Integrated care: a fresh perspective for international health policies in low and middle-income countries.
OBJECTIVE
To propose a social-and-democrat health policy alternative to the current neoliberal one.


BACKGROUND
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.


METHODS
National policies, international programmes and pilot experiments--including those led by the authors--are examined in both scientific and grey literature.


METHODS
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
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.
Unger
Jean-Pierre
JP
Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. jpunger@itg.be
DePaepe
Pierre
P
Ghilbert
Patricia
P
Soors
Werner
W
Green
Andrew
A