health care. Consequently, there was a switch to emphasis on primary health care and
immunisation in the 1970s, led by WHO and UNICEF, broadly following the BN approach to
development. The new approach was more effective, being much lower cost and reaching
larger numbers, but it was no more participatory than before. However, when it became
impossible for most people to secure the medicines they believed they needed from the public
health system, there was a switch to traditional practitioners and self-medication. In East
Africa, ‘needle men’ and drug sellers became increasingly prevalent despite the practices
being outlawed, as indicated by the spate of prosecutions against them (Illiffe). These
alternatives, as well as NGO-supported efforts, tended to be COOP, and/or M in mode of
operation.
C. Liberalisation and globalization
The neo-liberal reaction to the post-independence interventionism started in the early 1970s.
But it had little effect until the 1980s when it received a powerful boost both from the policies
adopted in the UK and US and from the debt crisis which enabled the International Financial
Institutions to impose pro-market and laisser-faire policies on borrowing countries.
Globalization and liberalisation are closely intertwined - liberalisation provided an impetus to
globalization, and globalization contributed to forcing liberalisation on recalcitrant countries.
The 1990s has also seen some reaction to the liberal revolution of the 1980s, both
theoretically - with powerful criticisms of the underlying model - and in policy focus, with
renewed emphasis on human objectives, especially poverty reduction. But policy response to
this reaction has been quite severely constrained by globalization.
The 1980s liberal revolution: The first and most important revolution occurred in developed
countries, Thatcher (from 1979) and Reagan (from 1981) espousing monetary policies, in
principle, if not always in practice. This had the immediate effect of raising world interest
rates, ushering in world recession and a downward movement in commodity prices. It also
imparted a new monetarist, anti-government, pro-market, laisser-faire philosophy which
permeated the IFIs, bilateral aid administrations, educational establishments in developed
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