Public health debacle in South Asia: a reflection of the crisis in welfarism. South Asian regional meeting on health effects of structural adjustment policies, New Delhi, September 1997.

Abstract

Over the past decade, reforms of the health sector have evolved as a global phenomenon. The active promotion of these reforms has been associated with an assumed consensus on the need for privatization of public services through mechanisms such as contracting, introducing user charges and the more general application of market principles in the design and delivery of health care among other services. The concerns of participants at the meeting reflect a growing voice from the developing world that global enforcement does not entail a consensus (as portrayed by the advocates of reform) that public services be replaced by private ones. The Centre for Social Medicine and Community Health at the Jawaharlal Nehru University, New Delhi, together with members from the Department of Community Medicine at the University of Cambridge recently held an EC-supported seminar focusing on South Asia but attended also by a small number of participants from Europe, to assess the health effects of structural adjustment policies in the South Asian region. The following is a brief report of the meeting. The three-day meeting, held in New Delhi, was attended by 100 participants. There was representation from non-governmental and independent policy-research institutions from Bangladesh, Sri Lanka, Nepal, Pakistan, India, Finland and the United Kingdom. Most had been involved in some aspect of health services research. Many, for example, were involved in the delivery of services and included health practitioners, health service managers and health policy makers. The aim of the regional meeting was threefold: (1) to understand the impact of structural adjustment policies upon existing programmes of primary health care; (2) specifically to ascertain the implications of determining priorities in health services as advocated by current prescription to divide services into essential and non-essential ones; (3) to exchange ideas and information on the experiences in the region from a historical perspective, so as to explore alternative models premised upon comprehensive health service coverage as propagated by the Health for all strategy. There was general support for this approach, which was considered still to be relevant