Should we plan for contraction in health services? The Jamaican experience

Internationally a ‘standard scenario’ has been developedtreating the world economic recession since 1982 as the causeof declining health care and health in developing countries.Attempts to apply this scenario to Jamaica suggest that thedecline can be blamed equally on limitations of planning andmanagement. Existing planning procedures are associated withexpansion, and do not work well in situations of contraction;nor does the existing health service management system provideimpetus for contraction as it does for expansion. For planningand management under contraction, the required procedures mayinvolve greater privatization and decentralization. Part of the required impetus may come from external agencies,and part from emerging management groups within the health services.Both these sources present problems for developing countrieswhich remain to be solved. It is suggested that while the specificsof health care planning and management will differ from countryto country, the best prospect for improved management systemslies with a national merging of critical professional subgroups- health administrators at the local institutional level, andbroadly qualified epidemiologists and public health staff atthe national level.