Public-Private Mix

africa: CONDOMS COUNT: MEETING THE NEED IN THE ERA OF HIV/AIDS

This report, produced by Population Action International, argues that condom promotion and provision is one of the most effective methods for preventing HIV/AIDS. They state that 8 billion would have been the minimum number of condoms to have made a difference to the spread of HIV in 2000, and that the 950 million provided by donors were therefore hugely inadequate. The report says that a number of different interventions are necessary for effective prevention programmes: the authors highlight the need for addressing poverty, gender inequity and promoting the 'ABCs' of abstinence, fidelity and condom use. However, they state that the mix of interventions must always include condoms. In calling for universal access to condoms, the report states that public/private partnerships will be necessary and that market segmentation, whereby those who can afford to pay more than the poorest, should be encouraged.

African app cuts medical costs with community "virtual pharmacy"
Reuters: Times Live, February 2017

A mobile app in Senegal helps families save money and reduce waste through a "virtual pharmacy" where users can exchange leftover medication for new prescriptions. JokkoSante is scaling up after a two-year pilot phase in one Senegalese town. It aims to reach 300,000 families in the West African nation by the end of the year. The app allows users to trade in unused, packaged medicine for points which can go toward the purchase of new medicine when they need it. All of the exchanges are done at health centres or pharmacies by licensed professionals. Users can send points to family members and friends, and donors can buy points for people in need. The project has been driven by telecoms companies. It reaches a certain demographic, such as women in their thirties, and if a matching user doesn't have enough points to pay for a prescription she will receive a text saying which company donated to complete her purchase.

African Newsletter on Occupational Health and Safety Issue of Infectious Diseases
African Newsletter on Occupational Health and Safety 25 (1), 2015

This issue of the African Newsletter on Occupational Health and Safety examines infectious disease and occupational health. Marie-Paul Kelly explores governance and leadership, both at regional and global levels in preventing health emergencies. The issue explores guidance to workplaces and occupational health professionals in prevention of occupational infections and examines the workplace as an arena for raising awareness on infectious diseases. Further papers look at protecting front-line health care workers and enterprise workers from Ebola. Jeanneth Manganyi and Kerry Wilson author a paper on the importance of respirator fit testing and proper use of respirators. Further articles in the issue explore food-borne illnesses at workplaces, the effectiveness of personal protective equipment to prevent Ebola transmission and the use of blunt suture needles to halve the risk of needle stick injuries among surgeons.

African Union Technical Committee meeting on Local Production on Pharmaceuticals Johannesburg, South Africa
Dr Manto Tshabalala-Msimang, MP Minister of Health of South Africa and Chairperson of the Bureau of the Third Session of the African Union Conference of Ministers of Health, 18 February 2008

As the World celebrates 30 years of the Alma Ata Declaration that launched the Primary Health as the Pillar of Quality services, there is greater need for all of us to improve access to affordable medicines. Even in rich countries, access to affordable medicines cannot be guaranteed. Of course, the problems are much greater in many developing countries, with insufficient or no manufacturing capacities in the pharmaceutical sector. In Africa we are too reliant on other countries to provide essential medicines for us. This is not strategic and correct, as we cannot guarantee availability of appropriate technologies that truly respond to our current and emerging needs.

Agreements and disagreements with Oxfam
Montagu D, Feachem R, Feachem NS, Koehlmoos TP, Kinlaw H, Smith R: 17 April 2009

The point made by Oxfam’s chief executive concerning failed states and the proliferation of private security firms is indicative of the ideological predisposition that impedes an open debate regarding healthcare delivery in developing countries. The view that healthcare is a fundamental responsibility of the State and must be largely provided by agencies of the State is not generally accepted outside of the UK, and is increasingly being challenged within the UK. British organisations tend to be skeptical of the private sector, but elsewhere the important role of the private sector in health systems, in countries both with and without well functioning state health programmes, is widely acknowledged. Public versus private provision is not a binary choice facing governments, donors, patients, and global policy makers – there is enough space for both to co-exist.

Alternatives to privatisation of health services: Perspective from Africa
Dambisya Y: University of Limpopo and EQUINET in the Municipal Services Project: 2010

The Municipal Services Project and Focus on the Global South held a one-day workshop on building alternatives to the privatisation of basic services on 31 March 2010 in New Delhi, India. This presentation on health in Africa was given at the workshop. The presenter discussed some alternatives to privatisation, such as community-based health insurance and mutual health organisations. Functional national health insurance schemes are already in operation in Ghana and Nigeria, while South Africa is busy putting together its own scheme and a similar scheme is in its initial stages in Uganda. Community-based alternatives to the privatisation of health services were considered but measures are needed to promote equity through cross-subsidisation provisions for democratic participation and improved quality of health services. However, the presenter pointed out that administrative efficiency and the cost effectiveness of collecting the premiums in community-based approaches were often problematic and sustainability was also a challenge, and faced dwindling membership due to low income. Benefits, including improved accountability through greater member involvement, were more likely if these approaches were integrated with national health systems, as shown in Rwanda, Tanzania and Ghana.

Amanzi Ngawethu (The Water is Ours)
Coalition Against Water Privatisation, Centre for Applied Legal Studies, Anti-Privatisation Forum, Friction Films, Phiri Concerned Residents and Unitarian Universalist Service Committee: 2010

In September 2009, the Constitutional Court of South Africa heard the final appeal in a case brought by five Soweto residents challenging prepaid water meters and insufficient free basic water. The Bill of Rights of the South African Constitution guarantees right of access to sufficient water. However, poor communities in Johannesburg's townships do not have sufficient water and do not receive the same water service as the richer suburbs. Amanzi Ngawethu (The Water is Ours) is a short documentary representing the six-year legal battle against water privatisation. It brings together protest songs, photos and video from people and organisations involved in the struggle and working in solidarity.

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda
Okal J, Kanya L, Obare F, Njuki R, Abuya T, Bange T, Warren C, Askew I and Bellows B: Health Research Policy and Systems 11(38): 18 October 2013

This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages. Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program.

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher programme in Uganda
Okal J, Kanya L, Obare F, Njuki R, Abuya T et al: Health Research Policy and Systems 11(38), 18 October 2013

This paper describes a reproductive health voucher programme that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the programme to include public sector facilities. Researchers conducted interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher programme in south-western Uganda. Barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the programme by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in south-western Uganda is constrained by both facility and individual level factors that can be addressed by inclusion of the public facilities in the programme. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher programme with other services is likely to address some of the barriers. Accrediting public facilities has the potential to increase voucher programme coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening links between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilisation of resources to support the sustainability of the programmes. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher programme.

An assessment of private General Practitioners contracting for public health services delivery in O.R. Tambo District, South Africa
Hongoro C; Funani I; Chitha W; Godlimpi L: Journal of Public Health in Africa 6(2) doi: http://dx.doi.org/10.4081/jphia.2015.525

Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contract related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The authors suggest that the idea of a one-size-fits-all contract was probably inappropriate.

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