Structural Adjustment and Health

Abstract

A clear statement is contained in the World Development Report 1993 (Report) on the World Bank’s (Bank) view with regards to health sector reform in less-developing countries. As is the case in reading many other Bank documents, this one seems to have drawn on numerous critiques of conventional health practices. Government inefficiency and corruption is criticized. Also, the practice of heavy expenditures on curative medicine and related specialized health training, which subsidizes the rich or the offspring of the rich, is criticized; and restructuring expenditures from tertiary medicine to primary healthcare (PHC) is endorsed. Indeed, in some respects, the Report makes the Bank sound like a 1960s radical. Adopting such a view would, however, be erroneous. While the Bank suggests many sensible reforms, such as the ones mentioned above, there remain important differences in the Bank’s approach and that of its radical critics.

Paper prepared for the Sustainable Development Policy Institute Working Paper Series by Shahrukh Rafi Khan and Sajid Kazmi. Thanks are due for comments to Mozaffar Qazilbash and Haris Gazdar.