Public-Private Mix

A pilot study on quality of artesunate and amodiaquine tablets used in the fishing community of Tema, Ghana
Affum AO, Lowor S, Osae SD, Dickson A, Gyan BA and Tulasi D: Malaria Journal 12(220), 28 June 2013

This pilot study on the quality of anti-malarial tablets for sale in retail outlets during the major fishing season was conducted in a malarious fishing village located along the coast of Tema in southern Ghana. Researchers randomly sampled blisterpacks of anti-malarial tablets and assessed them according to the International Pharmacopoeia and Global Pharma Health Fund Minilab protocols. When testing for genuine artesunate per tablet, 10% of one manufacturer’s tablets and 50% of the other’s passed the titrimetric test. While 100% of the first manufacturer’s tablets passed for genuine amodiaquine, 17% of a similar package by the second manufacturer failed spectrophotometric testing. The inadequate amounts of artesunate and amodiaquine detected in the tablets suggest that both pharmaceutical companies may not be following recommended drug formulation procedures, or the active pharmaceutical ingredients might have been degraded by improper storage conditions. The authors conclude that the drugs being sold at Kpone-on-Sea, Ghana may likely be classified as substandard drugs and are not suitable for malaria treatment.

A Public-Private Partnership for Sustainable Malaria Prevention
USAID, 14 November 2006

In 1999, the U.S. Agency for International Development launched the NetMark, in partnership with the Academy for Educational Development, to reduce the human cost caused by malaria. Since its launch, NetMark has developed partnerships with 37 African and 9 international commercial partners. NetMark's mission is to reduce malaria cases and deaths in Africa by increasing the availability, affordability and use of insecticide-treated bednets (ITN) through partnerships with commercial net and insecticide manufacturers, their African distributors, ministries of health, and NGOs. To accomplish this goal, NetMark works through public-private partnership to achieve both short and long-term public health impact. NetMark's model, based on efficient and effective delivery of ITNs, could easily be applied to other areas of malaria prevention.

A Survey of Prescribing Practices of Health Care Workers in Kibaha District in Tanzania
Massele AY, Nsimba SE, Fulgence J: Tanzania Medical Journal 22 (1): 31-33, 2007

Previous studies in the public sector in Tanzania, have demonstrated major prescribing problems due to poly-pharmacy and irrational use of antibiotics and injections. Little is understood about prescribing in the private sector. This paper measures and compares prescribing practices in public and private dispensaries in Kibaha District Tanzania. Prescribing of antibiotic and injections was significantly higher in private than in public dispensaries (P<0.05). The extent of prescribing in private dispensaries calls for intervention to reduce overuse of antibiotics and injections.

A Trojan horse of the private sectors interests at the World Health Organisation
People’s Health Movement; Medicus Mundi International: 26 January 2016

A January 2016 statement of the People's Health Movement (PHM) and Medicus Mundi International (MMI) identified that the Framework of Engagement with Non-State Actors (FENSA) currently under discussion at the World Health Organisation (WHO) fails to provide a robust framework against undue influence of the corporate sector and its philanthropies. In the statement the PHM and MMI argue that FENSA is symbolic of a more fundamental issue of the compromise to WHO’s independence due to its under-funding and tightly earmarked voluntary contributions making it vulnerable to such influence. They argue for an end to the dual freeze on the WHO Programme Budget and on assessed contributions which severely limits WHO’s functioning. "Until and unless this is addressed, WHO stands at risk of private sector capture and further loss of its integrity, independence, and credibility", the statement warned.

Abolishing user fees for child health

This Save the Children brief shows that abolishing user fees and covering the relatively small cost of abolition would immediately save nearly a quarter of a million children under five. It argues that user fees for basic healthcare, paid in the poorest countries around the world, are in reality "killer bills". Children and their families either don’t go to the health clinic when they are sick or when they do, and have to pay, they are forced further into poverty and sometimes have to go without food. Some families remove children from school in order to pay for health care.

Access to Health and Public-Private Partnerships
Krebs V: Geneva Health Forum, 30 August 2006

As a medical doctor, working in the field of maternal and neonatal health, Dr. Imtiaz Jehan sees public-private partnerships and the challenges related to access to health from a Southern perspective. She shares with us how she believes progress can be made for the public and the private sectors to working together.

