WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR
THE WESTERN PACIFIC
BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMr.rrTI'EE
TECHNICAL DISCUSSIONS
Nineteenth Session Manila 1-8 October 1968
\-IPR/RC19/TD2
4 September 1968 ORIGINAL: ENGUSH
• HEAL'IH PLANNING AS PART OF THE DEVELOIMENT PROCESS1 Approach and prospects in Latin America: by
A synopsis
• 1 __
Hernan Duran, M.D., M.P.H. Chief of Training Division Pan American Program for Health Planning Pan American Health Organization
«_.
Background document for reference use at the technical discussions on "Health Planning as an Administrative ToollI.
1
CONTENTS
1.
BACKGROUND INFORl'l1ATI ON •••••••••••••••••••••••••••••••••
1
2.
HEALTH PROB.LElVIS IN IATIN AMERICAN DEVELOPMENT •••••••••• HEAL'lli PLANNING IN IA TIN Ar.'lERICA •••••••••••••••••••••••
2
3.
5 7 9
A. B.
The formulation of health policy .•.........•.•..•• The effectiveness of the planning process ••••••••• ....................................... " .................................................... ..
4.
RI?S~TS
15
•
•
WPR;RC19/I'D2 page 1
1.
B!\CKGROUND INFORMATION
During the nineteen-sixties, the Latin American countries have been making a special effort to plan for health as part of their general economic and social development process, a path to which they formally committed themselves when they signed the Charter of Punta del Este in August 1961. It is stated in the Charter that "there is an agreement between the governments of the American states for the
•
simultaneous planning of economic growth and social progress and tilat, in view of the mutual relationship which exists between health, economic development, living standards and well-being", arrangements should be made to prepare national health plans for development purposes. 1rfi th this aim in mind, it was agreed to create planning and
evaluation units in the ministries of health, with appropriate representation at the national agencies for the overall planning of economic development and social progress to ensure the closest possible co-ordination. In addition, the Charter recommended that the Pan American
'.
Sanitary Bureau should assist the governments concerned in establishing systems of health planning and in formulating and carrying out the plans. Various technical and political meetings subsequently adopted a number of recommendations for fulfilling the commitments undertaken and achieving the goals set, and the measures proposed have been put into effect. It was of course recocnized that it was necessary to train senior public health officials in health planning techniques ~~d
the general
principles of economic and social development planning.
It ",as also
considered essential to prepare a methodology of health planning that Iwould take into •••
vlPRjRC19jTD2 page 2
would take into consideration the problems inevitably produced by the integration of health plans and development plans, thereby tacitly acknowledging that the health programmes formerly prepared by the public health services had not paid sufficient attention to those aspects. In order to comply with the mandate laid down in the Charter of Punta del Este and implement subsequent recon~endations,
the Pan It concluded
American Sanitary Bureau adopted a number of measures.
