SHOULD WE PLAN FOR CONTRACTION IN HEALTH-SERVICES - THE JAMAICAN EXPERIENCE

Internationally a 'standard scenario' has been developed treating the world economic recession since 1982 as the cause of declining health care and health in developing countries. Attempts to apply this scenario to Jamaica suggest that the decline can be blamed equally on limitations of planning and management. Existing planning procedures are associated with expansion, and do not work well in situations of contraction; nor does the existing health service management system provide impetus for contraction as it does for expansion. For planning and management under contraction, the required procedures may involve 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 countries which remain to be solved. It is suggested that while the specifics of health care planning and management will differ from country to country, the best prospect for improved management systems lies with a national merging of critical professional subgroups - health administrators at the local institutional level, and broadly qualified epidemiologists and public health staff at the national level.