From "Planning" to "Systems Analysis" : Health services strengthening at the World Health Organisation, 1952-1975
Gorsky, Martin (London School of Hygiene and Tropical Medicine)
Sirrs, Christopher (London School of Hygiene and Tropical Medicine)

Date:	2019
Abstract:	This article discusses the early postwar history of international engagement with the strengthening of health services by the World Health Organisation (WHO). Standard narratives emphasise that the WHO prioritised vertical programmes against specific diseases rather than local capacity-building, at least until the Alma Ata Declaration of 1978 launched a policy focus on primary health care. There was, however, a longer lineage of advisory work with member states, and our aim is to examine this intellectual and policy history of health services planning and administration. We begin by surveying the relevant secondary literature, noting that this theme appears only briefly in the institution's first official histories, with minimal contextualisation and analysis. We then proceed chronologically, identifying an early phase in the 1950s when, despite its marginalisation at the WHO, the interwar European social medicine tradition kept alive its ideals in work on health planning. However, the sensitivities of the USA and of the colonial powers meant that consideration of social security, health rights and universal coverage was absent from this discussion. Instead it was initially concerned with propounding Western models of organisation and administration, before switching to afocus on planning techniques as an aspect of statecraft. In the 1960s such practices became incorporated into economic development plans, aligning health needs with infrastructure and labour force requirements. However, these efforts were entangled with Western soft power,and proved unsuccessful in the field because they neglected issues of financing and capacity. In the 1970s the earlier planning efforts gave rise to a systems analysis approach. Though in some respects novel, this too provided a neutral, apolitical terrain in which health policy could be discussed, void of issues of rights and redistribution. Yet it too foundered in real-world settings for which its technocratic models could not account.
Note:	Research funded by a Wellcome Trust Medical Humanities Investigator Award (grant no.:106720/Z/15/Z)
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Health systems ; Planning ; World Health Organisation ; Global health ; Development ; Sistemas de salud ; Planificación ; Organización Mundial de la Salud ; Salud global ; Desarrollo
Published in:	Dynamis : Acta Hispanica ad Medicinae Scientiarumque. Historiam Illustrandam, Vol. 39 Núm. 1 (2019) , p. 205-233 (Articles) , ISSN 2340-7948

Adreça original: https://raco.cat/index.php/Dynamis/article/view/353635
Adreça alternativa: https://raco.cat/index.php/Dynamis/article/view/353635
DOI: 10.30827/dynamis.v39i1.8672
PMID: 32076359

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