Paper for Panel #2 of the Committee on Health Politics
Prepared for delivery at the 2004 Annual Meeting of the
American Political Science Association, 2-5 September 2004, Chicago
Copyright by the American Political Science Association
Neo-Liberal Impacts on Administrative Reform:
Public/Private Partnerships in Health Policy
James Warner Björkman
Institute of Social Studies & Leiden University
The Netherlands
Keywords: neo-liberal; health policy; public/private partnerships; development
Résumé: This paper sketches the emergence of neo-liberal approaches in world
health policy, reviews the logic of New Public Management (NPM) in the health
sector, examines reforms for the delivery of health services through public/private
partnerships, and suggests strategies for public policy that take capacity into account.
Neo-Liberalism and World Health Policy
The link between development and health policy requires governance at two levels.
Governance must secure mechanisms that help people to get well when they are sick.
And it must foster socio-economic environments that keep people healthy or stop
them from becoming sick in the first place. While governance for the health sector
must provide specific medical interventions to tackle challenges such as tuberculosis,
malaria and HIV/AIDS, it must also address the challenge of social transformation.
To be effective in this era of globalization, when ‘the fundamental social, economic
and environmental determinants of population health are becoming increasingly
supranational’ (McMichael and Beaglehole, 2000), governance must advance both of
these aspects simultaneously.
In order to translate the 1978 Alma Ata Declaration into a policy reality, the 1981
World Health Assembly endorsed the ‘Health for All by the Year 2000’ strategy. The
earlier declaration had enshrined health as a fundamental human right to be secured
by a participatory process of comprehensive primary health care in the context of
multi-sectoral development. Health had earlier appeared as a fundamental human
right in the UN Covenant on Social, Economic and Cultural Rights. Both the UN
Covenant and the Alma Ata Declaration acknowledge the central responsibility of the
state and the international community for ensuring realization of the human right to