Public health and categorization of countries


For the purpose of generally identifying their stage of HEALTH DEVELOPMENT, the countries of Latin America and the Caribbean can be classified in the following categories:

Group A: Ecuador, Bolivia, Guatemala, El Salvador, Honduras, Haiti.

Group B: Peru, Paraguay, Dominican Republic, Colombia, Nicaragua, Brazil

Group C: Argentina, Uruguay, Venezuela, Chile, Panama, Mexico, Costa Rica

The following is a brief characterization of the approximate level of health development in each group of countries and certain priority aspects of health development programs which might be emphasized.

Group A Countries

Group A countries generally have the most unsatisfactory health situation in the region and should receive priority attention in the Bank's health program. In Group A countries assistance should concentrate over the next decade on ridding the country of eradicable and reducible diseases or other major health hazards which have a broad impact and can be attacked at a relatively low-cost utilizing existing or easily augmented resources. In such situations mass programs, such as malaria eradication can be used to awaken awareness of the necessity for community organization in health development. Environmental improvement and the prevention and treatment of a specific schedule of diseases should take precedence over the establishment of medical facilities except as these relate to basic medical and public health programs.

A simple health plan for the initiation or reorganization of existing health services and facilities to meet the measure priority needs should be a prerequisite to assistance in this group of countries. Preinvestment in health planning may have to be undertaken in advance of project assistance.

Group B Countries

In Group B countries, development in health is at a stage where specific project activities can be applied within the context of national health development plans. Priority needs in these countries involve the expansion of health services to rural areas and environmental and basic health services for the slum sections of urban centers as well as rural areas. These services can be expanded within the available resources by the maximum use of auxiliary personnel trained and employed under professional supervision within a health development plan. Project assistance for the training of specific categories of auxiliary health and sanitation personnel may be required.

Any application for assistance in hospital development should be scrutinized with special concern for the relationship of such a facility to an integrated (central and district hospital) plan for provision of health services and care. It should also be related to the stage of development of basic health services. Assistance intersectorally is also required in these countries to establish and implement national nutritional policies. The local production of low-cost protein rich foods would be a suitable type of project activity in Group B countries.

Group C Countries

The countries in Group C are those already spending substantial funds in the field of health. Assistance to these countries could well concentrate on increasing the output from already available resources before further major capital investments are contemplated. Assistance towards improving the planning and management of health services should receive favorable consideration.

Projects for this group of countries should be limited primarily to those which produce benefits of demonstrated regional significance, or to the solution of specific problems related to industrialization, such as industrial health and safety.

Centers for training in health planning, in public health practices, and for research techniques which are of a region-wide consequence should receive favorable consideration, as should investment in the production of low-cost equipment and materials of wide-spread applicability in public health, especially for use in countries in the poorer health category.

Objective technical analysis of each individual loan request related to the stage of health development of the individual country or region of a country is necessary to ensure priority related investment. 

* The operational policies of the Inter-American Development Bank are intended to provide operational guidance to staff in assisting the Bank's borrowing member countries. Over the course of the Bank's more than 40 years of operations, the approach to developing operational policies has taken various forms, ranging from the preparation of detailed guidelines to broad statements of principle and intent. Many policies have not been updated since they were originally issued, and a few reflect emphases and approaches of earlier years which have been superseded by specific mandates of the Bank's Governors, the most recent being the Eighth Replenishment mandates of 1994.

In accordance with the Bank's information disclosure policy, the Bank is making all of its operational policies available to the public through the Public Information Center. Users please note that the Bank's operational policies are under a process of continuous review. This review process includes preparation of best practice papers summarizing experience at the Bank and other similar institutions, and sector strategy papers.