Achieving universal health coverage in East and Southern Africa: what role for for-profit providers?
Doherty J: Paper presented at the Panel session T03P13: Private sector and universal health coverage - examining evidence and deconstructing rhetoric International Conference on Public Policy, 1-4 July 2015, Milan, Italy

This paper considers evidence on the effectiveness, equity and sustainability of for-profit private provision, and the effectiveness of government’s stewardship of the sector, in East and Southern Africa. It draws conclusions about policy and regulatory requirements to encourage for-profit providers to make a more useful contribution towards achieving universal health coverage in the region. The author observes a recent increase in the size of a formerly relatively small for-profit private sector in some countries in the region, but also the emergence of 'boutique’ hospitals (targeted at the high-income local market, expats and foreign NGO workers, as well as medical tourism) in otherwise underdeveloped settings. As warned by the international literature that critiques the commercialisation of health care, such developments could worsen inequity and destabilise national health systems if inadequately regulated.

Activists call on NCD Alliance to protect public health from private interests
Rundall P: Baby Milk Action, 19 May 2012

In the run up to the 65th World Health Assembly (21-26 May 2012) the NCD Alliance, a major international alliance of organisations working in the field of non-communicable diseases (NCDs) revised its statement calling on its Member States to support the creation of a Global Platform on NCDs. After the Conflict of Interest Coalition expressed its concerns to the Alliance over private sector involvement in health policy and planning in such a platform, the Alliance added the clause ‘with appropriate safeguards for public interest over private profit’ and issued a new statement in May 2012. Rundall argues that this amendment does not adequately address the need for a clear differentiation between policy, norms and standards development and involvement in implementation. She warns that lack of clarity will play into the hands of those who favour slow, industry-friendly, voluntary approaches rather than legally binding measures that hold the private sector accountable for their practices.

Advance market commitment for pneumococcal vaccines: Putting theory into practice
Cernuschi T, Furrer E, Schwalbe N, Jones A, Berndt ER and McAdams S: Bulletin of the World Health Organisation 89(12): 913-918, December 2011

Markets for life-saving vaccines do not often generate the most desired outcomes from a public health perspective in terms of product quantity, quality, affordability, programmatic suitability and/or sustainability for use in the lowest income countries, according to this paper. The perceived risks and uncertainties about sustainably funded demand from developing countries often leads to underinvestment in development and manufacturing of appropriate products. The pilot initiative Advance Market Commitment (AMC) for pneumococcal vaccines, launched in 2009, aims to remove some of these market risks by providing a legally binding forward commitment to purchase vaccines according to predetermined terms. To date, 14 countries have already introduced pneumococcal vaccines through the AMC with a further 39 countries expected to introduce before the end of 2013. The authors of this paper describe early lessons learnt on the selection of a target disease and the core design choices for the pilot AMC. They highlight the challenges faced with tailoring the AMC design to the specific supply situation of pneumococcal vaccines and points to the difficulty – and the AMC’s apparent early success – in establishing a long-term, credible commitment in a constantly changing unpredictable environment. One of the inherent challenges of the AMC is its dependence on continuous external funding to ensure long-term purchases of products. The authors examine alternative design choices and aim to provide a starting point to inform discussions and encourage debate about the potential application of the AMC concept to other fields.

Advertisement and knowledge of tobacco products among Ellisras rural children aged 11 to 18 years: Ellisras Longitudinal study
Monyeki KD, Kemper HCG, Amusa LO and Motshwane M: BMC Pediatrics 13(111), May 2013

Tobacco products use is the leading cause of chronic diseases morbidity and mortality. This study explores an exposure to tobacco advertisements factors and knowledge, an association with snuff/pipe usage and cigarette smoking among rural children aged between 11 to 18 years in Ellisras, South Africa. A total of 1,654 subjects (854 boys and 800 girls) completed the questionnaire. Results showed that a significant number of boys (11.7%) compared to girls (8.8%) received free cigarettes from the members of the community. Bill boards were successful in advertising tobacco products among the Ellisras rural boys (17% boys and 12.8% for girls). The authors found significant association between cigarette smoking and advertisements of tobacco products on the TV screens, videos or movies. Though tobacco products legislation exists in South Africa, the authors argue that efforts should be taken by the health professionals to emphasise the danger of using tobacco products even among the illiterate. Teachers and parents should refrain from advertising tobacco products at schools and at homes.

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