Albert Francis E. Domingo, MD

my flight of ideas

MSc Essays – World Bank Structural Adjustment Programs in the Philippines

Posted on | June 12, 2015 | No Comments

Critically assess the World Bank’s impact on public health with reference to structural adjustment. Discuss with reference to a specific country or region.

Albert Francis E. Domingo, MD[1]

[Also available as a PDF at this link.]


On 14 October 2014, the Philippines’ Finance Secretary heralded news that the country has signed on to a new Third Development Policy Loan (DPL 3) worth $300 million with the World Bank. As reported in the mainstream news media, “[u]nder the loan, the Philippines will receive support in strengthening priority public investmentment implementation, reducing the cost of doing business for jobs creation and poverty reduction, developing the human capital of the poor, promoting fiscal transparency and good governance, as well as consolidating fiscal sustainability through revenue mobilization and risk management,” and the Department of Finance will promote “policy dialogue and monitoring and evaluation” with other government agencies, including the Department of Health (Rivera 2014). A few months later at a press conference in Japan, World Bank Group President Jim Yong Kim (2015) gave an optimistic overview of how the Bank can end extreme poverty by the year 2030, thereby boosting shared prosperity. In his speech, Kim made reference to an earlier pronouncement by his predecessor in 1973, Robert McNamara, who described a situation that the Bank wanted to avoid: “a condition of life so degraded by disease, illiteracy, malnutrition, and squalor as to deny its victims basic human necessities.”

In 1980, after McNamara eloquently sketched the above picture of “absolute poverty” and shifted the Bank’s focus from post-war reconstruction to poverty eradication (Konkel 2014), the Philippines, with then President Ferdinand Marcos in power, signed on to its first Structural Adjustment Loan (SAL) Agreement (Loan Number 1903; Anon 1980). There have been earlier efforts (as far back as 1949) at structural adjustment independent of the Bank’s influence. One closer action was by the International Monetary Fund (IMF) in 1976-1979 through its Extended Fund Facility (EFF) (Montes 1988). Often lumped together with other “neoliberal” policies, structural adjustment programs (SAP) by the Bank have been strongly criticised globally as having a negative impact on public health, through its three main policy interventions of (i) reduced government expenditure, (ii) liberalisation of markets, and (iii) exchange rate devaluation (Breman and Shelton 2007). Caution has often been aired however that a nuanced analysis of this claim has to be informed by a specific country context, including how macroeconomic policies translate to microeconomic decisions of the population being studied, and that as far as is practicable, an empirical and data-driven approach should be used (Herrin 1992).

This essay shall critically assess the World Bank’s impact on public health with reference to structural adjustment. It will do so with reference to the country experience of the Philippines. It shall begin by describing the original mandate of the Bank, and analysing how a financial institution for post-war reconstruction turned into an influential actor in global health. It will then examine the actual practices of the Bank in a specific period known for neoliberal policy influence and structural adjustment through conditionalities imposed as part of contractual loans, including how these have affected public health outcomes. At that point, the unique country context of the Philippines will be highlighted – particularly in light of political developments that may have provided justification for neoliberalism first as a tool to enrich a dictator and his cronies, and then as a means to undo the damage that was inflicted by a corrupted state. The essay will then discuss frameworks by which SAP impacts on public health may be evaluated, how difficult it is to do this, and how empirical data on the Philippines may be interpreted both positively and negatively. A brief update on the changing context both as regards the Bank’s practices and concerning the Philippines’ situation will then be provided. The essay will finally conclude with a summary of its key points, and some recommendations for further analysis.  Read more

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MSc Essays – Active Purchasing

Posted on | June 10, 2015 | No Comments


“An active approach to purchasing of services is fundamental to achieving efficiency and thereby expanding access to healthcare.” Critically assess this claim with reference to a country or region of your choice.

Albert Francis E. Domingo, MD[1]


Health systems will have to be designed, funded, and operated within the strengths and limitations of a particular sociopolitical and economic context. Managers have commonly sought to improve efficiency in order to expand access by beneficiaries to essential goods and services that can be used to maintain or improve health status. That resources are limited and contested by other social services needed by the population can either constrain or enable the attainment of health goals, depending on whether or not – and how – purchasing is to be used as leverage.

This essay shall critically assess the claim that an active approach to purchasing of services is fundamental to achieving efficiency and thereby expanding access to healthcare in the Philippines. It shall begin by specifying the term “efficiency” as to what it means in health systems parlance, followed by a discussion of what “access” to healthcare is. A discussion on an active or strategic approach to the purchase of health services shall follow, with attention to provider payment mechanisms.

Then, the context of the Philippines shall be explained according to the purchaser-provider split, with a programme to achieve universal health care (UHC) as the country’s current reform direction. The fundamental need for strategic purchasing in the context of the Philippine’s national health insurance program will finally be described, particularly on how the national health insurance firm should take a lead active purchasing role to help the Philippines achieve UHC.

MSc Essays – Active Purchasing

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Je ne suis pas Charlie (Yo no soy Charlie; I am not Charlie)

Posted on | January 9, 2015 | 1 Comment

by José Antonio Gutiérrez*

I start by clarifying, first of all, that I consider an atrocity the attack on the offices of the satirical magazine Charlie Hebdo in Paris and I do not think that in any sort of circumstances it would be justifiable to turn a journalist into a military target. The same is true in France, as it is in Colombia or Palestine. Also, I do not identify myself with any fundamentalism, nor Christian, nor Jew, nor Muslim, nor with the Frenchified secularism which rises the sacred “République” as a goddess.

Thousands of people understandably affected by this attack have circulated messages in French saying “Je suis Charlie” (I am Charlie), as if this message was the last word in defense of freedom. Well, I’m not Charlie. I do not identify with the demeaning portrayal and “caricature” that it makes of the Islamic world, at the height of the “war on terror”, with all the racist and colonialist burden this entails. I can not see with good face the constant symbolic aggression that is also balanced with real physical aggression through bombing and military occupations of countries belonging to this cultural horizon. Read more

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