THE ENGINE OR THE CABOOSE - HEALTH-POLICY IN DEVELOPING-COUNTRIES

A discussion of health policy in developing countries is presented. It argues that developing countries must adopt a progressive approach to health policy which rejects the two-tiered system of public and private health care. However, it also points out that ideology is not sufficient to maintain support. A progressive health system must utilize administrative and social and behavioral sciences to achieve effectiveness and efficiency in health care delivery. It cannot ignore these goals any more than a private health care system can.; Health services delivery is dependent on an ideology of whether health care is a commodity governed by market forces or a public good. The commodity position means denial of access to those who cannot afford health care. Moreover it involves minimal interference from government. Thus health services are located where the most profits can be generated rather than community need--a caboose following the general economy. Health policy makers of this ideological position claim to consider the public good, however, by allowing 2 levels of health service (private and public health). The private sector has the favored position. Some health planners consider health care a public good and propose a progressive approach to health policy in developing countries--engine leading the general economy to improved health care. It requires population based health planning and a unified public sector. Real need dictates resource priorities. Political will is needed to cause major changes in the health system in a reasonable length of time. The engine approach to planning requires widely available information to conduct needs assessments. This depends on the development of an infrastructure to conduct routine surveys. Planning must consider the interdependence of various health problems to create a holistic health care delivery system. The approach must create an organizational culture which fosters commitment to overall goals in the system's members. Further it must promote a proactive approach to client services resulting in outstanding and responsible service. Health policies need to expand and integrate services and stop corruption. A positive organizational culture cannot exist, however, without talented committed scientists and health providers who have ample resources and support. Thus training program in management and administrative studies are warranted.