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International Health and Aid Policies


  • 5 b/w illus. 20 tables
  • Page extent: 314 pages
  • Size: 234 x 156 mm
  • Weight: 0.54 kg

Library of Congress

  • Dewey number: 362.1
  • Dewey version: 22
  • LC Classification: RA441 .I565 2010
  • LC Subject headings:
    • Public health--International cooperation
    • World health
    • Poor--Medical care
    • Medically underserved areas
    • Medical care--Developing countries

Library of Congress Record


 (ISBN-13: 9780521174268)

International Health and Aid Policies
Cambridge University Press
9780521174268 - International Health and Aid Policies - The Need for Alternatives - By Jean-Pierre Unger, Pierre De Paepe, Kasturi Sen and Werner Soors

International Health and Aid Policies: The Need for Alternatives

International Health and Aid Policies

The Need for Alternatives

Jean-Pierre Unger, Pierre De Paepe, Kasturi Sen and Werner Soors

Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Dubai, Tokyo

Cambridge University Press
The Edinburgh Building, Cambridge CB2 8RU, UK

Published in the United States of America by Cambridge University Press, New York
Information on this title:

© Institute of Tropical Medicine 2010

This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press.

First published 2010

Printed in the United Kingdom at the University Press, Cambridge

A catalog record for this publication is available from the British Library

Library of Congress Cataloging in Publication Data

International health and aid policies : the need for alternatives / [edited by] Jean-Pierre Unger … [et al.].
p. cm.
Includes bibliographical references and index.
ISBN 978-0-521-17426-8 (pbk.)
1. Public health–International cooperation. 2. World health. 3. Poor–Medical care. 4. Medically underserved areas. 5. Medical care–Developing countries. I. Unger, Jean-Pierre, 1954–II. Title.
RA441.I565 2010
362.1–dc22 2010021038

ISBN 978-0-521-17426-8 Paperback

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.


List of abbreviations
Introduction: Overview and purpose
Section 1:Paradigms of international policies
1         Donor led policies: analysis of an underlying doctrine
2         The Achilles heel of international health policies in low- and middle-income countries
Section 2:The failure of the aid paradigm: poor disease control in developing countries
3         Why do disease-control programmes require patients in health services to succeed in delivering? The case of malaria control in Mali
4         How do disease-control programmes damage health care delivery in developing countries?
5         Privatization (PPM-DOTS) strategy for tuberculosis control: how evidence-based is it?
Section 3:Impact of international health policies on access to health in middle-income countries: some experiences from Latin America
6         Costa Rica: achievements of a heterodox health policy
7         Colombia: in vivo test of health sector privatization in the developing world
8         Chile’s neoliberal health reforms: an assessment and a critique
Section 4:Determinants and implications of new liberal health policies: the case of India, China and Lebanon
9         Political and economic determinants of health care systems: the case of India
10        An economic insight into health care provision in six Chinese counties: equity in crisis?
11        Health care financing and delivery in the context of conflict and crisis: the case of Lebanon
Section 5:Principles for alternative, publicly oriented health care policies, planning, management and delivery
12        Paradigm shifts in the health sector: mission and methods
13        Principles for an alternative, social and democratic health policy
14        Quality standards for health care delivery and management in publicly oriented health services
15        Principles of publicly oriented health planning
16        A code of good practice for the management of disease-control programmes
Section 6:A public health, strategic toolkit to implement these alternatives
17        Person-centred care: a key to strengthening health care and systems in low- and middle-income countries
18        Improving access
19        Improving clinical decision making
20        Reorienting academic missions: how can public health departments and public health teaching in particular best support access to good quality comprehensive health care?


This book explores health policies through examining patterns of commercialization that have underpinned the vast majority of these policies in different regions of the world, at the same time providing the reader with both concepts in public health and techniques to develop health services with a social mission. The chapters in the book include case studies and an extensive review of the literature.

We began this task with one main purpose: to explore the extent to which donors and international agencies have, over the past two decades, shared the same underlying motivation: that is to primarily commercialize the health sector of low-income countries (LIC) and middle-income countries (MIC), despite the stated aim of improving access to health care and addressing issues of poverty and exclusion. In this book, we provide evidence showing the contradictions between access to care and strengthening health systems on the one hand and increased commercialization on the other.

The ideas and evidence presented in this book thus call for an exploration of the contradictions of commercialized health care delivery under the guise of maintaining public provision. The book challenges the discourse and status quo among national bodies, in global policy circles, among donors and northern governments. It argues for

  • the creation of health care services that have a social rather than a commercial motivation, and

  • delivery of publicly oriented health care based on (professionally defined) ‘needs’ and on the (population) ‘demand’ to access quality, polyvalent health care, rather than on health interventions efficiency only.



Jean-Pierre Unger

(MD 1979 and PhD 1991, Free University of Brussels; DTM&H 1980, ITM Antwerp; MPH 1983, Harvard School of Public Health) is senior lecturer at the Institute of Tropical Medicine, Antwerp. He started his career in 1981, as a doctor, in the ITM Kasongo project, Congo, then gained experience in health systems and academic development mainly in Africa (in the 1980s and early 1990s) and in Latin America thereafter. He researched strategies to develop publicly oriented health care services (in Africa, Latin America, Asia, Middle East, and Europe), and, since 2000, studies international health policies.

Pierre De Paepe

(MD 1977, Antwerp; MPH 1985, Buenos Aires; certificate in health economics 2005, York) spent 25 years in Latin America (Haiti, Peru, Argentina and Ecuador) and has worked at the ITM since 2003 at the Public Policy and Management Unit. His professional experience focused on the implementation of primary health care programmes, health systems analysis, the documentation of country case studies of Latin America, health systems funding, and financing. He is currently studying Colombian and Brazilian health policies.

