(1998; 49 pages) [French] [Spanish]
1.1 Reform and models of development
Reform is thought to be the direct response to stimuli which highlight the deficiencies of existing models (whether or not these have been previously successful) in meeting current and future needs. In health care, these stimuli may be: aging populations with different health needs; the resurgence of diseases such as cholera and tuberculosis; the appearance of new diseases such as AIDS; increases in inequity to access to health services; the inability of public funds to cover all basic health needs for a population; or the inability of current financing mechanisms to cope with the higher costs of and higher demand for technically advanced interventions. Therefore, health care reform is an issue of significant consequence to both industrialized and developing countries.
However, in many countries, reform is driven not so much by the inadequacies of existing health systems but by dramatic political and economic transitions which result from both internal and external forces. The economic forces include large external debts, structural adjustment programmes, and devaluing currencies. These countries are faced with the difficult, simultaneous challenges of redefining both their economies and their social sectors.
The policies determining the nature of economic reforms in these countries have been influenced in no small part by the resurgence of traditional free-market thinking, sparked by the increasing globalization of markets and the collapse of centrally planned economies. Although the benefits and drawbacks of free-market thinking can be argued, two points merit consideration.
First, economic and social development are intertwined but are not the same. In several cases it appears that the economic models of development (whatever they may have been) have taken precedence over the social ones, thereby degrading many social efforts from the status of true progress to that of remedies aimed at compensating the harm caused to portions of society by economic development. Health reforms, if they are to escape this “band-aid” status, must focus on the achievement of the health objectives and must be comprehensively integrated into the larger development model. In many countries, this cannot be achieved without a drastic redistribution of the available resources and of the wealth which may be generated through economic growth.
Second, the future of a country cannot be constructed independently of the varied aspects of its cultural, historical, political, and economic past and present. Economic and social development should respect a country’s identity. As there are many identities, there must be many different modes of development. The universal implementation of a singular “formula” for development, regardless of its merits, would negate this principle.
In view of this, the World Health Organization (WHO) seeks to work with its Member States and its partners to develop new models and alternatives for the health sector which are aimed at best meeting health objectives .