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Health care needs state control

AN INTRODUCTION TO HEALTH PLANNING IN DEVELOPING COUNTRIES Andrew Green Publisher: Oxford University Press, UK Price: Rs 475

By Andrew
Published: Friday 15 October 1993

The need-based outlook. IT HAS become fashionable to argue that the private sector manages resources more efficiently than the state sector. However, this does not hold true for health care, especially primary health care, which, according to Andrew Green, must remain the key responsibility of the state. In An Introduction to Health Planning in Developing Countries, Green argues the private sector is driven by motives of profit, whereas the state has a more need-based outlook, which is prerequisite in the health sector.

The state is the best mechanism to control health care because the ability to pay should not determine access to medical facilities, which is a basic right. Secondly, basic public health needs cannot be adequately provided by individuals. Finally, the public is not always aware of their own health needs and require the help of an expert.

Systematic planning
Green emphasises the need for planning, which, according to him, is essential to provide for the future in a systematic manner, while taking into account resource constraints. "The art of successful planning for health must take into account analysis of power structures alongside its technical aspects," he writes in the book, and adds that planning is about change -- and change inevitably has its losers -- and of course opponents. Planning is concerned as much with identifying the losers and winners of situations, and deciding how to handle them, as it is with technical analysis.

The book aims to introduce its readers to the technical aspects of planning within the context of the wider political arena. It is not intended to be a comprehensive planning manual, but rather an introduction to some of the techniques of planning and the issues involved.

There are two essential, but contrasting, aspects of planning. The first is that planning should be systematic and logical. This rational component of planning is important to provide a framework for clear decision-making. The second aspect is that planning deals with issues of power, which makes analysis of power relations a necessary component of planning exercises.

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