Kasturi Sen

(Dip Soc. Pol, PhD) is a social scientist who has worked on issues of public health and development for the past 25 years. She helped set up a network of seven countries to monitor the public health implications of health reforms in the late 1990s in India and also worked with statisticians, economists and epidemiologists to collect one of the largest data sets on household level impact of changes in the organization of health services in three states of India, on safety nets, on quality and on access to care. Kasturi has taught in public health departments at London (1991–1995), Cambridge (1996–2004) and at Oxford (2005–2008) where she helped establish a course on public health and development. She is working on a collaborative project on global health policies at ITM.

Werner Soors

was born in 1955 in Antwerp (MD 1986, University of Antwerp, DTM&H) and worked in Nicaragua up until 2003, with a strong focus on public health care and community participation. Back in Antwerp, he attained his MPH and has been with ITM since 2004. He works in ITM’s Department of Public Health on health systems and reform analysis (Public Policy and Management Unit) and on social protection in health (Health Policy and Financing Unit).


Luis Abad

MD (State University of Cuenca, Ecuador), MPH (National North East University, Argentina), has been district medical officer for the Azogues Health Area, Cañar Province in southern Ecuador, since 1992. He has been a public health advisor of the ‘Primary Health Care – APS project’ by the Belgian Technical Cooperation Organisation in Ecuador (1994–2003). He also lectures on occasion in public health and health systems organization in the Masters in Public Health Course of the Pontificia Universidad Católica del Ecuador, PUCE, Ecuador.

Oscar Arteaga

MD, MSc, DrPH. Health Policy and Management Unit, School of Public Health, Faculty of Medicine, University of Chile. Academic Director of University of Chile’s Master in Public Health Programme.

Lennart Bogg

MSc, PhD economist, BA (Sinology), MScBA (Uppsala University). Served with UNICEF in Burma and in China (1982–1988); from 1988 with Swedish International Development Cooperation Agency (SIDA), Stockholm, first as Financial Controller in the Finance Department and later as Economist (Health Policy) with the Department of Eastern Europe and Central Asia, with UNRWA as Finance Director (Gaza), and with the World Bank Baltic Regional Office as social sector economist. Since 2004 Senior Researcher, Division of Global Health (HCAR), Karolinska Institute (research addressing rural health insurance in Asia, barriers to maternal health in China), and Senior Lecturer (Financial Management), School of Sustainable Development of Society and Technology (HST), Mälardalen University, Sweden.

Rene Buitrón

MD, MPH, MSc, physician and epidemiologist by training, has directed the Institute of Public Health, Pontificia Universidad Católica del Ecuador, Quito, where he is now Professor of pre- and postgraduate courses and Vice Dean of the medical faculty.

Daniel Burdet

MD (Free University of Brussels 1977), general practitioner working in a multidisciplinary primary care team (Maison Médicale Forest), is training supervisor in general practice, quality coordinator, health care manager and a member of the Health Promotion and Quality workgroup (EPSQ) in the Fédération des Maisons Médicales.

Bart Criel

MD, DTM&H, MSc, PhD, senior lecturer at the Department of Public Health of the Institute of Tropical Medicine (ITM) in Antwerp, Belgium. He worked as medical officer in rural Democratic Republic of Congo (1983–1990) and joined the ITM in 1990. He has extensive experience in health systems research with a special focus on district health systems and on arrangements for social protection in health in sub-Saharan countries and in the Indian sub-continent.

Umberto d’Alessandro

MD (Pisa 1982), MSc (London 1990) and PhD (London 1996) is Professor of parasitology and head of the epidemiological parasitology unit (Institute of Tropical Medicine, Antwerp). He has extensively studied malaria control and clinical trials in malariology.

Tony De Groote

MD, DTM&H, MPH, worked mainly in sub-Saharan Africa and Latin America. He is Assistant Professor at St. George’s University in Grenada.

Paul De Munck

MD, MPH, DTM&H, general practitioner, has 14 years’ experience in family and community medicine in a Brussels multidisciplinary, self-managed primary health care centre. Since 1997 he has worked as a public health doctor to support health systems in sub-Saharan Africa.

Moussa Diao

is a retired nurse (Ecole Nationale des Infirmiers d’Etat, Dakar). He has had extensive experience in the field of primary health care and has been supervisor of the primary health care Kolda district in Senegal during the 1990s.

Dong Hengjin

BA in Public Health (1978–1983, Shanghai Medical University), MSc (in Health Statistics and Social Medicine 1983–1986), MA in Health Management, Planning and Policy (1990–1991, Nuffield Institute for Health, Leeds University), PhD (Karolinska Institute, area of Health Services Research). Professor and director of the Department of Hospital Management, vice-director of Health Technology Assessment (HTA) and Research Centre, Dean Assistant of School of Public Health at Shanghai Medical University (SMU) (1997–2000). Senior research fellow in Health Economics Research Group, Brunel University, UK (2004–2006) and senior lecturer at Heidelberg University (2000–2004). Currently leader of the Junior Group of International Health Economics and Technology Assessment at Heidelberg University, Germany.

Sylvie Dugas
Patricia Ghilbert
Andrew Green
Pierre Leemans
Bruno Marchal
Amadou Mbaye
Imrana Qadeer
Edgar W. Rojas González
Abla Mehio Sibai
Giorgio Solimano,
Jacques Unger
Jean Van der Vennet,
Patrick Van Dessel
Monique Van Dormael
Ingrid Vargas Lorenzo
Maria Luisa Vázquez
Marie-Jeanne Wuidar
Walter Zocchi,

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