Health in Global South: Critical Analysis of Neoliberal Reforms

This presentation provides a critical analysis of the impact of neoliberal reforms on healthcare equity in the Global South, based on a study by Janes et al. (2006) focusing on Mongolia. The presentation begins with an overview of the Alma Ata Declaration and its shift towards efficiency-led reforms, influenced by the World Bank's 1993 report. It examines the three main elements of these reforms: market-based healthcare financing, universal provision of essential health services, and holistic disease burden measurement. The study explores the effects of these reforms on healthcare equity, particularly the economic, public health, and moral consequences. It highlights Mongolia's experience as a post-socialist country transitioning to market-based reforms and the resulting contradictions between social justice commitments and market-based approaches. The research methods involved household surveys, interviews with policymakers and practitioners, and focus groups. The results reveal that despite health insurance coverage, barriers to healthcare access persist, especially for the poor, leading to delayed care and financial burdens. The presentation critically evaluates the strengths and weaknesses of the study, including its focus on equity criteria and the limited scope of the study period, while also emphasizing the negative outcomes of the World Bank's approach and its impact on healthcare fragmentation. The study's findings underscore the need for improved healthcare distribution and risk pooling to address inequities in the Global South.

Running head: HEALTH IN THE GLOBAL SOUTH
HEALTH IN THE GLOBAL SOUTH
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Article used for summary: Janes, C.R., Chuluundorj, O., Hilliard, C.E., Rak, K. and Janchiv, K.,
2006. Poor medicine for poor people? Assessing the impact of neoliberal reform on health care
equity in a post-socialist context. Global Public Health, 1(1), pp.5-30.

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Introduction
Over the past 25 years, it has been seen that the principles which are community led to
the formulation of the Alma Ata Declaration in the year 1978. This was later on replaced by the
efficiency led reforms that advocated the universally led healthcare is to be made universally
available for the public health services and then it needs to be replaced by a minimum package of
essential health. The guiding blueprint for the health care vision is developed and mentioned in
the World development report by the World Bank in the year 1993. It is important to mention
that this report has set forth the strategy of cost-utility so that the health services can be
reformed. The health services consisted of the three main elements like the focusing on the
market approach pertaining to the healthcare financing and healthcare provision; the
interventions are to be provided universally and it will be essential for the public health services
and clinical health services; holistic measurement of the disease burden and illness burden. The
World Bank report has highlighted that the government is inefficient in its terms of health
services.
The main goals of providing equitable health information are to eliminate the economic
and social barriers that exist due to the social differences in accessing healthcare. Equitable
strategies, therefore, help in removing the social privilege that acts as a determinant of access
and it basically focuses on the need. The healthcare equity is depending on the mobilization of
the resources so that the healthcare of everyone can be met; there is a need for distribution of the
healthcare services based on the needs. The healthcare services must be distributed based on the
type of care, quality of care and access to care. Pooling the risk to a specific place so that the risk
arising from the economic consequences can be averted from the catastrophic illness. Even if
there is a rising concern over healthcare inequality and the reasons include the economic

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consequences, public health consequences and moral consequences at the policy level. It is
important to note that the despite concern over the healthcare inequity, the market development,
and ideologies of privatization still continues to top the agenda of global reform.
The purpose of the study and explore the discourses that are taking place in the global
healthcare reform in terms of economic efficiency, equity and health reform. All of these are
worked out on a local level and it includes the post-socialist Mongolia. The authors have
presented a study on Mongolia because it has highlighted that the case study of social health and
justice doe various reasons. Unlike the other low-income countries, Mongolia had a few
experiences with the capitalism-driven colonialism. When Mongolia chose to embrace the
market-based reforms, it had departed from its old history of socialist development and the
rationally well-organized health care system. The previous system was taken from the Soviets
that induced a substantial form of improvement into public health improvement. Current reforms
have brought a sharp relief into the liberal economic reform and to includes social solidarity and
equity. The fundamental philosophies govern the distribution of social services and health
services. During the year the 1900s, Mongolia has become a model for liberal economic reform,
a huge influx of foreign aid is seen. It has also been seen that the western-based mode of the
global development community has entered into the healthcare system of Mongolia. Therefore, it
is important to mention that Mongolia offers an instructive example of healthcare reform. The
Mongolian experiences reveal that the Mongolian experiences reveal a transitional and post-
socialist that are used to address the contradictions present in the existing commitment to social
justice and equity and the market-based research.

