ECONOMIC-REFORM AND HEALTH SECTOR POLICY - LESSONS FROM STRUCTURAL ADJUSTMENT PROGRAMS

From a purely economic perspective, structural adjustment programs (SA Ps) and economic reform policies are viewed as short-term austerities that lead to long-term growth and development. These intertemporal tra de-offs, however, are not always acceptable in health. Unique biologic events such as intrauterine development and neural development cannot be postponed even for a short period. Health policymakers need to und erstand the expected and unexpected impacts of economic reform on heal th outcomes in individuals and on the population. The interactions are complex, involve multiple sectors, and can be better understood by lo oking at the experience of developing countries over almost fifteen ye ars of SAP experience. Health care budgets may be vulnerable to reduce d government spending, quality of care deteriorates, nutrition will su ffer more likely in urban areas, and cost-effective preventive program s may stop if labor and capital are not properly matched. Health outco mes overall do not appear to suffer but a more detailed look, with bet ter data, shows that the incidence of preventable diseases rises and i rreversible deterioration in health status does occur within countries . To prevent this from happening in the future, health policymakers ne ed to take a multidisciplinary focus to first understand the effects o f economic reform and then to plan a coordinated response. Better data , alternative financing, and strong political leadership are also impo rtant lessons.