ABSTRACT
As we know, SAPs invariably favour private trade as opposed to public initiatives. But, even though the World Bank and other international organisations have placed such a high priority on increasing the role of private providers in social sectors of third world countries for over a decade, there has been little examination of the consequences. Finally, however, concerns have been raised about the application of neoclassical economic theory to developing-country contexts (Bennett et a l, 1997). Most basically, there has been a questioning as to the degree to which competitive or contestable markets really exist. In many rural areas the dearth of providers in developing countries and poor accessibility, for example, limit com petition or choice between such providers. Additionally, there is some concern that the growth related to private markets may not be equally distributed. Ugalade and Jackson (in Bennett et al., 1997) argue that privatisation disadvantages the poor, making access to crucial, life-enhancing services dependent upon the ability and willingness to pay. Of course, there are those who argue the reverse. For instance, Stren (cited in Labonte, 1998), in a discussion of urban services in Africa, suggests that the growth of private markets has improved the welfare of the poor by providing them with access to services not available to them. In bringing this argument to bear on the healthcare sector, the World Bank has suggested that the private sector can bring in new resources, thus allowing governments to focus upon the poor and on essential services, even expanding services to those who previously did not receive them. However, this oft-cited 'trickle down' claim of neoliberal economics is not supported historically (Hettne, 1995 and Amin, 1997, cited in Labonte, 1998). Indeed, the past two decades of economic and social policies based on privatisation of public services, declining government regulation, and increased free trade and invest ment, have seen global wealth inequalities more than double (New Internationalist, January 1997). Another worry is that the developing country government may be in no position to regulate or manage relationships with the private sector and with the form of competition which arises. We are not, after all, discussing nations with a long tradition of democratic government and entrepreneurial capitalism as their normal modus vivendi.
