Enseñanza de la lectura y escritura del idioma Q’eqchi’

differentiate between effective, sustainable development and ineffective, unsustainable development. While it may well be true that some supposed development has a minimal (or even harmful effect) on Majority World countries, Postdevelopment Theory regards all development as harmful and suspicious (Maiava and King, 2007).

2.3.5 Implications of Development Theories for Health Services in Majority World countries

Although development theories are primarily concerned with economic

development, the potential implications of each model on the development of healthcare services in Majority World countries are significant.

Modernisation Theory suggests that the process of industrialisation benefits all areas of society including welfare and healthcare (Rostow, 1991). If correct, this theory has implications for healthcare workers in Majority World countries. While Development Theory suggests that all countries will (eventually) achieve healthcare systems to match those of the Minority World, it also suggests that such levels of developed healthcare will remain unachievable until Majority World countries reach accompanying levels of financial and industrial development. Rostow provided a loose timeframe for the 5 stages of

development: at least fifty years to complete the transition. It is only in the final stage of this process that Rostow claimed a welfare state could emerge and be successfully supported by a country’s economy and infrastructure (Rostow, 1991). Applying these stages to the world of today, many Majority World

countries appear to be in what Rostow (1991) would consider the initial stages of development: the "Traditional Society” or the "Preconditions for Take-Off.” Sub-Saharan Africa, for example, is the least urbanised area of the world (Njoh, 2003).

While it is true that, in Majority World countries, more urbanised and

industrialised areas have lower mortality rates and higher healthcare standards (Njoh, 2000), these disparities, may be better explained in terms of a country’s colonial history (the uneven infrastructure and healthcare systems established by Europeans; the continued underdevelopment of the Majority World by richer countries; the geographical challenges of many Majority World countries; and the passing of colonial power to in-country elites) than as a fulfilment of Rostow’s development theory (Njoh, 2000).

While Rostow’s Modernisation Theory (1991) posits far-reaching benefits of industrial development (with urbanisation and expansion leading to better healthcare and welfare), rapid development and urbanisation projects in sub- Saharan Africa (and the ensuing housing and employment issues these

developments created) have sometimes been seen to have the opposite effect: overstraining and reducing healthcare services (Njoh, 2000). In further

contradiction of this aspect of Modernisation Theory, Frey and Field (2000) found an increase in industrialisation had no influence on rates of infant mortality.

Dependency Theory

The concept of intentional or malicious underdevelopment (the idea that the Minority World wilfully exploits and drains resources from the Majority World) has been applied more specifically to the relationship between Minority and Majority World countries in the delivery of healthcare. It can be argued that a practical, measurable form of “underdevelopment” — as described in

Dependency Theory — can be observed in the way Minority World countries attract and “drain” skilled workers from Majority World countries to boost their own economies while weakening those of Majority World countries (also known as the “brain drain” effect). Literature on the effects of brain drain from the Majority World highlights a number of “push” and “pull” factors that serve as motivations for such emigration. “Push” factors include a lack of professional development opportunities and work pressures such as high caseloads. “Pull” factors include improved living conditions, improved working conditions,

increased opportunities for career advancement and professional development (Kirigia et al., 2006).

Unfortunately, for the Majority World, there is an apparently cyclical nature to this “brain drain” effect (comparable to the Prebisch-Singer thesis described above), in which increased emigration levels worsen conditions for remaining professionals (contributing to increased caseloads and lessening the return of any training investment the country has made) in turn driving further emigration (Korte et al., 2003 cited in Stilwell et al., 2004:598)).

A number of writers suggest it may be unethical to actively recruit healthcare workers from the Majority World. As Kirigia et al. (2006:89) state, if the ‘poaching of scarce human resources for health’ continues, ‘the chances of achieving the Millennium Development Goals would remain bleak.’ If true, this statement has universal implications, particularly when considering how reliant some countries’ are on health care support from foreign-born workers. This arrangement — though beneficial to the Minority World — contributes to underdevelopment because the cost of training is usually financed by the Majority World country (whether the undergraduate course is subsidised or if the students pay their fees directly). Even below the level of specialist training, a Majority World country would have invested in a person’s general primary and secondary education, while Minority World countries reap the economic benefit (Raghuram, 2009). The work of Raghuram (2009) and Kirigia et al. (2006) does not, however, consider the continuing contribution of Majority World-born

healthcare workers, who may still contribute to their native economies (e.g., by sending money back home to their families).

To combat the negative consequences of brain drain, writers such as Rizvi, (2006:181) outline a number of strategies Majority World countries can undertake to retain their educated professionals, such as guaranteed jobs on their return (if studying abroad), and ‘bilateral and multilateral arrangements under which developed countries pledge not to recruit skilled people from the developing states,’ or ensuring a period of commitment to working in a home country before a person can emigrate. The Commonwealth Code of Practice for the International Recruitment of Health Workers was ratified by the UK

government in 2003 (Commonwealth Secretariat, 2003) to alleviate the unfair poaching of human healthcare resources by ensuring foreign-born health

professionals have contributed economically to their native countries before entering the Minority World country (Raghuram, 2009). The majority of Minority World countries have not, however, ratified this code (Raghuram, 2009).

2.4 Health and health services

Health is a complex and elusive concept (Brüssow, 2013; Brülde, 2000). One of the best-known definitions was published in the World Health Organisation’s (WHO) 1948 constitution, first presented in 1946, defining health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (World Health Organisation, 1946). This definition has drawn widespread criticism. The majority of criticism stems from the use of the word “complete” regarding the different areas of well-being, the changing health demographics of populations, and the use of the term “disease” (Huber et al., 2011). People with disease or disability may consider themselves healthy in spite of this definition (Bircher and Kuruvilla, 2014).

Although a number of alternative definitions or models of health have been posited against the WHO’s definition, Callahan (1973:77) describes such attempts as a game of ‘king of the hill, where the aim of all players is to upset the… WHO definition of “health.”’ Despite this, a number of alternative

definitions or models of health have been suggested, with Frenk and Gómez- Dantés (2014) justifying the need for constant and continuous redefinition because of the complexities of health. One such model is the Meikirch Model of Health, developed by Bircher and Kuruvilla (2014). This model suggests a need to consider health as a balance between the demands of life, against individual potentials which are both biological and personally acquired. This model also explores this in the wider context of the environment and society.

The WHO (2018) defines health services as:

all services dealing with the diagnosis and treatment of disease, or the promotion, maintenance and restoration of health. They include personal and non-personal health services. Health services are the most visible functions of any health system. Service provision refers to the way inputs such as money, staff, equipment and drugs are combined to allow the

delivery of health interventions. Improving coverage and quality of services depends on key resources being available; and how services are organized and managed. Equity in health outcome is the ultimate aim.

Health services are part of health systems, which are all the organisations and individuals involved where their primary focus is the promotion, restoration or maintenance of health (WHO, 2007).