Does health planning work anywhere, and if so, why?

Beginning in 1976 the Department of Health Education and Welfare of the United States Government (DHEW) and the Pan American Health Organization, which is the regional office of the World Health Organization (PAHO-WHO), jointly developed a study of health planning as currently practiced around the world. This thrust to extend our understanding and capability of application of health planning was recognized at PAHO-WHO and DHEW as being long overdue, given the diversity of health planning efforts, the thinness of theory and the frequently unsatisfactory results of health sector planning in so many countries. In 1976 a series of descriptive-analytical studies were commissioned from 17 countries representing nearly every continent and every stage of development. These studies were further analyzed and abstracted and became the basis for a 5-day discussion in Copenhagen in 1977 among 35 practicing and academic health planners gathered from 16 countries, WHO, and DHEW. The thrust of the first assembly was to identify the determinants of (1) the establishment of formal health planning machinery, (2) the scope and content of concerns assigned to health planning, (3) the participants in the process, and (4) the relationships of planners to policy makers and implementors. In 1978 the second 5-day meeting was held in New Orleans to analyze the methodologies of health planning and to determine what could be generalized and disseminated as guidance to all countries. This was based on a new series of methodologically focused case studies which were abstracted and made available to each of the 53 health planning participants from 22 countries, PAHO-WHO, and DHEW. The four major foci of this conference were (1) the state of the art in health planning methodology, (2) how methods are being developed and adapted, (3) identification of major methodological shortcomings or constraints, and (4) surmounting the difficulties facing health planning in affecting major health-influencing forces which lie outside the territory traditionally considered to be part of the health sector. This article is a report on some of the things the author learned from participating in what he considers the two most informative planning meetings he ever attended.