The World Development Report 1993:
The Brave New World of Primary Health Care
Most post-colonial nations that were faced with the task of building a modern state after gaining freedom, attempted to restructure investment patterns. Health, education, and the public distribution system became the basis for the welfarist nature of these states. A welfare state however, by its very nature, does not call into question the societal processes of creation arid appropriation of wealth. It merely invests a certain proportion of the natiohal surplus into welfare to harness its political legitimacy. At the same time, this welfare sector, is also part of the same processes of appropriation which steadily transform it into a sector for profit generation.
It is within this framework that we would like to analyse the World Bank's approach towards Primary Health Care (PHC), particularly with reference to India. This paper is divided into three sections.
The first section looks at the evolution of the concept of PHC and its links with international interests. The second section examines what could be described as the dualism in India's plans to build the health sector. The third section examines the World Bank's interventions in health and attempts to link it with India's receding commitment towards Health For All through Primary Health Care.
World development over the sixties and seventies was characterised by two main features: the widening gap between countries, and the growing disparities within them. Alarmed by this situation the World Bank's President,1 and the Willy Brandt Commission Report2
Centre for Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University.
Social Scientist, Vol. 22, Nos. 9-12, September-December 1994