Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

Abstract

PurposeTo review the evidence basis of international aid and health policy.Context of caseCurrent 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 sourcesNational policies, international programmes and pilot experiments are examined in both scientific and grey literature.Conclusions and discussionWe 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.

Implementación de la política de hospitales autogestionados en Chile: percepción de los profesionales hospitalarios

“…para los profesionales, la percepción respecto de lo que implica la autogestión hospitalaria está determinada por la autonomía respecto de la toma de decisiones, la asignación de recursos y gestión financiera. Si bien la autogestión hospitalaria en Chile no está relacionada a una completa autonomía de los hospitales respecto de la función de financiación del sistema, la percepción de los profesionales se alinea a los objetivos de la autonomía hospitalaria como una política basada en la contención de costos y la eficiencia hospitalaria 23,24 . no obstante, un resultado relevante respecto de dicha concepción se relacionó a la ausencia del concepto de redes asistenciales como parte de la autogestión hospitalaria.…”

Atenção primária integral e sistemas segmentados de saúde na América do Sul

“…Por um lado, são influenciados pela retórica da Organização Pan-Americana da Saúde (OPAS) que classifica a atenção primaria de países europeus, com sistemas universais, como apenas serviços de saúde de primeiro nível, e não reconhece os benefícios da medicina generalista, de família e comunidade, para a atenção individual. Por outro lado, essa seletividade decorre, em parte, de exigências de agências financeiras multilaterais que condicionam apoio a reformas com privatização e seletividade de serviços sociais, transferindo ao mercado a atribuição da atenção individual, especializada e hospitalar 23 .…”

International health policy and stagnating maternal mortality: is there a causal link?

“…We would argue that the technical requirements for contracting out clash with political and administrative realities on the ground. 5 Efficient sub-contracting requires stringent control and regulation, which is difficult to fulfil in most LIC/MIC settings. The World Health Report 2000 recognised that failure to develop such capacity when entering into contracting out and demand-side financing reforms can have negative consequences, to judge from experiences in India, Mexico, Papua New Guinea, South Africa and Zimbabwe.…”

“…This is a problem because curative and preventive health activities need to be integrated -into comprehensive and accessible health care. 5 Most disease control interventions are clinical. To be effective, they require services to be used by a sufficient number of patients and achieve early detection and treatment.…”

“…It allocates disease control interventions to the public sector and comprehensive health care to the private sector. 5 This is a neoliberal doctrine, which includes:…”