an agreement with the Centre for Development Studies of the Universidad Central de Venezuela (CENDES), for the preparation of a methodology of health planning for development purposes, which was published in
1965. 1
•
It also signed an agreeme.'1t with the United Nations Latin American Institute for Economic and Social Planning in 1962, under t'lhich it has been possible to train about 200 officials from the health services of all the Latin American countries in the theory, practice and techniques of health planning for development purposes. These officials have trained others, in their turn, and by now some 2000 persons have acquired sufficient expertise to shoulder the task of plan formulation. 2. HEALTH PROBLEMS IN LATIN AMERICAN DEVELOPMEln
Despite their profound differences, all the Latin American countries have certain features that stamp them as developing areas. methods of manufacturing are still fairly rudimentary. ~
•
1:1i th
the exception of one or two regions in the larger countries, their capita income ranges from about 100 dollars a year to approximately 700 dolJa rs in the countries that export more, but income distribution is highly unequal in all of them. The population of the region grows at the rate
. lor & Testa, M. No. 111
about •••
lAhumada, J., Arreaza Guzman, A., Duran, H., Pizzi, M., Sarue, E. (1965) Conceptual and methodological problems of health programming, Pan American IIealth Organization Scientific Publications,
vIPR/RC19/ID2 page 3
of about 3 per cent. annually; its structure, its distribution between town and country, the proportion of active population and, in fact, its characteristics in general are typically those of a developing area. The magnitude and nature of the health problems are also typical of developing countries. The high mortality and morbidity rates are
caused by the heavy incidence of communicable, infectious and parasitic diseases, which could be reduced and even eradicated. They are largely the
result of bad sanitary conditions, malnutrition and. the s'tructural and functional problems produced by the shortage and mismanagement of public health resources. This, in its turn, stems fror:l the conditions in which a~d
such shortages occur, and from the political
social disputes that
break out over the division of resources, when the structure of government is unsound for those same basic reasons. These health problems are made worse not only by the insanitary conditions, under-nourishment and the lack of adequate and well-managed resources, but also by other factors that are characteristic state of under-development. of the
The rapid growth of the population means
that the resources are spread very thin, and the situation is aggravated
'.
by the want of co-ordination with the private sector and the failure to distribute health personnel adequately ever the country as a whole. Owing to the slow grovrth of agriculture, unsatisfactory industrial policies and the limited nature of export trade, the cost of health inputs is pushed up enormously, thereby raising the cost of the services as well. Proper utilization of the resources available is made even more difficult, especially in rural areas, by the low educational level of the po pula tion and the lack of transport facili ti.es and road networks, which makes it impossible for the people to get to the facilities that do exist. Health administration and organization are ,inadequate, with lO~l
the result that productivity is
to begin with, and is reduced even
more by the gap bet"reen expenditure and investment in health itself, sinoe the bulk of what resources there are must be devoted to consumption expenditure and less to building construction and up-keep. /The low level ••.
WPR/Rc1 9jTD2 page 4
The low level of health in the Latin American countri-es compared with the superior levels and differences of structure found in more developed countries has far-reaching social repercussions. being met. On the one hand, health requirements as an end in thenselves are obviously not
On the other, the low level of health reduces manpower pro-
ducti vi ty by affecting the calibre and numbers of health personnel. However, the efforts made to raise the level of health cannot rely for their inspiration solely on considerations of productivity, which is the factor usually invoked in the developed countries when public health measures have to be taken. A low level of health is a structural defect from which large sectors of the population SUffer, and its improvement is one of the requisites of social change which is in itself a development target. Moreover, expenditure on health will obviously have to be stepped up as medicine becomes technically more advanced and the demand for medical services increases. Current studies show that developing countries are allocating at least 10 per cent. of their budget and 2 to 3 per cent. of their gross national product to health. l These are the main reasons for making health planning a part of the development process. In so doing, it is hoped that the resources earmarked for health requirements will be used more rationally within the balanced overall distribution of funds to all the sectors that play a part in development.
•
.'
/3. 1
HEP.LTH PLANNING •••
Abel-Smith points out that the rate of increase is usually such as to indicate that everJ ",en years an additional 1 per cent. of the gross national product wilL be set aside for medical expenditure and that, by the end of the century, certain countries will be spending more than 10 per cent. of their gross national product on health LAbel-Smith, B. (1967) An international study of health eipenditure and its relevance for health plan..'1ing, Geneva (WId. Hlth erg. Publo HI th Papers, ].?V
WPR/RC1 9/TD2 page 5
3.
