Socioeconomic and Political Aspects of Health Care
Not only the lack of health resources, but also the maldistribution of resources constitutes a major problem facing Third World countries. In some cases, health planning is based on a country's particular political philosophy. On the other hand, socioeconomic and political forces formulate different types of health services systems within a country. The three chapters included in this part deal with case studies from Zambia, India, and Ethiopia.
In Chapter 5, which is on politics, planning and primary health care, Paul J. Freund outlines the policies of the Zambian government on the need to improve the health status of the people. However, the schemes designed to alleviate malnutrition were all vertical approaches (rehabilitation centres, suppplementary feeding, weaning mixes) which dealt to some extent with the immediate consequences. These errors are being rectified through various developmental sectors with an aim to reduce malnutrition through agricultural policies. The political economy of health care is an attempt to specify the ways in which economic interests and political processes structure the provision of services. In Chapter 6 Rogers Jeffery states that in India health policy is generally so closely dominated by national and international class interests that little scope remains for major change. At the same time one must not ignore the very real achievement of the Indian health policy, concerning shifting of resources towards preventive medicine, rural areas and near successful campaigns against smallpox and malaria. The decision making basically has been centralised in the hands of a bureaucratic and political elite which has given rural provisions a priority, based first on socialist and Gandhian perspectives and second on a populist strategy. Jeffery discusses the policy changeover from socialist to populist and its implications for the formulation of health care plans.