Global Health Watch 1 in one file

tralized management structure. Central and intermediate-level policy makers
and managers would ensure national coherence and coordination, common
standards and equitable resource distribution amongst districts.
2 The demise of health for all
Macro-economic factors Health care systems require the availability of basic
physical and human infrastructure throughout a country if they are to be effective
and equitable. Countries need to invest in the development of this
infrastructure, but many have no resources to do so.
Low- and lower middle-income countries need to spend at least US$30–40
(2002 prices) each year per person if they are to provide their populations with
‘essential’ health care (Commission on Macroeconomics and Health 2001).
This sum is about three times the current average spending on health in
the least developed countries and more than current spending in other lowincome
and lower middle-income countries. More to the point, it is over five
times the average government health spending of the least developed countries
and about three times that of other low-income countries. Estimates of
this kind are fraught with methodological limitations and assumptions, but
they indicate the size of the resource gap facing most developing countries.
The causes of impoverished health care systems are varied. Many countries
with low levels of health care expenditure are in fact able to invest much more
than they do. However, many macro-economic factors (discussed in part A)
that help to keep poor countries poor, by extension, keep levels of health care
expenditure low.
Historically, a key macro-economic event was the hikes in oil prices during
1979–1981, which precipitated an economic recession in industrialized countries,
prompting governments in those countries to raise interest rates. The
combination of recession in the industrialized world, higher oil prices and
raised interest rates precipitated a macro-economic crisis in many developing
countries, especially in Latin America and Sub-Saharan Africa. These countries
experienced reduced export demand, declines in primary commodity
(non-fuel) prices, deteriorating real terms of trade, lower capital inflows and
soaring debt service payments. Many countries had negative economic growth,
reduced government revenue and increasing poverty.
The effects on health care systems, so soon after the bold and visionary
aspirations of the Alma Ata Declaration, were nothing short of disastrous.
Most health care systems have never had a chance to recover from these effects
which included:
Approaches to health care
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