AfroPHC: Reflections on the World Development Report 1993: Investing in Health

10 September, 2019

Dear HIFA colleagues,

For those with an interest in primary health care in Africa, I would like to recommend the Afro PHC discussion forum []. The forum is currently reflecting on one of the key publications in the history of global health: World Development Report 1993: Investing in Health

I reproduce below a contribution from Jan De Maeseneer, with permission.


Dear all,

this report is neo-liberal non-sense, that is very influential still nowadays.

Example: when World Bank advocates to focus on investment in Community Health Workers, and not to invest in nurses and family physicians, it puts the principles of the 1993-report in practice, utilising the strategies of decreased funding and rationing of the health budget, and leaving no other choice to local governments than just a limited financing of Community Health Workers (without the necessary integration in interprofessional primary care teams) and leaving it to individuals and the market to find "solutions".

So, the 1993 report is still relevant to understand what happens today, 26 years later.

Looking forward to your views and reactions,

Prof Jan De Maeseneer

Prof. em. Jan De Maeseneer, M.D., Ph.D.

Department of Family Medicine and Primary Health Care

Ghent University

Postal address:

University Hospital - 6K3

Department of Family Medicine and Primary Health Care

Corneel Heymanslaan 10

B-9000 Gent


Tel: +32 332 35 42

Mobile: +32 478 544 188


Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: