relations than in the Colonial era. In a formal way M relations were downgraded (both for
transactions within the public sector and for the private sector), although they entered in a
sporadic way informally in the form of parallel markets and rent-seeking.
Medicine in the planning era
At the beginning of this era, the formal medical system was organised on strictly P/C lines,
dominated by expatriates and largely devoted to their needs. Government objectives with
respect to medicine were similar to the wider societal aims - to indigenise the provision of
medicine, especially in the higher echelons, and to provide the standards and type of medicine
enjoyed in the West for the whole population: “Kenya must copy the British model of
medical services and nothing else” stated Mungai, the Kenyan Minister of Health in 1963
(quoted in Illiffe, 1998, p131). To this end new hospitals and medical schools were
established, and students were sent abroad for training. Medical services were to be provided
primarily by the State, generally free of charge. As with the wider political system, these
changes involved indigenising the services but not transforming them. Consequently, the
basic P/C mode was maintained - although Russian-trained doctors adopted a more collective
approach (Patton, 1996), while local domination of the service and the professional
association increased solidarity among doctors (Illiffe). In practice, patients sometimes made
illicit payments to secure high quality treatment, thereby introducing an element of M into the
system (Jeffery, p 261-2). COOP also played a role - with medical personnel being motivated
by the desire to serve and to do a good job, as well as because they were ordered or paid to do
so. For example, a Cuban doctor, operating in a highly P/C system, stated: “Medicine is a call
to services, my business is seeing the patient get well, not the size of my salary” (Economist,
May 8th 1999). In some areas, community health workers, selected from the local
community, provided a more COOP model (e.g. in Mahashtra). In general, however, doctors
were determined to maintain a hierarchy which they dominated. In Uganda, for example, they
rejected proposals to develop a cadre of assistant doctors, while proposals to introduce
community health workers in India were postponed for decades (Illiffe, p121; Jeffery).
The inappropriateness of the model gradually became apparent - in particular, the financial
impossibility of providing Western standards for all, and the need for priority for preventative
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