Fragmenting health care: The World Bank prescription for Africa

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Volumn 21, Issue 2, 1996, Pages 211-235

  Owoh, Kenna ^a  

^a YORK UNIVERSITY   (Canada)

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EID: 21344460720     PISSN: 03043754     EISSN: None     Source Type: Journal    
DOI: 10.1177/030437549602100204     Document Type: Article

References (65)

1. This article draws on ongoing research in Jos Local Government Area, Plateau State, Nigeria, first undertaken in 1987 and followed up in 1992 and 1996. The 1992 research was sponsored by the Canadian Society for International Health.
2. World Bank, World Development Report 1993: Investing in Health (Oxford: Oxford University Press, 1993)
3. and World Bank, Better Health in Africa (Washington, DC: World Bank, Human Resources and Poverty Division, 1993).
4. World Council of Churches, CONTACT 142 (April/May 1995).
5. WHO/UNICEF. Primary Health Care: Report of the International Conference on Primary Health Care. Alma-Ata, USSR, 6-12 September 1978 (Geneva: WHO "Health for All" Series, no. 1).
6. I am using the term discourse as developed in the ideas and concepts of Michel Foucault. See Paul Rabinow, The Foucault Reader (New York: Pantheon, 1984).
7. Meredith Turshen, "The World Health Organization at 47," paper presented at the Conference on the United Nations at Fifty: At the Threshold of a New World Order" (March 16-18, Hofstra University, Hempstead, New York, 1995).
8. G. K. Helleiner, "External Debt and External Finance for Sub-Saharan Africa: the Continuing Problem," in Gerald Helleiner, Shahen Abrahamian, Edmar Bacha, Roger Lawrence, and Pedro Malan, eds., Poverty, Prosperity and the World Economy: Essays in Memory of Sidney Dell (London: Macmillan, forthcoming);
9. United Nations Conference on Trade and Development, Trade & Development Report, 1994 (New York: United Nations, 1994);
10. Kevin Danaher, ed., 50 Years Is Enough (Boston: South End, 1994;
11. World Bank, The World Bank Annual Report 1995 (Washington, D.C.: World Bank, 1995).
12. G. A. Cornia, R. Jolly, F. Stewart, eds., Adjustment with a Human Face (Oxford: Clarendon, 1987);
13. UNICEF, Africa's Children, Africa's Future, prepared by the Organization of African Unity and the UN Children's Fund for the OAU International Conference on Assistance to African Children, Dakar, Senegal (25-27 November, 1992);
14. G. K. Helleiner, "From Adjustment to Development in Sub-Saharan Africa: Conflict, Convergence, Consensus?" in Giovani Andreas Cornia and Gerald K. Helleiner, eds., From Adjustment to Development in Africa: Conflict, Controversy, Convergence, Consensus? (New York: St. Martin's, 1994).
15. Kenneth Newell, ed., Health by the People (Geneva: WHO, 1975);
16. V. D. Djukanovic and E. P. Mach, eds., Alternative Approaches to Meeting Basic Health Needs in Developing Countries (Geneva: WHO, 1975).
17. WHO/UNICEF, 1978.
18. WB, Better Health, note 2, pp. 43-45.
19. Gillian Walt, Angela Melamed, eds., Mozambique: Towards a People's Health Service (London: Zed Books, 1983);
20. Ruth and Victor Sidel, The Health of China (London: Zed Press, 1983);
21. Julia Walsh and Keith Warren, "Selective Primary Health Care," International Health 301, no. 18 (1989).
22. WB, Better Health, note 2, p. 103;
23. Alan Fowler, "Distant Obligation: Speculations on NGO Funding and the Global Market," Review of African Political Economy 55 (1992): 2-29.
24. Third World Resurgence no. 52 (1995);
25. Third World Resurgence and nos. 61-62 (1995).
26. Marcus Arruda, "Structural Adjustment: A Constructive Overview from the Perspective of Civil Society, "text prepared for the NGO Working Group on the World Bank, NGO-WG Committee Meeting (October 5-6, 1993).
27. See Maarten Ettema, Guite Hansma, and Lea Kloosterman, SAP Does Not Fill the Gap (Amsterdam: WEMOS, 1991);
28. Sigrun Mogedal, "Making the Most of the Focus on Health Services," Contact 141 (1995): 13-17;
29. InterChurch Coalition for Africa, Responding to the Health Crisis in Africa (Toronto: ICCAF, 1993).
30. WB, Better Health, note 2, p. 26.
31. Anne Renfrew, "ESAP & Health: The Effects of the Economic Structural Adjustment Programme on the Health of the People of Zimbabwe" (Harare, Zimbawe: Mambo Press, 1992).
32. WB, Better Health, note 2, p. 110.
