Population change, health planning and human resource development in the health sector

Abstract

As a result of the demographic and epidemiological transitions now occurring rapidly in many developed countries, a dramatic shift in the age structures of populations and the burden of disease towards the middle-aged and elderly is expected to take place over the next several decades. In the 1990s, however, there remains great diversity across countries in fertility levels and mortality patterns. The World Bank's 1993 World Development Report assessed the global burden of disease in order to define the minimum packages of public health measures and clinical interventions that would improve health conditions in low-income countries in a cost-effective and affordable way. Strategically implementing these programmes will require that government investments be directed toward a limited number of cost-effective health interventions, delivered equitably to the entire population. At the same time, steps must be taken to improve the efficiency and contain the costs of health care delivery in the public and private sectors. Such a population-based health strategy will require the development of a wide range of scientific, analytical and technical capacities, currently rare in most ministries of health. This will require the involvement of epidemiologists, demographers, sociologists, analysts, operations research specialists and environmental health scientists. Building up these capabilities in health ministries, universities or the private sector will be an essential ingredient of health system reform.

PIP: In the 1990s, the demographic transition in the less developed countries is characterized by great variation in fertility, mortality, population age structure, age pattern, and cause of death. This heterogeneity is reviewed in selected demographic indicators from 7 major less developed regions of the world. At one extreme is Sub-Saharan Africa, with high fertility and high mortality, where 46% of the population is under age 15, and 60% of all deaths are found in this age group (the majority of deaths occur under the age of 5). At the other extreme is China, with low fertility and a high life expectancy, where only 27% of the population and 13% of all deaths are in the youngest age group. The 1993 World Development Report proposed a minimum package of public health measures and essential clinical interventions which would cost only $12 per capita a year in a low-income country, and would reduce diseases by 31%. Interventions are primarily directed toward preventing and treating diseases. The interventions for children include immunizations, micronutrient supplementation, and treatment of worm infections, while for adults they entail prenatal and delivery care, family planning, short-course chemotherapy for tuberculosis, and treatment of sexually transmitted diseases. The traditional Western-model, high-technology medical health care systems in developing countries have been institution-based, with hospitals and health personnel most concerned with one-on-one sickness care. The 1993 World Development Report puts priority on a population-based health development strategy that will require major reform of the health system in many countries. The medical education institutions are to be reoriented in developing and developed countries to curtail specialist training and promote primary care. The International Network of Community-Oriented Educational Institutions in the Health Sciences adopted one model of curriculum reforms that emphasize community-based and problem-based learning.