ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Dismantling the Health Sector

strategies. Dismantling the Health Because of this dissociation, disease con- Sector Disinvesting in Health: The World Bank

Dsmantling the Health Sector could have been added to the title of this very useful book on the theme of what passes for the health sector in India. Foregrounding the World Bank’s World Development Report (WDR) 1993, (which was devoted to health and entitled, Investing in Health), the book discusses a range of issues. Taken together these document the depth and nature of the mess afflicting the health scene in India. Rao’s introduction brings out quite clearly the distinct approaches adopted (and justification provided) in understanding the precept and practice of health in the developed and developing countries. Ignoring completely the history of western experience of dealing with primary health care issues, and, despite accumulating evidence of the extremely limited usefulness of solutions derived solely from applications of medical technology and/or germ-centred health theories, the current move is to narrow down even further the scope of public provisioning of health. Worse, as Qadeer points out in her paper, by a sleight of hand, the World Bank has succeeded in replacing the term primary health care by ‘essential’ public health and clinical services, thereby creating the illusion that the old notion of minimum basic health care is still the central concern.

The text of the document, however, negates any such illusions. The Bank has in fact given new meanings to old terms. This generates three important distortions influencing the future of PHC. These are: altered priorities, delinked clinical and public health services, and conscious denial of those welfare inputs which were earlier considered necessary for basic health (pp 55-56).

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