from alma-ata to the global fund: the history of international health policy de alma-ata ao fundo global: a história da política internacional de saúde

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ID: 216646
2007
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Abstract
'Verticalization' of health care delivery, in one form or another, is the common theme pervading the history of international health policy over the last sixty years. It is often accompanied by radical policies of privatization of health services, everywhere resulting in people being forced to pay for all services. The failure of the vertical approach, of which the global public-private partnership initiatives are a modernized version, has been well recognized and its reasons are clear: actions on the distal determinants of disease (income, education, housing, the environment and infrastructure, etc) are overlooked; distribution of services dedicated to specific diseases and interventions (such as AIDS, malaria, tuberculosis, etc.) are artificially and temporarily reinforced, creating absurd and harmful forms of competition between services and making even more precarious and inefficient the work of already fragile basic health systems. This article describes the role played in this disturbing historical development by the prevailing economic ideology and its operational arm, the World Bank, with the view to reclaim international policy making processes and actors that really respond to people's health needs.
A "verticalização" da assistência à saúde, de uma forma ou de outra, é o tema comum que permeia a história política internacional de saúde ao longo desses últimos sessenta nos, muitas vezes acompanhada com políticas radicais de privatização dos serviços de saúde, resultando, em todos os lugares, na obrigatoriedade de pagamento pelo povo, de todos os serviços. A falência da abordagem vertical, cujas iniciativas de parcerias globais público-privadas constituem sua versão moderna, tem sido reconhecida, tendo sido claras as suas razões: negligenciamento das ações sobre os determinantes distais das doenças (renda, educação, moradia, o ambiente e a infra-estrutura, etc.); a distribuição de serviços dirigidos para doenças específicas e intervenções (tal como AIDS, malária, tuberculose, etc.) é artificial e temporariamente reforçada gerando maneiras perigosas e absurdas de competição entre os serviços e tornando o trabalho já frágil dos sistemas de saúde ainda mais precário e ineficiente. Esse artigo descreve o papel exercido neste desenvolvimento histórico perturbador ocasionando pela ideologia econômica predominante e seu braço operacional, o Banco Mundial, com o objetivo de reclamar que o processo de decisão política internacional e seus atores realmente respondam pelas necessidades de saúde do povo.
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Authors Gavino Maciocco, Angelo Stefanini
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Journal sociology
Year 2007
DOI
10.1590/S1519-38292007000400016
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1519-38292007000400016
Keywords
gynecology and obstetrics

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