Health policy in less developed countries: Past trends and future directions

Abstract

Health policies worldwide have changed dramatically in the last few decades. We reflect upon these changes, highlight current trends and identity key issues and challenges as the year 2000 approaches. The article comprises five sections: (i) comments on concepts of health and of policy; (ii) historical developments which have influenced policy; (iii) discussion of the context within which health policies in low income countries are formulated and implemented, including macropolitical and macroeconomic developments, health needs and determinants, financing, approaches to health planning and priority setting, and the key international health policy actors; (iv) an overview of the content of current health policy proposals in less developed countries which considers the financing, organization and management of health systems and (v) a concluding section which identifies key issues for the coming years. The recent World Bank Development Report,Investing in Health(1993) and other health sector reform efforts, form the backdrop for this discussion.