Bitter Pills:Medicines & The Third World Poor | Page 27

immediate problems. Many governments appear to rate 'health' as a low priority
alongside more strategic sectors such as defence. For example, the Government
of North Yemen spends 44% of its budget, and Bangladesh 20%, on the armed
forces, compared with 3.5% which each Government allocates to health. (8)
Even governments whose policies commit them to achieving a greater degree of
social justice will not necessarily allocate a lot of funds to their health budget.
After all, health services play only a limited role in improving health. Governments
may decide they can do more to improve health by investing more in agriculture,
industry or education. (9)
Similarly, other sectors of government spending have some bearing on a
government's ability to distribute medicines to the people. For example, funds
allocated to setting up basic industries may be used to increase self- sufficiency
in essential drugs, and good transport and communications are vital to an efficient
drug distribution system.
Almost invariably the health budgets of poor countries are very limited. In 1978/9
the British National Health Service spent over 900 times more money providing
services to 54 million people in Britain than the Bangladesh Health Ministry spent
on health care for its 85 million people. (10) This lack of resources is of course a
major stumbling block to making health care available to the mass of the people.
But the di f ficulties have been greatly exacerbated by the fact that most Third World
countries have modelled their health systems on the expensive curative services
that form the basis of health care in rich industrialised countries. Even in these
countries the bias towards high-technology curative care as opposed to more
emphasis on disease prevention is increasingly questioned.

HOSPITALS OR HEALTH POSTS?
The escalating costs of health services are beginning to tax the governments of
rich countries. But to poor countries the high recurrent costs of these Westernstyle curative services are crippling. Money is syphoned off to pay for costly medical
equipment and keep hospital dispensaries stocked with all the latest drugs. The
cost of extending this level of services to the mass of the people is unthinkable.
So millions of the poor remain outside the system, denied the most basic health
care. Part of the problem is that it is of course much easier to spend the health
budget providing services for a compact urban population than on people dispersed
in the rural areas.
The tremendous drain of paying for hospital services is illustrated by the situation
in Tanzania, where the Government's 1979 Evaluation of the Health Sector reveals
that the hospitals alone are eating up 60% of the entire health budget. Yet the
same study shows how little of the population actually benefits from hospital
services. Over half of all hospital in-patients and three-quarters of out-patients
live within 5 to 10 kms of the hospital and almost all the hospitals are in the towns.
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