Disintegrated care: the Achilles heel of international health policies in low and middle-income countries
Identifieur interne : 003C85 ( Pmc/Checkpoint ); précédent : 003C84; suivant : 003C86Disintegrated care: the Achilles heel of international health policies in low and middle-income countries
Auteurs : Jean-Pierre Unger ; Pierre De Paepe ; Patricia Ghilbert ; Werner Soors ; Andrew GreenSource :
- International Journal of Integrated Care [ 1568-4156 ] ; 2006.
Abstract
To review the evidence basis of international aid and health policy.
Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries.
National policies, international programmes and pilot experiments are examined in both scientific and grey literature.
We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control.
Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored.
We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.
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PubMed: 17006553
PubMed Central: 1576566
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Disintegrated care: the Achilles heel of international health policies in low and middle-income countries</title><author><name sortKey="Unger, Jean Pierre" sort="Unger, Jean Pierre" uniqKey="Unger J" first="Jean-Pierre" last="Unger">Jean-Pierre Unger</name></author><author><name sortKey="De Paepe, Pierre" sort="De Paepe, Pierre" uniqKey="De Paepe P" first="Pierre" last="De Paepe">Pierre De Paepe</name></author><author><name sortKey="Ghilbert, Patricia" sort="Ghilbert, Patricia" uniqKey="Ghilbert P" first="Patricia" last="Ghilbert">Patricia Ghilbert</name></author><author><name sortKey="Soors, Werner" sort="Soors, Werner" uniqKey="Soors W" first="Werner" last="Soors">Werner Soors</name></author><author><name sortKey="Green, Andrew" sort="Green, Andrew" uniqKey="Green A" first="Andrew" last="Green">Andrew Green</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17006553</idno><idno type="pmc">1576566</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1576566</idno><idno type="RBID">PMC:1576566</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">003F62</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003F62</idno><idno type="wicri:Area/Pmc/Curation">003F61</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003F61</idno><idno type="wicri:Area/Pmc/Checkpoint">003C85</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003C85</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Disintegrated care: the Achilles heel of international health policies in low and middle-income countries</title><author><name sortKey="Unger, Jean Pierre" sort="Unger, Jean Pierre" uniqKey="Unger J" first="Jean-Pierre" last="Unger">Jean-Pierre Unger</name></author><author><name sortKey="De Paepe, Pierre" sort="De Paepe, Pierre" uniqKey="De Paepe P" first="Pierre" last="De Paepe">Pierre De Paepe</name></author><author><name sortKey="Ghilbert, Patricia" sort="Ghilbert, Patricia" uniqKey="Ghilbert P" first="Patricia" last="Ghilbert">Patricia Ghilbert</name></author><author><name sortKey="Soors, Werner" sort="Soors, Werner" uniqKey="Soors W" first="Werner" last="Soors">Werner Soors</name></author><author><name sortKey="Green, Andrew" sort="Green, Andrew" uniqKey="Green A" first="Andrew" last="Green">Andrew Green</name></author></analytic><series><title level="j">International Journal of Integrated Care</title><idno type="eISSN">1568-4156</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec id="st1"><title>Purpose</title><p>To review the evidence basis of international aid and health policy.</p></sec><sec id="st2"><title>Context of case</title><p>Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries.</p></sec><sec id="st3"><title>Data sources</title><p>National policies, international programmes and pilot experiments are examined in both scientific and grey literature.</p></sec><sec id="st4"><title>Conclusions and discussion</title><p>We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control.</p><p>Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored.