Bitter Pills:Medicines & The Third World Poor | Page 28

This means that most of the health budget is only benefiting people in the urban
areas - little more than 14% of the population.
Recurrent expenditure on each Tanzanian hospital (seeing 137,000 out-patients
a year) costs as much as it does to run 53 dispensaries (which, together, see 1,060,000
out-patients a year). The true cost of running the hospitals is clear from the fact
that two out of three villages are left with no health facility at all. ( U )
Dr. Klouda, OXFAM's medical adviser in Tanzania, reports that after paying
for the hospitals, "Only a little [ of the health budget ] is left to keep the
country's dispensaries and health centres going, as well as provide a tiny budget
for preventive services. The amount left for the dispensaries and health centres
covers salaries and a few drugs and other necessities. Little is provided for
transport, repairs, maintenance, spare parts or equipment. But even the drug
allowance does not cover the basic needs of a dispensary. This means that
dispensary staff provide inadequate treatment, are very rarely supervised, very
rarely visit the four or so villages they should cover,and are often demoralised."
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Yet Tanzania is a country which has given a higher priority than many to the
equitable spread of health care. "3)
The distortion between where money is actually spent on health care and where
it is needed recurs throughout the Third World, and indeed elsewhere. For example,
in Bangladesh, three-quarters of the money spent on curative health services is
channelled through health facilities in the towns, where only 8% of the people
live. There are specialised orthopaedic, cardiovascular and eye institutions already,
and plans to set up more of each, in addition to a new cancer research institute.
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Cancer and heart disease do not rank among the country's priority health
problems, but they are an increasing concern for the urban elite.
Meanwhile, in rural Bangladesh most people have no access even to the most
rudimentary health post. The 1977 official Health Profile states: "The seven
million urban population is relatively well covered by Government and private
health facilities but a major proportion of the 76 million rural population do not
have health care of any sort." "5>
A factor that contributes to the misallocation of funds away from real health needs
is that Third World governments and aid donors alike are keen on 'visible' projects.
Brand new health posts in the north-east of Brazil have been kitted out with electric
sterilisers where there is no electricity. Some of the buildings remain unused except
by the occasional visiting dignitary." 6 ' These gleaming white elephants
demonstrate the good intentions of planners frustrated by the shortage of money
for running costs and, above all, the absence of trained personnel where they are
most needed.

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