PLANNING IN THE HEALTH SECTOR - FOR WHOM, BY WHOM

To state that there are vested interests in health planning is to stat e the obvious. One can identify numerous actors ranging from internati onal agencies, government officials, pharmaceutical companies, health personnel and community and citizen's groups which would like to stake a claim on the direction and nature of planning and implementing heal th policy. We argue that the role of specific actors can only be seen in the broader social, economic and ideological framework which, conse quently, determines the working of the model of health care. Probably the most important factor influencing health planning is the influence of international donors, governments and agencies. The present ideolo gical tilt towards the market, privatization, less government and more liberalization, has had important repercussions on health planning an d delivery. Furthermore, the debt crisis, and the stabilization and st ructural adjustment programmes being followed by a very large number o f underdeveloped countries, are transforming health systems. Essential ly, vested interests in health planning within countries, need to be s een in the light of recent ideological and economic changes, and inter national relations of aid, power and domination.