</p><p>We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Walt, G" uniqKey="Walt G">G Walt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walsh, Ja" uniqKey="Walsh J">JA Walsh</name></author><author><name sortKey="Warren, Ks" uniqKey="Warren K">KS Warren</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Unger, Jp" uniqKey="Unger J">JP Unger</name></author><author><name sortKey="Killingsworth, Jr" uniqKey="Killingsworth J">JR Killingsworth</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Raviglione, Mc" uniqKey="Raviglione M">MC Raviglione</name></author><author><name sortKey="Pio, A" uniqKey="Pio A">A Pio</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lambert, Ml" uniqKey="Lambert M">ML Lambert</name></author><author><name sortKey="Van Der Stuyft, P" uniqKey="Van Der Stuyft P">P Van der Stuyft</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brewer, Tf" uniqKey="Brewer T">TF Brewer</name></author><author><name sortKey="Heymann, Sj" uniqKey="Heymann S">SJ Heymann</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Breman, Jg" uniqKey="Breman J">JG Breman</name></author><author><name sortKey="Alilio, Ms" uniqKey="Alilio M">MS Alilio</name></author><author><name sortKey="Mills, A" uniqKey="Mills A">A Mills</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hay, Si" uniqKey="Hay S">SI Hay</name></author><author><name sortKey="Guerra, Ca" uniqKey="Guerra C">CA Guerra</name></author><author><name sortKey="Tatem, Aj" uniqKey="Tatem A">AJ Tatem</name></author><author><name sortKey="Noor, Am" uniqKey="Noor A">AM Noor</name></author><author><name sortKey="Snow, Rw" uniqKey="Snow R">RW Snow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Criel, B" uniqKey="Criel B">B Criel</name></author><author><name sortKey="De Brouwere, V" uniqKey="De Brouwere V">V De Brouwere</name></author><author><name sortKey="Dugas, S" uniqKey="Dugas S">S Dugas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Dormael, M" uniqKey="Van Dormael M">M Van Dormael</name></author><author><name sortKey="Unger, Jp" uniqKey="Unger J">JP Unger</name></author><author><name sortKey="De Paepe, P" uniqKey="De Paepe P">P De Paepe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ageel, Ar" uniqKey="Ageel A">AR Ageel</name></author><author><name sortKey="Amin, Ma" uniqKey="Amin M">MA Amin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bossyns, P" uniqKey="Bossyns P">P Bossyns</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Loretti, A" uniqKey="Loretti A">A Loretti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moerman, F" uniqKey="Moerman F">F Moerman</name></author><author><name sortKey="Lengeler, C" uniqKey="Lengeler C">C Lengeler</name></author><author><name sortKey="Chimumbwa, J" uniqKey="Chimumbwa J">J Chimumbwa</name></author><author><name sortKey="Talisuna, A" uniqKey="Talisuna A">A Talisuna</name></author><author><name sortKey="Erhart, A" uniqKey="Erhart A">A Erhart</name></author><author><name sortKey="Coosemans, M" uniqKey="Coosemans M">M Coosemans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tulloch, J" uniqKey="Tulloch J">J Tulloch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilkinson, D" uniqKey="Wilkinson D">D Wilkinson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Unger, Jp" uniqKey="Unger J">JP Unger</name></author><author><name sortKey="De Paepe, P" uniqKey="De Paepe P">P De Paepe</name></author><author><name sortKey="Green, A" uniqKey="Green A">A Green</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buse, K" uniqKey="Buse K">K Buse</name></author><author><name sortKey="Walt, G" uniqKey="Walt G">G Walt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Widdus, R" uniqKey="Widdus R">R Widdus</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Newell, Jn" uniqKey="Newell J">JN Newell</name></author><author><name sortKey="Pande, Sb" uniqKey="Pande S">SB Pande</name></author><author><name sortKey="Baral, Sc" uniqKey="Baral S">SC Baral</name></author><author><name sortKey="Bam, Ds" uniqKey="Bam D">DS Bam</name></author><author><name sortKey="Malla, P" uniqKey="Malla P">P Malla</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hanson, K" uniqKey="Hanson K">K Hanson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lonnroth, K" uniqKey="Lonnroth K">K Lonnroth</name></author><author><name sortKey="Thuong, Lm" uniqKey="Thuong L">LM Thuong</name></author><author><name sortKey="Lambregts, K" uniqKey="Lambregts K">K Lambregts</name></author><author><name sortKey="Quy, Ht" uniqKey="Quy H">HT Quy</name></author><author><name sortKey="Diwan, Vk" uniqKey="Diwan V">VK Diwan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lonnroth, K" uniqKey="Lonnroth