Introduction

Policy fundamentally determines both the delivery and management of health care. In theory policy makers should collect information on the performance of health services based on explicit criteria – which is what this section explores – in order to influence health care services and systems. In practice, however, this evaluation of field results and experiences has rarely taken place, leading to malfunctioning health systems in many regions of the world. We have argued that both alternative health care and models of service delivery should be promoted with appropriate resources while health professionals and citizens should have the opportunity to influence this process.

We have made a case throughout this book that neoliberal health policies have had a pernicious effect on health systems worldwide. However, challenging these policies also requires us to formulate alternative principles – not only for the sake of showing that another paradigm is feasible but also to offer different criteria for policy evaluation and to ground alternative initiatives in knowledge, experience, and history.

The first four sections of this book questioned the credibility of dominant health policies, for instance by contrasting them with success stories of heterodox health systems such as that of Costa Rica or the failures of others which, like Colombia, followed neoliberal policies. Whilst such evidence nested in practice is necessary, it is perhaps not sufficient to shake the conceptual model that has become so embedded in aid and trade circles. For instance, Costa Rica could be presented as an idiosyncratic accident of history.