HEALTH PLANNING IN IATIN Al"lERICA
The situation that has just been outlined is sufficient reason for the Latin American countries to make every effort to plans for economic and social development. Although they have only just began to make headway in this task, imp~'ove
it
by means of health plans drawn up in conjunction with their national
•
they have already obtained some results that indicate the Nay in which they should proceed in future. They are, in fact, searching for solutions on the basis of a new methodology and approach, which transform the methods of programming traditionally used for the public health services. They take as their starting point a description of the health situation in the cou.~try
as a whole and in different parts of it so
as to establish the local and regional variations and the nature and quantity of the factors that determine the different levels of health existing there. The description will show how these levels are The next step is to make a study of health associated with the economic and social environment that gives rise
••
to the factors in question.
resources and of the policies that have so far governed their utilization in each area of the country in terms of the capacity of the resources allocated to bring about a satisfactory level of health or to improve the existing situation. By linking resources and methods
and their respective costs with particular levels of health, the terms of reference are obtained for establishing goals and targets for the heal th plan in the light of national health policy requirements. policy in which due account has been taken 01' the limitations of resources and economic and social demands. /By working on ••• This policy must, in its turn, have been framed in relation to a development
-",-
ltJPRjRC19/TD2
page 6
By working on these lines, an integrated solution can be found for health problems in relation to development, but its im:plementat!on ~lil1
entail radical changes in the outlook, system and
!.!!9d~
operand!
of the public admip.istration. These are the theory and principles that have guided the Latin Americ~n
countries in formluating national health plans as part of
the development process, and the practice that they have followed. Nearly all the governments set up or j.mproved a system of national health planning as soon as they had a trained group of specialists avallable. Six countries drew up a hea.lth plan in the first iutl-lf of the Other countries subsequently embarked upon the nineteen-sixties, and some of these have all'eady reached the more complex stages of evaluation. nON work of plan formulat.ion, and most of the Latin American countries have follO\~ed
•
suit.
There are, however, a few that have not yet done so,
or that continue to rely on traditional principles and methods of programming health services. Their experiences have varied considerably. owing to their great differences in size, the medley of geographical, economic and social areas of which so many are composed, the calibre of their leaders, technicians a.'1d officials in general, and their poli tico-administrati ve structures. Thus, it is clear that the decision to embark upon health planning as a part of the development pr,-'cess is nc,t necessarily the outcome of a formal commitment or of the fact that the technical experts trained can be certain of findinG an easy field for applying the kno\,lledge they have acquired. The obstacles and possibilities encountered and the good
or bad results obtained have been used to shape a strategy for the introduction and development of health planning "'lhich has met the main planning requirements, identified the various factors to be dealt with and /determined the •••
WPRjRC19/TD2 page 7
determined the importance and timing of the measures to be adopted. These basic requirements seem to be chiefly related to the formulation of health policy and to the factors that ensure that the planning process ~Iill
be effective in practice and not simply a formal undertaking
on paper YillOwn as the National Health Plan.
A.
The formulat.ion of health policy Health policy encompasses a vast number of decisions which
•
reflect the degree of importance placed on health as an end and a means in the national development process. It is through the adoption
of a policy for health that the field of planning is demarcated, and its radius of action and the social requirements with which it should comply are determined in practice. It is, however, the effectiveness and dynamic force of the planning process itself that will be the instrument for modifying that policy. The major decisions that make up a health policy may deal with the following points: (1) The choice of national institutions through which the health
sector will operate, either directly or indirectly, the real and financial resources to be allocated to health through the medium of those institutions, and the financial and manpower training policies involved. These questi()ns are particularly important in Latin America, where the growth of the population and the social pressures that are producir~
a cultural transformation give rise to particularly thorny
problems in such areas as social security policy, the role of the private sector, professional training at the university level, etc. (2) The geographical, economic and social areas that will be
considered in relation to the administration of the health services, and in particular, to the integration of local and regional health plans in regional and national progrfu~es.
/Given the wide •••
WPRjRC19/TD2 page 8
Given the
~Iide
variety of conditions in the La tin American coun-
tries as regards the distribution of resources and the potentialities of the differGnt areas, this point is of vital importance for health policy, since it should determine all decisions on allocation. natio~al
resource
(3)
The population groups to be given preferential attention in
the light of development aims and means of implementatj.on. OvercroNding in the big to~ms,
the high proportion of the popula-
tion that is under 15 years of age, the relatively small number of people that are economically active, and the progressive depopulation of the rural areas are some of the many problems a health policy must grapple ,.,i th, and are particularly serious in Latin America for the reasons set forth above. (4) dance ~ti th
•
Priorities for attacking specific health problems, in accortheir importance for national development.
