The healthcare context Competing ideologies exist in healthcare. On the one hand is the altruistic, socially inclusive approach of adherents to the WHO 'Health For AlP (1978) philosophy, on the other is the view of health as a market commodity, to be bought (by those who can afford it). The moral dilemma implicit in these competing approaches is foreseen as problematic to the delivery of health services (WHO, 1997):

Health systems worldwide have failed to recognize the implications of the fundamental shift in the paradigm that has come to dominate economic and social development over the last decade. The paradigm can he paraphrased as 'the market approach'. It poses a number of fundamental

challenges to the pursuit of health for all. These include advancement of the notion that health is merely a commodity, and as such has a price and can he traded off against other commodities . . . [what is needed is] a radical reorientation towards development of health systems whose goal is the improvement of the health status and well-being of entire populations, with priority to those in greatest need.