K">K Lonnroth</name></author><author><name sortKey="Uplekar, M" uniqKey="Uplekar M">M Uplekar</name></author><author><name sortKey="Arora, Vk" uniqKey="Arora V">VK Arora</name></author><author><name sortKey="Juvekar, S" uniqKey="Juvekar S">S Juvekar</name></author><author><name sortKey="Lan, Nt" uniqKey="Lan N">NT Lan</name></author><author><name sortKey="Mwaniki, D" uniqKey="Mwaniki D">D Mwaniki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ferrinho, P" uniqKey="Ferrinho P">P Ferrinho</name></author><author><name sortKey="Van Lerberghe, W" uniqKey="Van Lerberghe W">W Van Lerberghe</name></author><author><name sortKey="Julien, Mr" uniqKey="Julien M">MR Julien</name></author><author><name sortKey="Fresta, E" uniqKey="Fresta E">E Fresta</name></author><author><name sortKey="Gomes, A" uniqKey="Gomes A">A Gomes</name></author><author><name sortKey="Dias, F" uniqKey="Dias F">F Dias</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shaw, Rp" uniqKey="Shaw R">RP Shaw</name></author><author><name sortKey="Elmendorf, Ae" uniqKey="Elmendorf A">AE Elmendorf</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="George, S" uniqKey="George S">S George</name></author><author><name sortKey="Gould, E" uniqKey="Gould E">E Gould</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stocker, K" uniqKey="Stocker K">K Stocker</name></author><author><name sortKey="Waitzkin, H" uniqKey="Waitzkin H">H Waitzkin</name></author><author><name sortKey="Iriart, C" uniqKey="Iriart C">C Iriart</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Unger, Jp" uniqKey="Unger J">JP Unger</name></author><author><name sortKey="D Alessandro, U" uniqKey="D Alessandro U">U D'Alessandro</name></author><author><name sortKey="De Paepe, P" uniqKey="De Paepe P">P De Paepe</name></author><author><name sortKey="Green, A" uniqKey="Green A">A Green</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Groote, T" uniqKey="De Groote T">T De Groote</name></author><author><name sortKey="De Paepe, P" uniqKey="De Paepe P">P De Paepe</name></author><author><name sortKey="Unger, Jp" uniqKey="Unger J">JP Unger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arbelaez, Mp" uniqKey="Arbelaez M">MP Arbelaez</name></author><author><name sortKey="Gaviria, Mb" uniqKey="Gaviria M">MB Gaviria</name></author><author><name sortKey="Franco, A" uniqKey="Franco A">A Franco</name></author><author><name sortKey="Restrepo, R" uniqKey="Restrepo R">R Restrepo</name></author><author><name sortKey="Hincapie, D" uniqKey="Hincapie D">D Hincapié</name></author><author><name sortKey="Blas, E" uniqKey="Blas E">E Blas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gish, O" uniqKey="Gish O">O Gish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lush, L" uniqKey="Lush L">L Lush</name></author><author><name sortKey="Cleland, J" uniqKey="Cleland J">J Cleland</name></author><author><name sortKey="Walt, G" uniqKey="Walt G">G Walt</name></author><author><name sortKey="Mayhew, S" uniqKey="Mayhew S">S Mayhew</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bachmann, Mo" uniqKey="Bachmann M">MO Bachmann</name></author><author><name sortKey="Makan, B" uniqKey="Makan B">B Makan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Unger, Jp" uniqKey="Unger J">JP Unger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kelly, M" uniqKey="Kelly M">M Kelly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brown, A" uniqKey="Brown A">A Brown</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mintzberg, H" uniqKey="Mintzberg H">H Mintzberg</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kavalier, F" uniqKey="Kavalier F">F Kavalier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walgate, R" uniqKey="Walgate R">R Walgate</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Green, A" uniqKey="Green A">A Green</name></author><author><name sortKey="Collins, C" uniqKey="Collins C">C Collins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Potter, Je" uniqKey="Potter J">JE Potter</name></author><author><name sortKey="Berquo, E" uniqKey="Berquo E">E Berquo</name></author><author><name sortKey="Perpetuo, Ih" uniqKey="Perpetuo I">IH Perpetuo</name></author><author><name sortKey="Leal, Of" uniqKey="Leal O">OF Leal</name></author><author><name sortKey="Hopkins, K" uniqKey="Hopkins K">K Hopkins</name></author><author><name