Table 2 Post Alma Ata developments versus new mechanisms for securing trust in health care in developing countries.
Post Alma Ata developments | Mechanisms for securing trust |
|---|---|
Interventions and Services | Â |
Post Alma Ata narrow focus on interventions by researchers and policy makers leaves services non-prioritized | Priority to services rather than interventions Better tools for monitoring and evaluation of generalized services |
Vertical and Horizontal | Â |
Priority to vertical programmes has contributed to a collapse of horizontal services | Includes horizontal services |
Vertical programmes easily deteriorate existing health services and create large transaction costs at higher levels | Aims at synergy between essential vertical programmes and generalized horizontal services |
Prevention and Cure | Â |
A policy focus primarily on prevention has led to a deterioration of curative services | Higher priority to clinical curative services |
Prevention interventions often health expert driven Curative services often excluded through funding mechanisms | Maintains focus on citizens and implementers opinions Accepts gap and seeks compromise between experts opinion and patient demand through reasonable, deliberative processes |
| Â | Maintains relevant preventive activities, with higher emphasis on their relevance to other sectors |
Quality and Quantity | Â |
Frameworks have almost focused on quantity and coverage before quality | Higher priority to quality assurance mechanisms |
Isolated focus on quantity is not pro-poor | Securing quality before increasing coverage |
Vertical programmes easily funded and researched due to easily identifiable objectives and quantifiable results | Maintains a dynamic and incremental focus aimed at describing complex structures and continuous improvement |
Priority setting mechanism | Â |
PHC based on social justice principles without adequate focus on availability of resources and tools to ensure implementation and social support | Priority setting in response to available resources Aims at fair and efficient priority setting Recognizes the importance of legitimacy and public support |
Providers not accountable to patients and the public | Aims at increasing accountability to all affected parties through deliberative processes and transparent decision making |