Three Paradoxes in Health Development

Abstract

PLANNING for health in developing areas of the world is agonizing and f rustrating. Conf ronting the planners are multiple problems directly concerned with physical health, magnified by socioeconomic and cultural factors that are almost overwhelming. A severe shortage of personnel and money complicates the already confusing picture, thereby preventing use of more than a small fraction of the scientific knowledge available for health and medical care. Furthermore, conditions in these coun¬ tries seem to result in the development of pro¬ grams that appear contrary to goals. Because of the immensity of the problems, I propose to examine three paradoxical situations. 1. The greater the proportion of the health budget spent on curative services, the longer the delay in permanent health improvement. 2. The greater the attraction of the mirage of Western health and medical care systems, the more difficult will be the development of an appropriate health and medical care system. 3. The smaller the difference in educational level between health auxiliary workers and the general population, the more effective those workers will be. At first glance, one or all of these statements seem contrary to usual practice and attack suppositions on which much of health work is founded. The first would downgrade the im¬ portance of curative services. The second desacralizes the "sacred cow" of Western medical care and health systems. The third seems con-Dr. Rice is a lecturer in international health, public health, and preventive medicine,

Towards universal health coverage in Zambia: impediments and opportunities

“…That is what we are seeing, that is what we were discussing now … '' These challenges reiterate challenges that Zambia's health sector has experienced since the 1960s; and which have been well described in the literature (Marquez and Farrington 2012;Rice 1966;Shiffman, Berlan, and Hafner 2009), namely how to balance investment between curative and preventive care services, whether to opt for comprehensive or selective health care, and how to prevent inequities that inevitably arise with the growth of private health services. Currently, Zambia seems to be trying to expand gradually from a narrow set of services to comprehensive services which focus on maternal and child health, communicable and non-communicable diseases, as also suggested in the literature on UHC (O'Connell, Rasanathan, and Chopra 2014;Sachs 2012;WHO 2014).…”