This article analyses the influence of the World Bank on reforms of the health sector in Bolivia during the period 1986-2006, and assesses their impact on the health care delivery system to date. The article examines the transformation of health services undertaken by the current socialist government since 2006. A literature review and interviews with decision-makers critically examine the outcome of reforms on criteria linked to health system integration. The study illustrates that Bolivia applied quite comprehensively the WB recommendations. Among others these included indirect privatization through public health services' restriction of access to a basic package at The University of Auckland Library on May 2, 2015 gsp.sagepub.com Downloaded from Silva et al.
23of care and decentralization with devolution. In consequence, the segmentation and fragmentation of the health system was exacerbated, accessibility and quality of care suffered and health status barely improved. The article attempts to locate the relationship between policy, health care delivery and health systems functioning.
Purpose: Mental health and psychosomatic problems are both widespread and disabling in low and middle-income countries (LMIC). There is a clear need for strategies to strengthen first line services for their treatment. Family ('systemic') therapy has been shown to be effective in this setting but there is a dearth of research investigating its use.
Methods:A family therapist, psychiatrist by training was interviewed by a public health doctor specialized in health services organization, to derive concepts useful for GPs and nurses working in LMIC first line services to handle the relational and emotional component of bio-psychosocial care. The interview was supplemented with a literature review.Results: Concepts in systemic therapy conditions dealt with by systemic therapy are detailed together with basic concepts in systemic approach e.g. symptom persons, family homeostasis, neurotic vs. psychotic families, therapeutic resources, circular questioning, reframing, paradoxical injunctions, therapy steps, strategies to accompany changes, and required organization features.
Conclusions:First line professionals can be involved in the treatment of psychic and relational disorders without in-depth preparation. Family/systemic therapy appears more effective than psychoanalytical techniques in LMIC because there is limited tradition of introspection in LMIC, and families in LMIC remain strongly structured and a key social safety net.Systemic therapies can have an important impact on quality of care where health professionals have no tradition of properly handling bio-psychosocial disorders and improve doctor-patient communication. However, more experience is needed to define the conditions for its optimal utilization in LMIC.
This paper aims at offering alternative methodological perspectives in health systems research, to produce critical, theoretical knowledge in domains such as health policy and management of health care, organization of disease control, political economy of health and medical practice.We first examined the reasons to believe that worldwide economic agents have driven publicly funded schools of public health to adopt their preferred policies and to orient their priority research topics. We then studied whether this hidden leadership has also contributed to shape research methodologies, which we contrasted with the epistemological consequences of a quest for intellectual independence, that is, the researcher’s quest to critically understand the state of health systems and generalize results of related action-research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research.
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