sortKey="Souza, Mr" uniqKey="Souza M">MR Souza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bassett, Mt" uniqKey="Bassett M">MT Bassett</name></author><author><name sortKey="Bijlmakers, L" uniqKey="Bijlmakers L">L Bijlmakers</name></author><author><name sortKey="Sanders, Dm" uniqKey="Sanders D">DM Sanders</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morley, Sa" uniqKey="Morley S">SA Morley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Der Hoeven, R" uniqKey="Van Der Hoeven R">R van der Hoeven</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Taylor, R" uniqKey="Taylor R">R Taylor</name></author><author><name sortKey="Blair, S" uniqKey="Blair S">S Blair</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marek, T" uniqKey="Marek T">T Marek</name></author><author><name sortKey="Yamamoto, C" uniqKey="Yamamoto C">C Yamamoto</name></author><author><name sortKey="Ruster, J" uniqKey="Ruster J">J Ruster</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Broomberg, J" uniqKey="Broomberg J">J Broomberg</name></author><author><name sortKey="Mills, A" uniqKey="Mills A">A Mills</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mills, A" uniqKey="Mills A">A Mills</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcpake, B" uniqKey="Mcpake B">B McPake</name></author><author><name sortKey="Hongoro, C" uniqKey="Hongoro C">C Hongoro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mills, A" uniqKey="Mills A">A Mills</name></author><author><name sortKey="Hongoro, C" uniqKey="Hongoro C">C Hongoro</name></author><author><name sortKey="Broomberg, J" uniqKey="Broomberg J">J Broomberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sepehri, A" uniqKey="Sepehri A">A Sepehri</name></author><author><name sortKey="Chernomas, R" uniqKey="Chernomas R">R Chernomas</name></author><author><name sortKey="Akram Lodhi, Ah" uniqKey="Akram Lodhi A">AH Akram-Lodhi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Paphassarang, C" uniqKey="Paphassarang C">C Paphassarang</name></author><author><name sortKey="Philavong, K" uniqKey="Philavong K">K Philavong</name></author><author><name sortKey="Boupha, B" uniqKey="Boupha B">B Boupha</name></author><author><name sortKey="Blas, E" uniqKey="Blas E">E Blas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stefanini, A" uniqKey="Stefanini A">A Stefanini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hsiao, Wc" uniqKey="Hsiao W">WC Hsiao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pannarunothai, S" uniqKey="Pannarunothai S">S Pannarunothai</name></author><author><name sortKey="Mills, A" uniqKey="Mills A">A Mills</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liu, X" uniqKey="Liu X">X Liu</name></author><author><name sortKey="Mills, A" uniqKey="Mills A">A Mills</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Molina, R" uniqKey="Molina R">R Molina</name></author><author><name sortKey="Pinto, M" uniqKey="Pinto M">M Pinto</name></author><author><name sortKey="Henderson, P" uniqKey="Henderson P">P Henderson</name></author><author><name sortKey="Vieira, C" uniqKey="Vieira C">C Vieira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Acosta, Ol" uniqKey="Acosta O">OL Acosta</name></author><author><name sortKey="Ramirez, M" uniqKey="Ramirez M">M Ramírez</name></author><author><name sortKey="Ca N, Ci" uniqKey="Ca N C">CI Cañón</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Cast O, R" uniqKey="Cast O R">R Castño</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Acosta, Ol" uniqKey="Acosta O">OL Acosta</name></author><author><name sortKey="Ramirez, M" uniqKey="Ramirez M">M Ramírez</name></author><author><name sortKey="Ca N, Ci" uniqKey="Ca N C">CI Cañón</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Rodriguez, C" uniqKey="Rodriguez C">C Rodríguez</name></author><author><name sortKey="Tokman, Mr" uniqKey="Tokman M">MR Tokman</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Arellano, Jpm" uniqKey="Arellano J">JPM Arellano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hiscock, J" uniqKey="Hiscock J">J Hiscock</name></author><author><name sortKey="Hojman, D" uniqKey="Hojman D">D Hojman</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Figueras, J" uniqKey="Figueras J">J Figueras</name></author><author><name sortKey="Saltman, Rb" uniqKey="Saltman R">RB