Adapted from: Unger J.-P., De Paepe J.-P., Ghilbert P., Soors W., Green A. Integrated care: a fresh perspective for international health policies in low and middle-income countries. International Journal of Integrated Care 2006; 6. ISSN 1568–4156.

Introduction

In Section 1, we reviewed the role that international aid and health policies have played in the disappointing health sector results in LMICs. Both policies are neoliberal in their promotion of commodification of health care. We argued that the combination of government-operated DSPs together with privatized health care services constrained both programme performance and people's access to care. Whilst we also recognized other factors that contributed to this failure (including, for example, state crisis, debt, corruption and patronage), we concluded that the only way forward was to support an alternative aid policy towards health services.

In this chapter we call for the promotion of a publicly oriented integrated health sector as a cornerstone of such a health policy, conceived to overcome the fragmentation and segmentation of LMIC health systems as it currently exists. We define ‘publicly oriented’ as opposed to ‘private for-profit’ in terms of objectives and commitment, not of (government vs. private) ownership. The combination of public aims and co-management with users and health professionals gives the name ‘social-and-democratic’ to such a policy.

We outline health system-specific strategies consistent with this policy, with the potential to improve both health care and disease control in LMICs.