Disintegrated care: the Achilles heel of international health policies in low and middle-income countries.
OBJECTIVE
To review the evidence basis of international aid and health policy.


BACKGROUND
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.


METHODS
National policies, international programmes and pilot experiments are examined in both scientific and grey literature.


CONCLUSIONS
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 middle-income countries justifies an alternative aid policy to improve both disease control and health care.
Unger
Jean-Pierre
JP
Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. jpunger@itg.be
De Paepe
Pierre
P
Ghilbert
Patricia
P
Soors
Werner
W
Green
Andrew
A