https://link.springer.com/content/pdf/10.2307%2F3343168.pdf

Development as Freedom

Citizen and Subject: Contemporary Africa and the legacy of late colonialism

The importance of social capital for sustainable development, is by now well recognized. Anthropologists, sociologists, political scientists, and economists have in their own ways, demonstrated the critical role of institutions, networks, and their supporting norms and values, for the success of development interventions. This success often hinges on accurate assessments of social capital in target communities. But the nature, and impact of social capital - the institutions, relationships, attitudes, and values that govern interactions among people - are not easily quantified. "Understanding and Measuring Social Capital" provides a conceptual review, and measurement tools, in a form readily available for development practitioners. The book discusses the respective value of quantitative, and qualitative approaches to the analysis of social capital, illustrating the discussion with examples, and case studies from many countries. It also presents the Social Capital Assessment Tool, which combines quantitative, and qualitative instruments to measure social capital at the level of household, community, and organization, drawing on multidisciplinary, empirical experiences, an application which can provide project managers with valuable baseline, and monitoring information about social capital in its different dimensions.

Understanding and Measuring Social Capital: A Multidisciplinary Tool for Practitioners

The State in a Changing World

The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives.

Community health insurance and universal coverage: multiple paths, many rivers to cross

Costa Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance. Costa Rica's population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system. However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system.

/pdf/costa-rica-achievements-of-a-heterodox-health-policy-5epz70fbcs.pdf

Costa Rica: Achievements of a Heterodox Health Policy

Summary This paper presents an overview of the development of Community Health Insurance (CHI) in subSaharan Africa. In 2003, nearly 600 CHI initiatives were registered in a dozen countries of francophone West Africa alone. At regional level, coordination networks have been created in Africa with the aim to support and monitor the developments of this innovative model of health care financing. At national level, governments are preparing the necessary legal frameworks for CHI implementation. CHI is increasingly seen as a strategy to meet other development goals than only health. It constitutes an interesting model to finance health care, to pool financial resources in a fair way and to empower health care users. The CHI movement however still faces many challenges. The relevance of more professional inputs in the management of CHI and the need for careful subsidy of CHI schemes are increasingly recognized. There is also need to optimize the relationship of CHI with the other actors in the health system and to scale-up CHI so as to gain in effectiveness and efficiency. The boom in the number of schemes in Africa during the last years is an indicator of the increasing attractiveness of the model. In practice however, enrolment rates per scheme remain low or are only slowly increasing. Context-specific research is needed on the reasons that prevent people from enrolling in larger numbers. On that basis, relevant action to be taken locally can be identified.

/pdf/editorial-a-view-from-beneath-community-health-insurance-in-4cxepac670.pdf

Editorial: a view from beneath: community health insurance in Africa.

Purpose: To review the evidence basis of international aid and health policy. Context of case: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy’s responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources: National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middleincome countries justifies an alternative aid policy to improve both disease control and health care.

/pdf/disintegrated-care-the-achilles-heel-of-international-health-46pnrjo2g2.pdf

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries.

Purpose: To propose a social-and-democrat health policy alternative to the current neoliberal one. Context of case: The general failure of neoliberal health policies in low and middle-income countries justifies the design of an alternative to bring disease control and health care back in step with ethical principles and desired outcomes. Data sources: National policies, international programmes and pilot experiments—including those led by the authors—are examined in both scientific and grey literature. Case description: We call for the promotion of a publicly-oriented health sector as a cornerstone of such alternative policy. We define ‘publicly-oriented’ as opposed to ‘private-for-profit’ in terms of objectives and commitment, not of ownership. We classify development strategies for such a sector according to an organisation-based typology of health systems defined by Mintzberg. As such, strategies are adapted to three types of health systems: machine bureaucracies, professional bureaucracies and divisionalized forms. We describe avenues for family and community health and for hospital care. We stress social control at the peripheral level to increase accountability and responsiveness. Community-based, national and international sources are required to provide viable financing. Conclusions and discussion: Our proposed social-and-democrat health policy calls for networking, lobbying and training as a joint effort in which committed health professionals can lead the way.

/pdf/integrated-care-a-fresh-perspective-for-international-health-1is42lez77.pdf

Werner Soors

Papers

Community health insurance and universal coverage: multiple paths, many rivers to cross

Costa Rica: Achievements of a Heterodox Health Policy

Editorial: a view from beneath: community health insurance in Africa.

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries.

Integrated care: a fresh perspective for international health policies in low and middle-income countries