33. This is not to say that employment in public hospitals and health centers has remained untouched by the slashing of public-sector allocations. Job losses in the public-health sector are estimated at 50 percent in the 1980s to 30 percent in the 1990s across Africa. The number of salaried workers is estimated at varying between 15 percent and 20 percent, half of them in the public services - International Labour Organisation, Labour (1994): 3.
34. Another recent study shows the exodus of human capital, including doctors and nurses. The brain drain from Africa is estimated at some 30,000 mid-level, high-level, and professional workers between 1984 and 1987 - Michael Chossoudovsky, Structural Adjustment, Health and the Social Dimensions: A Review (Ottawa: Canadian International Development Agency, 1992), p. 12.
35. WB, Better Health, note 2, p. 108.
36. Ralph Schram, A History of the Nigerian Health Services (Nigeria: Ibadan University Press, 1971);
37. Dennis Ityavyar, "The Development of Health Services in Nigeria 1960-85," (Ph.D. diss., University of Toronto, 1985);
38. Kenna Owoh, "Politics of Obstetrics: Impact of Privatization in Plateau State" (M.A. diss., University of Jos, Nigeria, 1987).
39. The 1992 study of Plateau State, Nigeria, found that between 1981 and 1991 private-sector facilities had increased from 23 registered for-profit medical establishments, to 645 facilities, exclusive of mission services. Plateau State Ministry of Health, Annual Statistical Bulletin (Jos, Nigeria, 1991.
40. UN Development Programme, Human Development Report 1993 (New York: United Nations, 1993).
41. A. E. Isenaklumhe and O. Ovbiawe, "Polypharmacy: Its Cost Burden and Barrier to Medical Care in a Drug Orientated Health Care System," International Journal of Health Services, 18, no. 2 (1988): 335-342.
42. WB, Better Health, note 2, p. 111.
43. UNICEF, note 8. See Turshen, note 6, for a critical reading of UNICEF's position; and Najmi Kanji, "Charging for Drugs in Africa: UNICEF's Bamako Initiative," Health Policy & Planning 4, no. 2 (1989): 110-120.
44. Chossoudovsky, note 20, p. 12.
45. WB, Better Health, note 2, p. 2.
46. UNICEF, Children and Women in Nigeria: A Situational Analysis 1990. (Lagos: Federal Republic of Nigeria/UNICEF, 1990);
47. UNICEF, note 8; Tola Old Pearce and Tobin Filially, eds., Child Health in Nigeria (Brookfield, Vt.: Avebury, 1994).
48. WB, WDR, note 2, 165;
49. WB, Better Health, note 2, p. 130.
50. Report of the Special Joint Committee Reviewing Canadian Foreign Policy, Canada's Foreign Policy: Principles and Priorities for the Future (Ottawa: Government of Canada, 1994).
51. WB, Better Health, pp. 42-44.
52. Ettema et al., note 16.
53. Fowler, note 13, pp. 9-29.
54. WB, World Bank Annual Report 1995 (Washington, D.C.: World Bank, 1995).
55. WB, World Bank Debt Tables 1994-95 (Washington, D.C.: World Bank, 1994).
56. Countries in the "low" category are: Burkina Faso, Ethiopia, Nigeria, Somalia, Sierra Leone, Zaire, and Uganda. "Medium" countries are Burundi, Cameroon, Gambia, Ghana, Kenya, Liberia, Malawi, Mali, Niger, Rwanda, Senegal, Togo, and Zambia. "High" countries are Botswana, Lesotho, Mauritius, Swaziland, and Zimbabwe.
57. WB, Better Health, p. 103.
58. Lest this appears to be an anomaly, the 1988 and 1989 figures are 25.9 percent and 27.9 percent, respectively - Central Bank of Nigeria, Annual Report and Statement of Accounts, CBN (Lagos, Nigeria: 1990), p. 54.
59. See Adebayo O. Olukoshi, ed., Nigerian External Debt Crisis: Its Management (Lagos, Nigeria: Malthouse Press, 1990).
60. See Netherlands Government, Africa Conference (Maastricht, July 2-4, 1990);
61. UNICEF, "Debt Relief for Africa: A Call for Urgent Action on Human Development," paper prepared by UNICEF (June 1993);
62. Percy Mistry, "The Multilateral Debt Problems of Indebted Developing Countries," paper prepared for the seminar on multilateral debt coorganized by EURODAD and NOVIB in the Hague (December 6, 1993);
63. and G. K. Helleiner, Debt Relief for Africa: A Call for Urgent Action on Human Development, UNICEF Staff Working Papers no. 11 (New York: UNICEF, 1994).
64. Isabella Bakker, "Engendering Macroeconomic Policy Reform in the Era of Adjustment and Restructuring: A Conceptual Overview," paper prepared for the North-South Institute Workshop: "The Impact of Economic Policies on Women in a Period of Structural Change and Adjustment-Toward a Framework" (Ottawa: June 19-21, 1992).
65. Bakker, note 43, p. 30.