From 'Planning' to 'Systems Analysis': Health Services and Development at the World Health Organisation, 1952-1975.
On the 17th of October 2017, the French Institute for Research in Africa (IFRA) in Nigeria teamed up with the Department of History of the University of Ibadan to organise a lecture entitled “From ‘Planning’ to Systems Analysis’: Health Services and Development at the World Health Organisation, 1952-1975”. The lecture took place in Room 40, Faculty of Arts, University of Ibadan. It was given by Prof. Martin Gorsky, Professor in the history of Public health at the London School of Hygiene and Tropical Medicine. The event was hosted by Prof. Ogbogbo, Head of the History of Department of the University of Ibadan and Dr. Elodie Apard, IFRA director. The event also had Prof. Ademola Dasyla, Dean of the Faculty of Arts as guest of honour.
Prof. Gorsky’s research has concerned the history of public health, health policies and health systems from the 19th century onwards. He has recently worked in the United Kingdom on the National Health Services (NHS) and health reports; he has also researched the public health posters in Poland in the XX century.
The speaker began his lecture by examining the birth of the World Health Organisation (WHO) in 1945. This UN specialised agency promoted an idealistic vision of world health policies through the notion of “health systems”, defined as “the organisations, people and actions whose primary intent is to promote, restore or maintain health”.
Prof. Gorsky then considered the struggle between policy factions on contradicting conceptions of health system strengthening mechanisms within the WHO. While some insisted on the formation of a global security systems in conjunction with the International Labour Organisation (ILO), others argued that the WHO should develop top-down disease control programmes and laid the emphasis on technical solutions. Finally, biomedical approaches gained prominence in the early 1950s. Yet, the period between the 1950s and the 1970s saw the emergence of numerous disease programmes, through widely implemented actions against malaria and smallpox among others, along with social medicine planning encouraged by expert committees of the WHO. The 1960s were known as the “Development decade” and various conferences took place worldwide (Manila, Addis Ababa…) to promote health planning dissemination programmes.
Finally, the WHO developed a comprehensive system analysis project in the 1970s which drew principally on applied research institutions exemplified by the RAND corporation and the International Institute for Applied Systems Analysis (IIASA). Colombia was one of the countries which prominently designed a comprehensive health planning project with the support of system Analysis institutions, even if political instability led to a failure.
In conclusion, Prof. Martin Gorsky noted that debates around health system analysis revolve around defining policy languages. They are negotiations between UN member states and the WHO as an autonomous actor. While the former tend to favour top-down interventions on health issues, the WHO has historically pledged for more “horizontal” practices through social medicine and progressive public health programmes.
The Question and Answer session that followed Prof.Gorsky’s lecture concerned various topics, including the impact of structural adjustment programmes in health policies and the place of West Africa in the history of health systems analysis.
Martin Gorsky lecturing
The audience in Room 40 of the History Department, Faculty of Arts
Prof. Ogbogbo, Dean of the Faculty of Arts, concluding the lecture
Dr. Apard, IFRA director, giving final words