Economic reform and health sector policy: lessons from structural adjustment programs
Peabody, J.W.
Social Science and Medicine 43(5): 823-835
1996
ISSN/ISBN: 0277-9536 PMID: 8870147 DOI: 10.1016/0277-9536(96)00127-xDocument Number: 310280
The study begins by examining what structural adjustment policies (SAPs) are, how they work and then discusses the potential ways SAPs are believed to affect health care in developing countries. Evidence from literature is reviewed to establish what effects SAPs actually have on health services. The final section suggests policy designs that will make health status be less vulnerable to economic misfortune. Health policymakers need to understand the expected and unexpected impacts of economic reform on health outcomes in individuals and on the population. The interactions are complex, involve multiple sectors, and can be better understood by looking at the experience of developing countries over almost 15 years of SAP experience. Health care budgets may be vulnerable to reduced government spending, quality of care deteriorates, nutrition will suffer more likely in urban areas, and cost-effective preventive programmes may stop if labour and capital are not properly matched. Health outcomes overall do not appear to suffer but a more detailed look, with better data, shows that the incidence of preventable diseases rises and irreversible deterioration in health status does occur within countries.
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