The economic and social justifications for the campaigns to eradicate cOmI:llli"icable diseases in the developing countries are too wellknmm to cite here. However, these cOlli"ltrles are also influenced by a number of tradittonal and cultural considerations associated with the importance that the people tn general give to health and the socioeconemic characteristics of the demand for health services.
(5)
The organizational} adrninistr'ati ve and technical reforms
•
required, since they bear on thG people's needs and the availability and use of health serv~ces.
Questions of health organization and administration loom large in the Latin American countries and are a vital consideration in the formulation of health policy"
I(f)
The preference •••
vlPRIRC19/TD2 J-
page 9
(6)
The preference given to the satisfaction of current health deman~~
requirements over future
or vice versa; that is to say, whether
the bulk of the funds available should be assigned to current expenditure or to capital investment. This is an ever-present problem in the developin,.:; countries because of the limited supply of funds and the social pressures for more current consumer expenditure on health for such ita~s
as medicines,
wages, hospital food, etc., at the expense of capital expenditure on, for example, construction of hospitals, training and research. B. The effectiveness of the pl~~ing
process
The second requirement for health planning is that it must be initiated and conducted as part of a continuing process, which necessarily involves the idea of continuous change or transformation, moving gradually and steadily from one stage to the next. This means introducing a multi-staged cycle extending over a period of time which would automatically ensure improvement through successive modifications, each bringing the process more into line with the proposed model for change. In practice, this ~Till
be the most difficult problem
~Ihich
will
have to be solved if plaD.'1ing is to bring about the changes required by any policy. this result, cess depends Experience in Latin first be defined. Americ~
shows that to achieve
~~e
requirements on which the effectiveness of the proAs these reqUirements are met,
m~st
the planning strategy that must be adopted Vis-a-vis government authorities and the different social and organizational groups that are to partiCipate in the process will emerge. If planning is to become part of a continuing process, three things are essential: , .4-
a favourable attitude towards planning, the
operation of a suitable planning system, and the adoption of methods by which the allocation of resources in line with the policy requirementa can be determined. /!'he Significance •••
WPR/Rc19/I'D2 page 10
The significa11ce of each of these factors is discussed below. (a) The attitude
A favourable attitude towards planning is one of recognition and acceptance of the need for planned action, which involves both the capaci ty to make an informed choice between al ternati ves and the will to carry throl~h
the changes required to reach the targets indicated
in the plan.
If the latter aim is to be achieved, there must also be
full authority over and full responsibility for the instruments with which the plan is to be carried out. The mere delineation of the problem reveals the complexities involved in promoting a positive attitude to planning, which is nothing more nor less than a complete departure from the traditional use of the resources with \'1hich the sector operates. It cannot be said that, in the short time that health planning has been part of the development process in Latin America, there has been any substantial change in the attitude of governments, or administrations towards planning. done much to bring about a The personnel already trained have certainly c~~nge
in this attitude, which is partly due Nevertheless, it is certainly
also to the favourable results achieved.
9,
in the field of health planning that one of the most complex and difficult tasks has to be undertaken in order to ensure that countries formulate and execute national health process. (b) The system pl~~s
as part of the development
The second factor which makes the planniw.g process effective is the existence and operation of a planning system with the following principal components: /(1) Personnel ...
."
WPRjRC19/I'D2 page 11
(i)
Personnel trained in the tasks of plan formulation, to ensure solution of the technical problems and facilitate co-ordination among the ~articipating
agencies.
