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Third World Health Care System in Shambles

Ress, P. (1998, June 10). Third world healthcare systems in shambles. East African Standard, Nairobi, p. 6.


There is a striking health gap between Least Developed Countries (LDCs) and Industrialized Countries (ICs):




Average Life Expectancy

52 years

78 years

Infant Death Rate

5 times higher in 1960; 10 times higher in 1996


Annual Health Expenditure



Risk of woman dying in pregnancy

1 in 7 in Afghanistan, Guinea, and Somalia

1 in 9,000 in Spain and Switzerland

A group of health ministers meeting in June, 1998 concluded that health service reforms suggested by Western countries and international financial organizations have failed to achieve reforms recommended by an earlier conference. Suggested strategies involved avoiding market considerations and uncritical use of high technologies but rather that "health sector reforms must focus on people and has to be oriented towards satisfying their needs for health and healthcare."

This criticism was outlined by the Columbian government which organized the Geneva meeting on behalf of the Non-Aligned Movement (NAM) with the support of the World Health Organization. The Columbian statement reads:

Health systems today are inadequate for achieving equity in health and sustainability precisely because health sector reform has been driven by the developed North (Northern nations), and especially by international financial institutions, rather than by the priorities of the South’s ministries of health.

South Africa’s minister of health, Dr. Olive Shishana, explained further by contrasting the North’s idea of health services reform to South Africa’s strategy of transformation. She said:

So much is wrong (with world health care systems) that no amount of fiddling will bring health care to the poor. The face of health care (in South Africa) is changing dramatically in favor of the disadvantaged majority. First and foremost our policies were designed with the poor in mind. We pay particular attention to the needs of the vulnerable members of our society.

More than 500 clinics have been built in underserved areas serving more than five million people. Essential drugs are now available at all PHC facilities. These drugs must be safe, effective, affordable, and rationally prescribed.

The same day as the health ministers were meeting in Geneva, the new director of the World Health Organization (WHO), 59-year-old Dr. Gro Harlem Brundtland, was expressing similar concern to the World Bank in Washington DC Here is the challenge of world health as she sees it:

People in developing countries (LDCs) carry 90% of the disease burden, yet have access to only 10% of the resources used for health. So in our quest for health we need to struggle against underdevelopment and poverty.

We cannot allow health to remain a secondary item on the international political agenda. We know that the vast majority of human suffering and early deaths in the world are poverty-related…ill-health leads to poverty and poverty breeds ill- health.

The task of reducing poverty is proving to be a long and difficult one. I believe that targeted strategies emphasizing health investments in the poor countries could significantly shorten the time it will take to dramatically reduce the world’s crushing burden of poverty.


  1. Should the more developed nations of the world have concern for the suffering in less developed nations, and if so, what should they do about it?
  2. What is the relationship of health care and economic development? What happens if health care is provided, and that doubles the number of surviving infants in a nation, and there is no economic development?
  3. Do you agree with the WHO director that effective health care systems and economic development must go hand in hand?
  4. To what extent can poor countries like Guinea and Somalia learn from South Africa and Afghanistan from Pakistan?
  5. Must economic and political reform and development precede effective health care reform?
  6. What, then, are we to do when children are suffering in impoverished countries?
  7. What questions or suggestions do you have regarding this issue?


  1. A shriveled face of a young mother holding a dying mother looks at us. Humanitarian concern or religious duty forbids us to turn our backs.
  2. It is nice when a group of European or American doctors can take a couple of months off to bring critical services to a rural area or when a church can raise money to give blind children their sight. This is good, not only for its own sake but because it brings the world together and raises awareness. But it is obviously not the solution to the overall problem.
  3. Anyone who knows anything about these crises knows two things: the developed nations cannot impose their strategies on the developing countries. (And) Just giving money to developing nations (even in the billions) will not solve these problems. (See George Kinoti, Hope for Africa.)
  4. Northern and Southern nations must work together both in terms of financial resources and in terms of strategies. In many places, reform must accompany transformation.
  5. Meanwhile, small gestures of relief must continue. Compassion should motivate, and realism should guide us.
Dean Borgman cCYS