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Health Planning in Latin America: Review and Evaluation

Published online by Cambridge University Press:  24 October 2022

Dieter K. Zschock
Dieter K. Zschock*
Affiliation:
State University of New York at Stony Brook
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THE GOVERNMENTS OF LATIN AMERICA, HAVING BEEN PREOCCUPIED MAINLY with industrialization since World War II, began to give more attention to social development during the Sixties. Priorities of development policy, stressed under the Alliance for Progress, now include education and health; improvements in both areas are regarded as means of raising output as well as furthering social progress. Analyses of Latin America's human resources, however, have concentrated mainly on manpower requirements and corresponding educational needs. They have been supported by evidence of high returns to investment in education,2 while studies of the region's health conditions have yielded no comparable evidence in support of health sector investments. Health improvements are evident, but economic analysis has not yet shown to what extent they are attributable to health expenditures alone. Poor health is closely associated with poverty, low education, and rural residence, but causal relationships among these and other variables remain largely unexplored.

Type
Topical Review
Information
Latin American Research Review , Volume 5 , Issue 3 , Fall 1970 , pp. 35 - 56
Copyright
Copyright © 1970 by the University of Texas Press

References

NOTES

1. During the Sixties, two international meetings on human resources planning in Latin America dealt exclusively with manpower, education, and training, with no reference to health planning as an aspect of human resources development. See Pan American Union, Methodological Meeting of Human Resources, papers and proceedings of a conference held in Mexico City, October 14-19, 1963; and Organization for Economic Cooperation and Development, Problems of Human Resources Planning in Latin America, papers and proceedings of a seminar held in Lima in March 1965.

2. For a summary of recent research, including his own, see Martin Carnoy, “Rates of Return to Schooling in Latin America,” The Journal of Human Resources, Summer 1967.

3. See Robin F. Badgley, ed., Behavioral Science and Medical Education in Latin America, Part 2 of the Milbank Memorial Fund Quarterly, April 1966; and, Arthur J. Rubel, “The Role of Social Science Research in Recent Health Programs in Latin America,” Latin American Research Review, Fall 1966.

4. See Clyde V. Kiser, ed., Components of Population Change in Latin America, Part 2 of the Milbank Memorial Fund Quarterly, October 1965; and, Clyde V. Kiser, ed., Current Research on Fertility and Family Planning in Latin America, Part 2 of the Milbank Memorial Fund Quarterly, July 1968.

5. For a brief review, see, e.g., Ernest R. May, “The Alliance for Progress in Historical Perspective,” Foreign Affairs, July 1963.

6. Act of Bogotá (1960); see “Measures for the Improvement of Public Health,” Title I, D.

7. Charter of Punta del Este (1961); see references to health in the “Declaration to the Peoples of America,” in “Objectives of the Alliance for Progress,” Title I, and in “Economic and Social Development,” Title II. Also see resolutions appended to the Charter: “Ten Year Public Health Program of the Alliance for Progress,” Resolution A.2; and, “Task Forces for Programming,” Resolution A.4.

8. Declaration of the Presidents of America (1967); see affirmation on health in Title I, and statement on health objectives in Title II, Chapter V, C.

9. Pan American Health Organization, Task Force on Health at the Ministerial Level, Official Document No. 51, Washington, D.C., April 1954.

10. Special Meeting of Ministers of Health of the Americas, Final Report, Buenos Aires, October 1968.

11. Health Planning: Problems of Concept and Method, Scientific Publication No. 111, Washington, D.C., April 1965.

12. For a brief review of several plans prepared during the early Sixties, see Instituto Latinoamericano de Planificación Económica y Social, “Resumenes de la formulación de los planes nacionales de salud de Bolivia, Chile, El Salvador, Perú y Trinidad-Tobago,” Santiago, November 1966. (Mimeographed).

13. For a more detailed presentation of the approach, see Hernán Durán, “Methodology for Health Planning in Latin America,” World Health Organization, Document NHP/INF/66.2, 1966; and, Antonio Valasco, “Health Planning: A Review of Methodologies,” in National Health Planning, World Health Organization, Document SEA/PHA/64, New Delhi, November 18, 1968.

14. Pan American Programme for Health Planning, Annual Reports, 1968, 1969, Santiago, January 1969 and January 1970. (Mimeographed).

15. See Milton I. Roemer, Medical Care in Latin America, Washington: Organization of American States and Pan American Union, 1963; and Pan American Health Organization, Basis for the Formulation of a Continental Medical Care Policy, Special Working Document TFH/9, Washington, D.C., March 8, 1963.

16. Pan American Health Organization, Administration of Medical Care Services, Scientific Publication No. 129, Washington, D.C., June 1966.

17. Asociación Colombiana de Facultades de Medicina, Medicina y desarrollo social, Bogotá, 1964.

18. Pan American Health Organization, Medical Education, Document No. CD19/16, 1969, with annex by Juan César García, “General Characteristics of Medical Education in Latin America.”

19. Federación Panamericana de Asociaciones de Facultades (Escuelas) de Medicina, Primera Conferencia General de Educación Médica, Bogotá: Asociacion Colombiana de Facultades de Medicina, August 1966.