Saltman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brugha, R" uniqKey="Brugha R">R Brugha</name></author><author><name sortKey="Zwi, A" uniqKey="Zwi A">A Zwi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jong Wook, L" uniqKey="Jong Wook L">L Jong-wook</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Unger, Jp" uniqKey="Unger J">JP Unger</name></author><author><name sortKey="De Paepe, P" uniqKey="De Paepe P">P De Paepe</name></author><author><name sortKey="Ghilbert, P" uniqKey="Ghilbert P">P Ghilbert</name></author><author><name sortKey="De Groote, T" uniqKey="De Groote T">T De Groote</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Integr Care</journal-id><journal-id journal-id-type="publisher-id">IJIC</journal-id><journal-title-group><journal-title>International Journal of Integrated Care</journal-title></journal-title-group><issn pub-type="epub">1568-4156</issn><publisher><publisher-name>Igitur, Utrecht Publishing & Archiving</publisher-name><publisher-loc>Utrecht, The Netherlands</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17006553</article-id><article-id pub-id-type="pmc">1576566</article-id><article-id pub-id-type="publisher-id">ijic200614</article-id><article-categories><subj-group subj-group-type="heading"><subject>Policy</subject></subj-group></article-categories><title-group><article-title>Disintegrated care: the Achilles heel of international health policies in low and middle-income countries</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Unger</surname><given-names>Jean-Pierre</given-names></name><degrees>MD, PhD</degrees><role>Senior Lecturer</role><aff>Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium</aff></contrib><contrib contrib-type="author"><name><surname>De Paepe</surname><given-names>Pierre</given-names></name><degrees>MD, MPH</degrees><role>Research assistant</role><aff>Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium</aff></contrib><contrib contrib-type="author"><name><surname>Ghilbert</surname><given-names>Patricia</given-names></name><degrees>RN, MCommH</degrees><role>Research assistant</role><aff>Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium</aff></contrib><contrib contrib-type="author"><name><surname>Soors</surname><given-names>Werner</given-names></name><degrees>MD, MPH</degrees><role>Research assistant</role><aff>Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium</aff></contrib><contrib contrib-type="author"><name><surname>Green</surname><given-names>Andrew</given-names></name><degrees>BA, MA, PhD</degrees><role>Professor</role><aff>Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK</aff></contrib></contrib-group><author-notes><corresp id="cor1">*Correspondence to: Jean-Pierre Unger, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium, E-mail: <email>jpunger@itg.be</email></corresp></author-notes><pub-date pub-type="collection"><season>Jul-Sep</season><year>2006</year></pub-date><pub-date pub-type="epub"><day>18</day><month>9</month><year>2006</year></pub-date><volume>6</volume><elocation-id>e14</elocation-id><history><date date-type="received"><day>26</day><month>10</month><year>2005</year></date><date date-type="rev-recd"><day>19</day><month>6</month><year>2006</year></date><date date-type="accepted"><day>3</day><month>7</month><year>2006</year></date></history><permissions><copyright-statement>Copyright 2006, International Journal of Integrated Care (IJIC)</copyright-statement><copyright-year>2006</copyright-year></permissions><abstract><title>Abstract</title><sec id="st1"><title>Purpose</title><p>To review the evidence basis of international aid and health policy.</p></sec><sec id="st2"><title>Context of case</title><p>Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries.</p></sec><sec id="st3"><title>Data sources</title><p>National policies, international programmes and pilot experiments are examined in both scientific and grey literature.</p></sec><sec id="st4"><title>Conclusions and discussion</title><p>We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control.</p><p>Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored.</p><p>We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>health policy</kwd><kwd>disease control</kwd><kwd>health care services</kwd><kwd>integration</kwd><kwd>developing countries</kwd><kwd>international cooperation and agencies</kwd></kwd-group></article-meta></front><floats-group><fig id="fg001" position="float"><label>Figure 1</label><caption><p>International aid-promoted health policy.