Global Health Watch 1 in one file

B1 | Health care systems and approaches to
health care
Introduction
An estimated 30,000 children die every day, mainly from preventable and
easily treatable causes (Black, Morris and Bryce 2003). Millions of people do
not have access to health care because health care systems in many countries
are either non-existent or moribund. In many countries in Sub-Saharan Africa
and in war-ravaged countries such as Afghanistan, health care systems are in
a state of collapse. Life expectancy in two regions, Sub-Saharan Africa and
the republics of the former Soviet Union (FSU), is deteriorating. In the FSU,
although health status and health care systems are better than in Africa, health
status is deteriorating at the same time that health care systems are struggling
to ensure universal access to care (Box B1.1). In middle- and high-income countries,
health care systems also struggle with widening disparities in health and
health care consumption; uncontrolled rises in health care costs; profit-driven
inefficiencies; and a deterioration in trust between citizens and providers.
Instead of focusing on particular diseases or issues such as HIV/AIDS, ‘mental
health’ or ‘child health’, this chapter is focused on developing an agenda
for health care systems development. In doing so, it advocates looking back
to the 1978 Alma Ata Declaration on Health (WHO/UNICEF 1978) and the
pledge made to achieve ‘Health for All’ through the Primary Health Care (PHC)
Approach.
The principles of the PHC Approach are as relevant today as they were
nearly 30 years ago and provide a guide not just for the organization of health
care systems, but also for how health care systems should act as an engine for
promoting health and development more generally, and as an instrument for
promoting equity and empowering the poor. Section 1 of this chapter reasserts
these principles.
Section 2 goes on to explore how the principles of the PHC Approach have
been undermined by various policies and events in five thematic areas:
1) macro-economic factors;
2) health sector reform, neoliberalism and the commercialization of health
care;
3) ‘selective’ health care and verticalization;
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