Strong public provision the only hope for health care in developing countries.
Dear Editor,
The editorial by Zwi et al laying out principles for the involvement
of private providers in delivering health care in developing countries is
important. I worked for 5 years in northern Nicaragua between 1989 and
1994. During that time I witnessed the strengths of the primary health
care system developed by the Sandinista government in partnership with
powerful community and social organisations. I also witnessed the entry
of the World Bank and the IMF into Nicaragua and its impact on health and
health care. One of the central beliefs imposed by the Bank and Fund was
that local people must pay “user fees” for health and education. Public
sector funding was drastically reduced and the result was the effective
conversion of free state health care into private, pay as you go, health
care provided by the state. Local people, for example, had to sell their
only cow (sole source of milk for the family) in order to pay for needed
medications, thus leading to further malnutrition. In parallel to this
doctors provided private health care in clinics. The effect of all of
this was deprive the poor majority of local people of access to health
care. The cut backs in public sector funding saw major reductions in
malaria control and other public health measures. The result of this was
significant increases in Malaria and dengue.
In the light of all of this it is hard to imagine how the private
sector can have anything but an inequitable effect on health care delivery
in developing countries. Poor people will not be able to pay. This is
particularly true when their livelihood is so vulnerable to international
markets and so many people in Nicaragua have been devastated by the
collapse in the international coffee market value (resulting from a coffee
glut due to the IMF and World Bank recommending to many new countries to
get into coffee production).
The hope for health care in countries like Nicaragua is the
phenomenal voluntary contribution made by the teams of health brigadistas
up and down the country in combating common diseases such a diarrhoea and
malaria. The international community can help by, promoting fair trade,
encouraging debt cancellation swapped for public health sector investment
and ensuring that vital drugs are not denied to poorer countries due to
excessive costs and patent periods.
Yours sincerely,
Dr Philip Crowley,
Specialist Registrar in Public Health Medicine,
Durham and Darlington Health Authority.
Rapid Response:
Strong public provision the only hope for health care in developing countries.
Dear Editor,
The editorial by Zwi et al laying out principles for the involvement
of private providers in delivering health care in developing countries is
important. I worked for 5 years in northern Nicaragua between 1989 and
1994. During that time I witnessed the strengths of the primary health
care system developed by the Sandinista government in partnership with
powerful community and social organisations. I also witnessed the entry
of the World Bank and the IMF into Nicaragua and its impact on health and
health care. One of the central beliefs imposed by the Bank and Fund was
that local people must pay “user fees” for health and education. Public
sector funding was drastically reduced and the result was the effective
conversion of free state health care into private, pay as you go, health
care provided by the state. Local people, for example, had to sell their
only cow (sole source of milk for the family) in order to pay for needed
medications, thus leading to further malnutrition. In parallel to this
doctors provided private health care in clinics. The effect of all of
this was deprive the poor majority of local people of access to health
care. The cut backs in public sector funding saw major reductions in
malaria control and other public health measures. The result of this was
significant increases in Malaria and dengue.
In the light of all of this it is hard to imagine how the private
sector can have anything but an inequitable effect on health care delivery
in developing countries. Poor people will not be able to pay. This is
particularly true when their livelihood is so vulnerable to international
markets and so many people in Nicaragua have been devastated by the
collapse in the international coffee market value (resulting from a coffee
glut due to the IMF and World Bank recommending to many new countries to
get into coffee production).
The hope for health care in countries like Nicaragua is the
phenomenal voluntary contribution made by the teams of health brigadistas
up and down the country in combating common diseases such a diarrhoea and
malaria. The international community can help by, promoting fair trade,
encouraging debt cancellation swapped for public health sector investment
and ensuring that vital drugs are not denied to poorer countries due to
excessive costs and patent periods.
Yours sincerely,
Dr Philip Crowley,
Specialist Registrar in Public Health Medicine,
Durham and Darlington Health Authority.
Email : philip.crowley@public-health.durham-ha.northy.nhs.uk
Competing interests: No competing interests