INTRODUCTION

DROP ME DOWN IN AFRICA, or Asia or Latin America. You give me US dollars 20 a head of the population I’m going to serve. And I’ll show you we can produce a miracle.*

‘We can do it!’ He said further, in the context of health development, ‘and with the resources we have, if we can only mobilise the minimum of international solidarity’ (Walgate, 1988).

The optimism of the man could not but have percolated to the office that he held. And to its policy-making. But inspite of such honest proclamations and the realisation that there is an organic relationship between health and human advancement, most community health care delivery systems contain an overload of pessimistic and demoralised staff members. This is specially true of developing countries. It is a huge infrastructure, but a sleeping one. And one that moves only on external motivation. And incentives.

How should we, then, view WHO slogans like ‘Health for All — All for Health”?** It is catchy as such slogans go. It takes the ball out of the medical man’s court and almost challenges the people to accept it in theirs. ‘Beginning with people, not doctors’, as the retired WHO Chief said, ‘turning the whole thing upside down... It is a question of whether you have the political guts to trust people, to allow ordinary people to decide the way the money is being spent in health care’ (ibid).

There’s the rub. And a big one at that. It involves fighting not only established dogma but the bureaucratic infrastructure of the medical establishment with its paraphernalia of medical institutions, the drug industry, and the enormous socioeconomic clout that both wield.