As mentioned above, Most of the personnel
special consideration has been given to this
.~ (ii)
task in Latin America.
trained to formulate health plans as part of the development process are tilling their training at various levels in the health agencies of the countries of the region. A planning unit linked to the national development planning machinery to advise participating agencies on the formulation of the national health plan. ~:as
This component of the planning machinery
described in the Charter of Punta del Este Practically, all Latin A,";1erican cotmtries
as fu! essential pre-requisite for national health plans. do have planning units at the sectoral level and, to a greater or lesser extent, they have been orgfu!i~ed
according to certain common principles.
(iii)
Availability of statistical data, both for the formulation of the plan and for its execution and evaluation. As is well known, the developing cOlmtries lack statistics with which to operate, which makes some people dublous about the possibility of fonnulating plans which will follow the guidelines being set in Latin America. be denied that the depth of the statistics. ~~d
--'.
It cannot
preciSion of the
ru1alysis will depend on the quantity and quality f _
It mtillt also be remembered,
however, tb.at the existence of a planning process lis probably •••
~vPR/RC19/TD2
page 12
is probably the best means of encouraging the collection of statistical data and improving their quality since the statistical information is constantly being compared \..i th the actual situation. In several Latin American countries, even before the formulation or execution stage of the plan, the mere initiation of the planning process has done much to promote the est3.blisrmlent of statistical offices a'1d improvement of the information they supply. (iv) The existence of long, medium or short-term national health plans, as indicators and operational tools. While such plans do not constitute the actual goal of the planning process, as we have pointed out before, they are an essential part of the process. To the extent that they are accepted and adopted as a formal expression of this process, they will also help to adapt the administrative machinery for their execution. (v) The adaptation of the traditional administrative machinery to the requirements of the formulation and, in particular, the execution and evaluation of plans is one of the most L~portant
•
elements in
the life of a planning system.
For the reasons improvements
given above, and especially because of the profound sociological significance of changes in the a~~inistration,
01'
the administration has become
one of the biggest obstacles to health planning for development purposes, and increasing atteD!tion is being given to it. /rhe problem •••
•
WPRj!tC19/TD2 page 13
The problem that has arisen in Latin America is how to obtain these formal instruments -- even if some trained persormel, as \~ell
as planning units and statistical data are available -- if the size of the country, negative political and adminis·trative attitudes or other obstacles do not favour the formulation of long-term indicative plans and their corresponding operational plans. This has become one of the most important problems in designing a planning strategy and it has meant, in many cases, that planners, 1'Ii. th greater or lesser official
•
support, have begun to plan by areas or by regions, or have begtID by studying the production functions of the public service agencies in the sector, when the sector has a very complex structure. these cases, results can be obtained from these approaches In all wr~ch
make
it possible to provide the public authorities and the administration in general with a quicker way to improve services and create a favourable attitude towards the introduction and improvement of the plarming process in all its dimensions. ( c) t>1et..rlOds
The third factor in the plarming process is the adoption of methods by vlhich resources can be allocated in the plan to meet policy reqUirements, as described above. As has already been said, the CENDES-PAHO method has been used in Latin America. The method Ims evolved by CENDES in conjunction Hith the Pan American Health Organization (PARO). The methods \'lere defined by a working group assisted by health administrators, economists, statisticians, epidemiologists and medical specialists in various fields and other tec~~ical
personnel who were
consulted on specific topics and problems. /!'he methods •••
I-lPHjRC19/TD2 page 14
The methods were worked out bearing in mind the theoretical and practical requirements for formulating a national health plan as part of overall development planning. Consequently, the central problem they deal with relates to the evaluation and adoption of criteria for distributing resources between health needs, i.e., between diseases and dangers to health, which must be applied in conjunction with the overall planning principles. These principles have already been defined and applied as part of the general process of develop;Jlent planning for the countries of Latin America which the Economic Commission for Latin America (ECLA) has been promoting for about the last fifteen years. on the following major considerations: (i) a cost-benefit analysis for the purpose of allocating l'esources with the greatest tecrulOlogical efficienoy consistent with the general principle that resources are relatively scarce in the context of under-development; (li) the application of ethical principles related to the value that the society places on health (fair shares for all, etc.) with a view to preventing a deterioration of the health levels already attained in the different parts of a country. This method has been a break-through in knowledge of and study of public health problems, especially problems related to the structure and management of sectoral resources. A cost-benefit analysis At the same Under the CENDESPAHO method, the allocation of resources to health needs would be based
•
:9 .
leads to complex and detailed studies and current techniques and to the revision of structural and functional standards.
