| Most countries of Latin American and the Caribbean have recently embarked in a process of health care reform, following the World Bank framework, which typically reduces the problems of health systems to technical issues of effectiveness, efficiency, and equity, ignoring historical, economic, social, and political issues. The purpose of this dissertation is to analyze the proposal of health care reform in El Salvador as a case study to critically assess the approach of the World Bank.;The research method used is the case-study approach: a study of a contemporary phenomenon, within its real life context, that uses multiple sources of evidence. The context includes the Post-Cold War period, the process of democratization, the modernization of the Salvadoran State, and the adoption of the World Bank-sponsored neoliberal policies. The sources of evidence include documents of the U.S. Agency for International Development (USAID), the Ministry of Health (MOH), and newspapers; interviews with officials of the USAID, MOH, non-governmental organizations; and observations at health care facilities, and different activities in the city of San Salvador.;The problems of the Salvadoran health care system are defined as: uneven geographical access, uneven financing, uneven use of technology, and uneven political power/undemocratic practices. Using the concept of "medical gentrification," the roots of those problems are grounded in the logic of capital accumulation.;Drawing on the theories of the social production of health and illness and uneven development, this dissertation argues that health care reform proposals in El Salvador do not respond to the needs and realities of the country. More specifically, it demonstrates that these health care reform proposals in the country may actually harm the public's health by magnifying its already existing problems.;At times when the ability to influence macro-social variables has been undermined, a strategy of resistance is the only alternative to stop the further advances of neoliberal health care reform in El Salvador. Toward this end, it is crucial to (1) strengthen the professional organizations of health workers, and (2) promote that international policy analysis/making institutions resist the discourses of development which imposes orthodox uniform solutions to any developing country. |
