thiopia, Gambia, Kenya, Lesotho, Malawi, Sierra Leone, Sri Lanka, Swaziland, Tanzania, Thailand, Uganda, and Zambia. Some of these reported costing studies. This report consists of a narrative description of the meeting itself followed by a commentary on some of the issues raised. There is then a discussion of Arssi Province and Ethiopia as a whole based on a 1-day field trip. Finally recommendations are given regarding the United States Agency for International Development's (AID's) further PHC costing efforts.
Assessment and implementation of health care priorities in developing countries: incompatible paradigms and competing social systems.
Social Science and Medicine. 1984; 19(4):373-84.This paper addresses conceptual issues underlying the assessment and implementation of health care priorities in developing countries as practiced by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing health care structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health which mass movements strive to eradicate with implications for capitalism at large. It is in this context that foreign agencies are shown to intervene for the reassessment and implementation of health care priorities in developing countires with the objective of defending capitalism against the delegitimizing effects of its own development, specifically the persistence of mass disease. Constrained by this objective, the interpretations they offer of the miserable state of health prevailing in developing countries and how it could be improved remains ideological: it ranges between "stage theory" and modern consumption-production Malthusiansim. Developing countries are entering into a new pattern of public health which derives from their unique location in the development of capitalism, more specifically in the new international division of labor. Their present position affects not only the pattern and magnitude of disease formation but also the effective alleviation of mass disease without an alteration in the mode of production itself. In the context of underdevelopment, increased productivity is at the necessary cost of public health. Public health improvement is basically incompatible with production-consumption Malthusianism from which the leading "Basic Needs" orientation in the assessment and implementation of health care priorities derives. Marx said that "countries of developing capitalism suffer not only from its development but also from its underdevelopment." (author's modified)