Planning in the health sector: for whom, by whom?

To state that there are vested interests in health planning is to state the obvious. One can identify numerous actors ranging from international agencies, government officials, pharmaceutical companies, health personnel and community and citizen's groups which would like to stake a claim on the direction and nature of planning and implementing health policy. We argue that the role of specific actors can only be seen in the broader social, economic and ideological framework which, consequently, determines the working of the model of health care. Probably the most important factor influencing health planning is the influence of international donors, governments and agencies. The present ideological tilt towards the market, privatization, less government and more liberalization, has had important repercussions on health planning and delivery. Furthermore, the debt crisis, and the stabilization and structural adjustment programmes being followed by a very large number of underdeveloped countries, are transforming health systems. Essentially, vested interests in health planning within countries, need to be seen in the light of recent ideological and economic changes, and international relations of aid, power and domination.