20. Pan American Health Organization, Facts on Health Progress, Scientific Publication No. 166, Washington, D.C., September 1968.

21. Ruth R. Puffer and G. Wynne Griffith, Patterns of Urban Morality, Washington: Pan American Health Organization, Scientific Publication No. 151, September 1967.

22. Thomas L. Hall, “Planning for Health in Peru—New Approaches to an Old Problem,” American Journal of Public Health, August 1966. The same author has also reviewed the project more extensively in his book, Health Manpower in Peru: A Case Study in Planning, Baltimore, 1969. His book, however, represents a comprehensive economic analysis of health manpower in Peru which was not part of the national health planning project.

23. “Health Manpower and Medical Education in Latin America,” Report on a Round Table Conference, in Mil bank Memorial Fund Quarterly, January 1964, No. 1, 11-66.

24. Asociación Colombiana de Facultades de Medicina, Boletin de la División de Educación, Planeación y Desarrollo, Bogotá, 1965. See, “Primera parte: Estudio de recursos humanos para la salud la educación,” 13-68.

25. Ministry of Public Health of Colombia and Colombian Association of Medical Schools, Study on Health Manpower and Medical Education in Colombia. Working documents of the International Conference on Health Manpower and Medical Education, held under the auspices of the Pan American Health Organization in Maracay, Venezuela, June 19-23, 1967, including: vol. I, Methodology, vol. II, Preliminary Findings; and vol. III, Working Papers and Reports.

26. Recursos humanos para la educación médica en Colombia, Bogotá, 1968.

27. Robin F. Badgley, ed., Social Science and Health Planning: Culture, Disease and Health Services in Colombia, Part 2 of the Milbank Memorial Fund Quarterly, April 1968.

28. Ministerio de Salud Publica y Asociación Colombiana de Facultades de Medicina, Estudio de recursos humanos para la salud y educación médica en Colombia, Bogotá, 1968. Final research reports, including (a) Hechos demográficos; (b) Diagnósticos de consulta externa; (c) La muestra; (d) Accidentes; (e) Atención médica; (f) Evidencia clínica; (g) La profesión médica; (h) Parasitismo intestinal; and, (i) Métodos y resultados.

29. This concept is developed in my paper, “Economics Aspects of Health Needs in Colombia,” in Badgley, Social Science.

30. By decree No. 2470 of September 1968, the Colombian government integrated the health services of the Ministry of Public Health; the two principal social security systems (Instituto Colombiana de Seguros Sociales, and Caja Nacional de Previsión), and of several special programs. This reorganization included the transfer of the Instituto de Fomento Municipal, which carries out rural sanitation projects, from the Ministry of Development to the Ministry of Public Health.

31. Antonio Ordoñez Plaja (Ministro de Salud Pública), Informe al Honorable Congreso de la República, Bogotá: Ministerio de Salud Pública, República de Colombia, informes anuales para 1966/67, 1967/68 y 1968/69.

32. Ministerio de Salud Pública, República de Colombia, Plan nacional de salud, 1968-1977, preliminary version. (Mimeographed).

33. Information obtained in personal interviews with representatives of the Secretariat of Public Health of Argentina and the Argentine Association of Medical Schools, in January 1969, in Buenos Aires.

34. Information obtained in personal contacts with Thomas L. Hall, representing Johns Hopkins University, throughout 1969, and in interviews with representatives of the National Health Service of Chile in January 1969, in Santiago.

35. Gustavo Molina and Freda Noam, “Indicadores de salubridad, económica y cultura en Puerto Rico y América Latina,” Boletín de la Oficina Sanitaria Panamericana, August 1964.

36. Recent inventories of the field include Herbert E. Klarman, The Economics of Health, New York, 1965; Donald Mainland, Health Services Research, New York: Milbank Memorial Fund, 1967; and Anne R. Somers, “Some Basic Determinants of Medical Care and Health Policy: An Overview of Trends and Issues,” Milbank Memorial Fund Quarterly, January 1968, Part 2.

37. See two early articles by Selma A. Mushkin, “Toward a Definition of Health Economics,” Public Health Reports, September 1958; and, “Health as an Investment,” Journal of Political Economy, October 1962, Part 2.

38. Burton A. Weisbrod, Economics of Public Health, Philadelphia, 1961.

39. Herbert E. Klarman, “Economic Aspects of Projecting Requirements for Health Manpower,” The Journal of Human Resources, Summer 1969.

40. The U.S. system of medical care is well described in Herman M. Somers and Anne R. Somers, Doctors, Patients and Health Insurance, Washington, D.C.: The Brookings Institution, 1961.

41. The development of the British system of medical care is chronicled in Almont Lindsey, Socialized Medicine in England and Wales, Chapel Hill, 1962.

42. See, for example, D. S. Lees, “The Economics of Health Services,” Lloyds Bank Review, April 1960; and Jack Wiseman, “Cost-Benefit Analysis and Health Service Policy,” Scottish Journal of Political Economy, February 1963.

43. Richard Auster, Irving Leveson, and Deborah Sarachek, “The Production of Health, an Exploratory Study,” The Journal of Human Resources, Fall 1969.