Health Sector Planning in Developing Countries

Abstract

One of the most visible concomitants of economic development is a fall in mortality rates and a rise in the general level of health. Good health and longevity are not only highly desired in themselves but are also important because of their potential contribution to economic welfare. Although some health improvements can exacerbate population problems, better health can also raise the rate of growth of income per capita by reducing population expansion and increasing the stock of human and physical capital per worker.' Despite the potential contribution of health improvements to the over-all process of economic development, economists have generally remained silent on the subject of programmes of health care and disease control in less developed countries.2 In particular, no attempt has been made to extend the methods of economic optimization to the health care sector. Unfortunately, public health administrators also have neither developed any systematic methods of planning nor sought to integrate health care into the broader context of development planning. The choice of health care activities has not reflected a conscious comparison of their multi-faceted benefits with their use of scarce inputs. Instead, public health administrators have often attempted to treat programme choice as a technical question, free of value judgments about the relative desirability of different health improvements. One result of this has been a concentration on diseases such as malaria in which complete eradication is technically feasible. A second result has been the use of the infant mortality rate as an indicator of the community's general health level. This has led health administrators into the fallacy of assuming that programmes which reduce infant mortality actually raise the entire level of health. Substantial resources have therefore been devoted to decreasing infant mortality, thus increasing population size but not improving health in other age groups. The current paper reports the first step towards the development of a systematic approach to health sector planning capable of integration into a more general programme of economic development. The aim of the present research has been to devise a potentially operational method for allocating the scarce health sector funds, manpower and facilities among different disease control programmes and individual activities in the way which yields the optimum feasible reduction of mortality,