/ time it
...
WPR/RcI9/ID2 page 15
time, it necessitates a major change in views on the classification of diseases and other concepts which are fundamental elements in formulating the plan. ),
+.
RESULTS
It is still too early to draw conclusions from an evaluation of what has been done in Latin America in this field, with a view to introducing radical changes in the policy and methods adopted • Successes of various kinds are observable, although it may also be asserted that no country has reached full maturity as regards the planning system or process. interest in plarilling. Among the favourable results achieved, primary importance is usually attached to the impact of the adoption and application of planning methodology on understanding of the structure and operation of health services. Espinosa 1
•
All are in the initial stages, and, as
has been pointed out, several countries have not yet shown any real
ThaIUts to this fuller knowledge, the measures
which should be taken to remedy defects can be more precisely defined. notes that planning activities in Chile's National Health Service, besides bringing about a manifest change in the attitude of the executive personnel, have made it possible to achieve practical resul ts in a number of fields. These include, .;i.~
?J.1§"
the improve-
ment of statistical data; the introduction of performance budgeting with the corresponding controls; better methods of supervising personnel ~~d
keeping staff files; measurement of costs in the health sector; more \~hich
exact knowledge of the "lay in
resources are allocated to the /various problems
...
lESPinosa Solis de Ovando, N. (1967) El proceso de planificaci6n en el Servicio Nacional de Salud de ~ule; A paper presented at a workshop organized by the ~lean Public Health Association (Sociedad Crulena de Salubridad)
HPR/RC1 9/TD2 page 16
various problems, vii th the consequent establishment of a sounder cri terion for the definition of prtort ti cs; clearer justtfication of health investment policy; and more accurate definttton of the type of technical and administrative standards and regulations that should be formulated. Tnese are achievements which stem from the establisr.rnent and implementation of a planning process, and vlhich may, therefore, be expected in any country where planning operates on similar lines and l'1here rational methods are applied to promote the more efficient use of health sector resources. The results of health plan.l1ing must also be evaluated in respect of what i!': genuinely new about it at the present time. In the opinion l of Evang .. what is ne~1 in the situation is not that health planning has been started, but that it is regarded as an integral part of economic and social plarilling for the country or region as a whole. VieVled in tb..is dimension, health plalll'1.ing cannot be evaluated unless, the concept of the relation betvleen health planning and economic and social planning is defined, and, in the second place, account is tal,en of how the whole planning effort has fared in the developing countries. As regc:"-"ds the first pOint, in connexion with the components of the health policy and the CENDES-PAHO methodology, an indication was given of the factors from which the relations in question can be inferred: for example, the production capa.city of health services,
•
.' ~--
instruments, expenditure, relations between the level of health and the level of 11 ving, health plan targets, investment, the domestic financing available and the economic policy pursued, etc. In this
/field, statistical .••
pa...'1.. amer., vol.
lEvang, K. (1966)Planificac1on de la salud, Bolo Of:i.e. sanit. 61, No. 3
WPR;RC19/TD2 page 17
field, statistical data may be described as illustrative of the positive correlation between the level of health and level of development , although very 11 ttle is known as yet of t1hat Cibotti 1 calls the "incremental ratio", Le., how great an increase in health is required to produce a given acceleration of the rate of development, or, conversely, to what extent the development process speeds up when a given improvement in the level of health takes place.
