Day 3: Health as a Public Good

Activity 8: Chile, India, Sri Lanka, South Africa – The global neoliberalisation of health

Day 3: Health as a Public Good

Activity 8: Chile, India, Sri Lanka, South Africa – The global neoliberalisation of health

3 hours


To help us to:

  • Deepen our political economy tools of analysis through exploring social stratifications that compound and intersect, exacerbating marginalisation 
  • Challenge dominant and normative perspective in political economy analysis

Task 1
Group work: Researching health neoliberalisation in countries of the South

(1 hour 30 mins) 

information on your country case study on the pages that follow, and then there are web links with additional information about the country. 

Each group will also have a resource person who has studied their country ahead of today: 

  • Case Study 1 – Chile with Masana 
  • Case Study 2 – India with Thandokazi
  • Case Study 3 – South Africa with Funzani
  • Case Study 4 – Sri Lanka with Dinga

Working in groups, take a maximum of 1 hour to read the information on your country. Engage with the often emotive language quoted or used, and how you respond to it! When papers are long, do a quick scan read, starting with the introduction and conclusion and then search for ‘health’ or ‘equity’ etcetera to zoom in on key sections. You will not have time or need to read full lengthy papers. Then take a maximum of 30 minutes to prepare a country report. Use your political economy tools of analysis in thinking through the key issues for your report, and if you need to, do some quick online searches to gaps in your reading. 

The following guiding questions can be used in preparing your flipchart presentation: 

  1. What does the health system look like today? (i.e. its structure)? 
  2. How does the system work? What are the key dynamics? 
  3. Who are the role players, who gets to benefit?
  4. What does state capacity look like?
  5. Are health needs of the local population being met?
  6. What is the quality of the healthcare provided?

Be ready to present your group’s flipcharts in a captivating way in plenary. 

Task 2
Plenary: Exchange Students World Café on Health Equity

(1 hour) 

For this task, we will introduce an adaptation of the World Café reporting methodology. Around the room four tables will be identified as Café tables. There should be no more than five chairs around each table. Please carry your journal and pen with you on your exchange programme! 

Here is how this will unfold (50 minutes):

  1. Each country group rapporteur is required to be stationary at each of the four tables, ready to share their country report in 5-6 minutes. They are the ‘table hosts’, who remain stationary throughout Task 2.
  2. Join a table of a country that you are interested in hearing about. This will be the first of three rounds of listening and conversation on the country you have chosen to visit. Five people, maximum should be seated at each table.
  3. Listen to your host tell you about the country they ‘visited’. At the end of their ‘report’ have a conversation for another 4-5 minutes, focusing on what you would want to borrow from that country and integrate into our NHI, to ensure equity. Take notes in your journal on what stands out for you as critical for a powerful equitable South African NHI! 
  4. At the end of the 10 minutes, each member of the group moves to a different country table. The host will tell them briefly what happened before they arrived, sharing their country report in 5-6 minutes. 
  5. Listen to the host story and engage in conversation for a further 4-5 minutes, again focusing on what you would want to borrow from that country to integrate into our NHI and ensure equity. Remember to take notes in your Journal each time! 
  6. Repeat the rotation for the final time two times.

The entire process should take no more than 45 minutes. The facilitator will prompt you to move tables when the time is up.

This World Café time will end with a 15-minute all-tables plenary conversation. Fellows will contribute their nuggets of what stood out for them from different countries as critical for a powerful equitable South African NHI. Secondly, we will hear from our country resource people to close any gaps on what came through at their café table. Last, the facilitator will offer a distilled picture of what we have learned about the critical features of a South African NHI, if it is to be on a definitive path away from neoliberalism.

Case Study 1


Chile, the country needs a serious and meaningful change, to move away from the economic and social model forged by Pinochet. It is widely acknowledged that the neoliberal model first took hold not in Margaret Thatcher’s Britain or Ronald Reagan’s United States, but in Pinochet’s Chile. Under the dictatorship, the state was shrunk to the minimum, relinquishing to profit-driven businesses the provision of rights through the privatisation of public services.

Recently, when Gabriel Boric was elected President with an overwhelming majority, Chileans are reported to have been elated. The known Left-wing Boric had been pitted against the far-right José Antonio Kast, who had systematically denied the climate crisis, attacked the rights of immigrants, women, and the LGBTQ community, and spoken admiringly of Augusto Pinochet, the murderous dictator who ruled Chile from 1973 to 1990.

Now the country moves to kill neoliberalism, known to have been born in Chile and Chile is where it’s death will be recorded, provoked by it’s new, young, elected president. 

Resource materials

Case Study 2


Throughout history pandemics have exposed limits of health systems, and recently the COVID-19 pandemic has exposed the toxic effects of a system that has for far too long dominated every aspect of our societies. Neoliberalism, as an economic philosophy of capitalism, has depleted our public services, turned education and healthcare systems into profit-driven businesses, hoarded profits at the expense of undervalued and underpaid workers, favored profitability over well-being, and aggravated inequalities between people and countries.

The neoliberal system has been wreaking havoc across the globe, including in India. The health system in India is in crisis as a result.

Resource materials

Case Study 3

South Africa

The African National Congress (ANC) post 1994 is known for its adoption of neoliberal policies and ideologies that has resulted in the deepening and perpetuating of socio-economic inequality along racial lines in ‘post-apartheid’ South Africa.

The historical context leading up to the ANC’s adoption of neoliberal policies in the local and global context, shows how neoliberal policies and its gears perpetuate socio-economic inequalities which render the transformative promises of the Constitution hollow, using specific examples like the privatisation of water and murder of workers in the Marikana massacre. What has this neoliberal agenda looked like in South Africa, and what has it meant for South Africans? 

The economic policies of austerity, deregulation, dismemberment of state enterprises and the financialisation of development. These have seen country’s chronic and now worsening myriad of social challenges. Through the parliamentary processes, government process, therefore, the macroeconomic institutions and the state continually embed in the national being to these neoliberal philosophies through social, economic, and juridical expectations.

Resource materials

Case Study 4

Sri Lanka

Sri Lanka is considered to be South Asia’s outlier in terms of the incidence of absolute poverty and severe deprivation.

In 2012, the country was ranked 92 in the UN Human Development Index which is higher than any other country in South Asia and grouped in the high human development category. This classification is based upon the island’s indicators of life expectancy, mean years of schooling in association with expected years of schooling and its per capita gross national income at higher purchasing power parity. Sri Lanka has a population of 20, 277 597 people, 51.5 percent of whom are women.

While Sri Lanka has been shaped by neoliberal policies through successive regimes since the reforms after 1977, the civil war had its costs which included slowed economic growth. With the end of the war in 2009, global finance capital and investment by other countries like China contributed to a massive transformation of the economy with infrastructure and some development.

The neoliberal trajectory of this post-war economy involved great financialisation of the economy, with relatively high levels of economic growth between but dependent on construction with foreign borrowings. The structure of foreign debt also went through a transformation, with high-interest short-term loans for sovereign bonds and euro dollar bonds for commercial banks and bilateral aid from China at commercial rates. Sustaining such growth through international debt required rolling over previous loans with newer and larger loans. Even as the chances of debt-related economic crisis increased. 

Resource materials