Disintegrated care: the Achilles heel of international health policies in low and middle-income countries
نویسندگان
چکیده
PURPOSE To review the evidence basis of international aid and health policy. CONTEXT OF CASE Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. DATA SOURCES National policies, international programmes and pilot experiments are examined in both scientific and grey literature. CONCLUSIONS AND DISCUSSION We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions--causing health care disintegration--which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.
منابع مشابه
Political Impetus: Towards a Successful Agenda-Setting for Inclusive Health Policies in Low- and Middle-Income Countries; Comment on “Shaping the Health Policy Agenda: The Case of Safe Motherhood Policy in Vietnam”
Agenda-setting is a crucial step for inclusive health policies in the low- and middle-income countries (LMICs). Enlightened by Ha et al manuscript, this commentary paper argues that ‘political impetus’ is the key to the successful agenda-setting of health policies in LMICs, though other determinants may also play the role during the process. This Vietnamese case study presents a good example fo...
متن کاملAre We Asking All the Right Questions About Quality of Care in Low- and Middle-Income Countries?
متن کامل
Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries
When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (S...
متن کاملUniversal Health Coverage and Primary Healthcare: Lessons From Japan; Comment on “Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries”
A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healt...
متن کاملThe Implications of Global Neurosurgery for Low- and Middle-Income Countries. The Case of Cameroon.
The unequal distribution of neurosurgical resources and diseases in the world contributes to inequality. Eight in ten neurosurgical cases needing essential neurosurgical care are found in low- and middle-income countries (LMICs); however, LMICs lack the neurosurgical resources to address these needs. Besides, where neurosurgical care is available, it is not financially accessible to the majorit...
متن کامل