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Health Sector Reform

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As a result of the Debt Crisis and in order to elevate the payment capacity of underdeveloped countries, deserving countries and multilateral financial organisations designed the Programs of Structural Adjustment. These programs were against the soul of Alma Ata, forcing us to reduce the size of the state, fundamentally at the expense of the social programs, especially health and education.

The Programs of Structural Adjustment had continuity with the so-called "Health Sector Reforms" which assumed the principles of the account presented in the World Bank's Annual Report of 1993 "Investing in Health"

Among the processes generated by the Reforms directed by the WB (isolated or combined to various extents) are:

  • the privatization of the specialized services in hospitals,
  • vertical programs (selective primary health care),
  • cost recovery programs in the public sector,
  • universal social security with private insurance options and state subsidy to basic packages for the extremely poor,
  • hiring of NGO's to provide selective PHC in rural areas,
  • rejection of generic medicines.
  • These processes are combined with a strong ideological offensive to weaken health as a basic human right and to introduce in the people's mind the idea of health as merchandise whose type and quality depends on payment capacity.

    In this topic we delve into these processes. We also learn, in order to strengthen and reproduce elsewhere, the ways in which communities all over the world have resisted privatization and the reforms directed by the WB; have maintained alive the spirit of Alma Ata and vindicated their right to health.



  • Alma Ata Declaration
  • People's Charter for Health
  • Barbara McPake & Anne Mills (200), What can we learn from international comparisons of health systems and health system reform? (Bulletin of the World Health Organization, 2000, 78 (6), 811-820)
  • Workgroup for People's Health and Rights (English)
  • For a critical reading of the position of the international organisations: Latin America and Caribbean Regional Health Sector Reform Initiative
  • The role of UNICEF and WHO In Questioning the Solution: The Politics of Primary Health Care and Child Survival by David Werner and David Sanders (English)
  • Banco Mundial, Informe sobre el Desarrollo Mundial, 1993: Inversión en Salud. Oxford, UK. Oxford U. Press. 1993
  • Discussion questions

    What multilateral financial organisms and technical cooperation agencies are financing and/or supporting health reform processes in your country?

    Which are the political instances in your country that are making decisions on health reform?

    What organizations of the civil society in your country have taken on the defence of health as a basic human right and resisted against health privatization?

    Assignment topics

    Students will have to identify in their respective countries, previous to the course, local experiences that lobby for health reform "from below" in agreement with the Alma Ata principles and People's Charter for Health; as well as processes geared towards Health Reforms "from above" in agreement with the postulates of World Bank.

    This topic has been developed with inputs from Eduardo D'Espinoza, Hani Serag and David Legge.