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Research methods
In order to provide the healthcare in an equitable way, a significant amount of focus is
placed upon the Asian development of health and Ministry of health department by the health
Policymakers. The significant amount of emphasis is placed on the new primary health services
and the accessibility of the new healthcare services. In order to evaluate the health reforms in
Mongolia, the authors have focused on the primary care and on the users that are facing
hindrances to access the primary care, the middle to low-income households that are residing in
the rural areas. The research is basically focussed on the three basic and equity criteria.
susceptibility of the families and the individuals as a consequence of the severe illness, properly
accessing the need, proper distribution of the costs, proper access of the needs, and the proper
distribution of costs. However, in addition to this, the focus on equity, users, policymakers,
healthcare providers, proper functioning of the healthcare system, financing, information of the
local.
During the two separate periods in the 2002 and 2004, a mixed method along with a
multi-method study of health reforms that were started by the teams from the University of
Colorado and the Health Sciences of the University of Mongolia. The main method of the study
included household surgery. The study also employed a cluster type sample design and the
multistage sample design that selected the in-depth quantitative and qualitative analysis. The
study also included the low-income household of the Ulaanbaatar along with the northern
Mongolia and the provinces of west-central. it is important to note that along with the household
survey, the policymakers and the practitioners from all the stages of the health system were also
questioned. The data collection strategies involved the two focus groups along with 2 family
doctors. for the districts of Ulaanbaatar; interviews were conducted with the heads of the family

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groups practices and the districts of Ulaanbaatar. Three interviews were conducted from the five
provinces that are visited in the Arhangai provinces and Huvsgol. In the Ulaanbaatar area, the
interviews were conducted with the 59 practitioners in the provincial capitals of Arhangai and
Huvsgol.
Results and discussions
The results of the study have highlighted that 80 percent of the individuals have health
insurance. The data also suggests that the vulnerable poor sections are unable to access the
healthcare due to the significant amount of costs and institutional barriers exist that hinder the
poor and vulnerable sections from receiving the desired health outcomes. Despite the barriers in
the healthcare needs of the households that are of the suffering and having an illness, the
households try their best to obtain the perceived services. It is important to mention that the
barriers will result in a delayed form of healthcare and the inability of the households to
overcome certain cases. The quantitative data have highlighted that the poor are generally unable
to access healthcare. The poor people pay a high proportion of their income in order to access
healthcare. The respondents expressed positively towards addition to the costs, the patients
highlighted that the referral practices were ineffective and time-consuming as well. Many of the
patients have believed that the family doctors were actually of little benefit in terms of
healthcare. several families have found it hard to gain admittance to the proper health care that
had chronic conditions and that are being taken care of by the family doctors. It is important to
mention that the long term usage of drugs for the purpose of essential medications was difficult
for poor patients. Whereas, it is important to mention that the household needs to top the regular
expenditure on the drugs.

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Conclusion
The strength of the study has highlighted the negative outcomes of the approach provided
by the World Bank. The approach leads to the fragmentation of the health services and it creates
institutional and the financial barriers that need to be overcame if the persons need to transfer
from one sector to another. Another strength is that the research is based on the equity criteria
and is basically focussed on the three basic and equity criteria. susceptibility of the families and
the individuals as a consequence of the severe illness, properly accessing the need, proper
distribution of the costs, proper access of the needs, and the proper distribution of costs.
However, in addition to this, the focus on equity, users, policymakers, healthcare providers,
proper functioning of the healthcare system, financing, information of the local. While the major
weakness of the paper highlights that the study took into account the two periods like 2002 and
2004 only. These two periods are not enough to highlight and reflect the true condition and it
requires a number for households and individuals so that the data can be used for other
developing countries as well. The healthcare services must be distributed based on the type of
care, quality of care and access to care. Pooling the risk to a specific place so that the risk arising
from the economic consequences can be averted from the catastrophic illness. Even if there is a
rising concern over healthcare inequality and the reasons include the economic consequences,
public health consequences and moral consequences at the policy level. It is important to note
that the despite concern over the healthcare inequity, the market development, and ideologies of
privatization still continues to top the agenda of global reform.

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References
Janes, C.R., Chuluundorj, O., Hilliard, C.E., Rak, K. and Janchiv, K., 2006. Poor medicine for
poor people? Assessing the impact of neoliberal reform on health care equity in a post-socialist
context. Global Public Health, 1(1), pp.5-30.