</p></caption><graphic xlink:href="ijic2006-200614-001"></graphic></fig><table-wrap id="tb001" position="float"><label>Table 1</label><caption><p>Infant and maternal mortality rates, Costa Rica, Chile and Colombia <xref ref-type="fn" rid="fn1">1</xref></p></caption><table frame="hsides" rules="groups"><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Reduction</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IMR</td><td valign="top" align="left" rowspan="1" colspan="1">IMR</td><td valign="top" align="left" rowspan="1" colspan="1">IMR</td><td valign="top" align="left" rowspan="1" colspan="1">MMR</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">1970</td><td valign="top" align="left" rowspan="1" colspan="1">2001</td><td valign="top" align="left" rowspan="1" colspan="1">1970–2001</td><td valign="top" align="left" rowspan="1" colspan="1">2001 </td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Costa Rica</td><td valign="top" align="left" rowspan="1" colspan="1">62</td><td valign="top" align="left" rowspan="1" colspan="1">9</td><td valign="top" align="left" rowspan="1" colspan="1">: 7</td><td valign="top" align="left" rowspan="1" colspan="1">29</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Chile</td><td valign="top" align="left" rowspan="1" colspan="1">78</td><td valign="top" align="left" rowspan="1" colspan="1">10</td><td valign="top" align="left" rowspan="1" colspan="1">: 8</td><td valign="top" align="left" rowspan="1" colspan="1">23</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Colombia</td><td valign="top" align="left" rowspan="1" colspan="1">69</td><td valign="top" align="left" rowspan="1" colspan="1">19</td><td valign="top" align="left" rowspan="1" colspan="1">: 4</td><td valign="top" align="left" rowspan="1" colspan="1">80</td></tr></tbody></table><table-wrap-foot><fn id="fn1"><label>1</label><p>Infant mortality rate as the probability of dying between birth and exactly one year of age, expressed per 1,000 live births (1970 and 2001 figures, from UNICEF); infant mortality rate reduction 1970–2001 calculated from the 1970 and 2001 figures; maternal mortality ratio as the annual number of deaths of women from pregnancy-related causes per 100,000 live births (data refer to the most recent year available during the period specified, from UNICEF's The State of the Worlds Children 2003, based on national data, adjusted for underreporting and misclassification in a joint effort by UNICEF and WHO); health expenditure per capita in PPP US$ (from WHO); GDP per capita in PPP US$ (from WB's World Development Indicators); GDP per capita annual growth rate (aggregates from WB for the Human Development Report Office).</p><p>Sources: United Nations Development Programme (2003) Human Development Indicators. In Human Development Report 2003. Millennium Development Goals: A compact among nations to end human poverty. UNDP, New York, NY, USA, pp 237–339, <ext-link ext-link-type="uri" xlink:href="http://hdr.undp.org/reports/global/2003">http://hdr.undp.org/reports/global/2003</ext-link>; United Nations Development Programme (2004) Human Development Indicators. In Human Development Report 2004: Cultural liberty in today's diverse world. UNDP, New York, NY, USA, pp 139–250, <ext-link ext-link-type="uri" xlink:href="http://hdr.undp.org/reports/global/2004">http://hdr.undp.org/reports/global/2004</ext-link>.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list></list><tree><noCountry><name sortKey="De Paepe, Pierre" sort="De Paepe, Pierre" uniqKey="De Paepe P" first="Pierre" last="De Paepe">Pierre De Paepe</name><name sortKey="Ghilbert, Patricia" sort="Ghilbert, Patricia" uniqKey="Ghilbert P" first="Patricia" last="Ghilbert">Patricia Ghilbert</name><name sortKey="Green, Andrew" sort="Green, Andrew" uniqKey="Green A" first="Andrew" last="Green">Andrew Green</name><name sortKey="Soors, Werner" sort="Soors, Werner" uniqKey="Soors W" first="Werner" last="Soors">Werner Soors</name><name sortKey="Unger, Jean Pierre" sort="Unger, Jean Pierre" uniqKey="Unger J" first="Jean-Pierre" last="Unger">Jean-Pierre Unger</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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