•
In the Latin American countries, even in the absence of complete information on these relationships, the evidence to hand has generated a movement towards progressively closer contact between the health sector and the other economic and social sectors, through the central planning offices of the governments concerned. ting mutual understanding of sectoral problems, of studies bases. Lastly, the llealth planning effort in Latin America must be judged in the light of what is happening at present in respect of the whole planning process in socialist world. present study. record. In the first place, planning as a development mechanism is no longer open to question, whatever its results may have been hitherto; the problem is how to tackle it. /Secondly, in the ... ~~e ~~d
In this v;ay, formal ~~d
machinery for inter-sectoral linkage is being set up, and is stimulaalso the conduct research designed to elucidate them on scientific
developing countries of the non-
Such an analysis would be beyond the scope of the However, a few important facts must be placed on
lCibotti, R. (1967) La integracion del sector salud en la planificaci6n del desarrollo: A paper submitted to the Pan American Health Organization's working group on health planning in the Americas, Washington, D.C.
WPR/RC19/TD2 page 18
Secondly, in the space of a very fe'VJ years, the idea· of planning has rapidly gained the support of the great majority of governments, and.tqey have taken action in various directions to put it into effect. Thirdly, the results of the initial planning efforts underta..'ken in the developing countries in the last ten years, particularly in Latin America, have fallen far short of expectations. Salgado 1
says
that the adoption of planning has brought about no radical changes in economic policy or in the traditional style of government; its influence may be regarded as superficial, and it is still "a foreign element in the institutional 11 fe" of many Latin American countries. Fourthly, despite these wealmesses. there are favour;;tble symptoms which suggest that where planning is in operation, a higher degree of 2 rationality in public sector activities is also observable. Studies of this situation lay emphasis on a variety of causes which possibly stem from the same structural factors of psychological and social origin that are linked to the causes or effects of underdevelopment itself. vlaterston, in a work 'Vlhich has by now become a classic, 3 stresses the importance of administrative obstacles and of the problems relating to plan implementation. ECLA, in a report prepared for the United /Nations Committee
•
...
lSalgado, G. (1967) First attempts at pla~igg in Latin America: Notes on an experiment: A paper presented at the second session of the United Nations Committee for Development Planning, Santiago, Chile (Document E/AC.54/L.l9) 2Latin American Institute for Economic and Social Planning (1966) Discusiones sobre planificacion. Informe de un seminario (Editorial XXI) 3Waterston, A. (1965) Development planning. Lessons of experience, Baltimore, Maryland. The Johns Hopkins Press.
\\'PR/RC~ 9/TD2
page 19
Nations Committee for Development Planning,l underlines the general inadequacy of the system. Gross 2
mal:es a very comprehensive analysis
of the conceptual and procedural errors imputable to planners themselves, but maintains that every hope of achieving results t.'1rough economic development planning is likely to be disappointed unless satisfactory administrative machiner<J is available. All these considerations are equally valid when attention is
•
turned to the effects of health planning on development, with the destiny of which it seems to be indissolubly linked. unfair and superficial to drat·, It would be an unfavourable conclusion from the
analysiS of the initial attempts at planning, since the process described must necessarily go hand in r2md with the difficult task of bringing about radical changes in the individuals and in the services involved.
On the other hand, the entry into operation of
the planning process immediately brings to light the existing defects in the serVices, and makes it possible to demarcate the areas of study and research to which the health sector should devote attention in order to :keep abreast of the scientific requirements of those modern disciplines which are tal<1ng part in economic and social development.
lECLA (1967) Experience and problems in the implementation of development plans. Planning in Latin America: A paper presented at the second session of the United Nations Committee for Development Planning, Santiago, Chile (Document E/AC.54/L.13) 2Gross , B.M. (1968) The administration of economic develOpment planning: Principles ant!. 1:allacies: A paper presented at the Seminar on Administrative Aspects of Plan Implementation, Santiago, Chile (Document S'l,/'rAO/W32)