Public-Private Mix

Anti-counterfeiting initiative aimed at protecting African medical industries
New W: Intellectual Property Watch, 8 August 2008

West African people should establish a medical anti-counterfeiting task force to promote local herbal medicines by protecting indigenous knowledge and genetic property. This is according to the communiqué from a workshop held in Accra, Ghana from 21-23 July 2008. A survey conducted by WHO between January 1999 and October 2000 found 60% of counterfeiting incidents occurred in developing countries and 40% in industrialised nations. To protect the local medical industries, the task force will prepare a mechanism for reporting counterfeit issues, including its harmful effect on local economy and health and launch awareness creation programmes as well as advising governments and local companies on ways to increase the use of security features on their products including medicines, cosmetics and medical devices. According to President Kufuor, this protection of intellectual property rights for local medical industries will sustain socioeconomic development that depends on investment and the growth of local industries, entrepreneurs and innovators who are willing to invest the capital needed to create brands and copyrights and to deploy money into research and development necessary to produce products which are accorded IP rights.

Are We In It for the Long Haul?

Many AIDS activists have been enraged by the export abroad of conservative American morality on sex, drugs and prostitution through HIV/AIDS programs funded by the U.S. government. Particularly galling is that it replaces accepted, evidence-based public health policies with ideology. But if there is one thing this U.S. government hates more than fags, junkies, hookers, condoms and clean needles, it's socialized medicine. Quietly, the President's Emergency Plan for AIDS Relief (PEPFAR) and other bilateral initiatives are exporting the HMO-ization of AIDS in Africa and elsewhere on the planet, in which a network of private institutions are being built up to provide antiretroviral therapy (ART) to the millions who need it.

Article: Insurance Benefit Preferences of the Low-income Uninsured

Marion Danis, MD, Andrea K. Biddle, PhD, Susan Dorr Goold, MD. Journal of General Internal Medicine
Volume 17 Issue 2 Page 125 - February 2002. A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints.

Further details: /newsletter/id/29182

This paper, Prepared and Presented at the 'Making Services Work for Poor People' World Development Report (WDR) 2003/04 Workshop, puts forward three arguments. First our understanding of the health sector is handicapped by trying to fit it into language and concepts which do not adequately capture its changing realities and the political economies within which health sectors are embedded. Second, this has disposed to putting forward decontextualised, and thus largely normative solutions, such as “regulation,” to the problem of improving service delivery in poorly performing environments. Third, approaches need to move beyond the dualism of public versus private and work creatively with messy and sometimes contradictory realities. It concludes with a discussion of how this analysis can be applied to a major international intervention set up to benefit the poor – the Global Fund for HIV/AIDS, TB and Malaria.

Big tobacco and the food and beverage industry are NOT civil society
Gonsalves G: Health-e News, 27 September 2011

The Global Business Coalition for Health (GBCHealth), which took part in the United Nations Conference on Non-Communicable Diseases (NCDs) held in New York in September 2011, has argued that companies must have a place at the tables where their future is discussed. GBCHealth, which represents companies that manufacture unhealthy (junk) foods and tobacco products, believes that their expertise is essential to developing public health policy. But activists disagree, arguing instead that industries producing unhealthy products should not be viewed as trusted partners and should not have a seat at the table during public health negotiations. In this open letter, AIDS activist Gregg Gonsalves responds to GBCHealth’s article justifying their right to be part of the negotiations. Though GBCHealth has had a long history of working on HIV and AIDS, he argues that big business cannot be considered representative of civil society, which is largely composed of marginalised groups, civil society organisations and other interested parties whose fight for civil, social and economic rights are not part of big business, whose primary goals are profit oriented. He calls on big business to stop trying to halt generic production of anti-retrovirals and drugs for NCDs (such as Novartis' continuing attempts to alter Indian patent law), to stop selling and promoting cigarettes and to stop advertising and marketing of high-sugar and high-fat foods across the globe.

Bill and Melinda Gates Foundation's grant-making programme for global health
McCoy D, Kembhavi G, Patel J and Luintel A: The Lancet 373(9675):1645–1653, 9 May 2009

Although the Bill and Melinda Gates Foundation’s contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. This paper is an analysis of 1,094 global health grants awarded between January 1998 and December 2007, totalling US$895 billion, of which $582 billion (65%) was shared by only 20 organisations. In total, $362 billion (40% of all funding) was given to supranational organisations such as the World Health Organization, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria. Of the remaining amount, 82% went to recipients based in the United States. Just over a third ($327 billion) of funding was allocated to research and development (mainly for vaccines and microbicides) or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.

Bill Gates Won’t Save You From The Next Ebola
Fortner R; Park A: The World Post, May 2017

The author points out that no single non-governmental institution or individual wields more influence, and no one’s support is more powerful in global health, than the Gates Foundation and its namesake founders, Bill and Melinda Gates. The foundation has $39.6 billion in assets and spent $2.9 billion on developmental assistance for global health in 2015 alone ― more than every country in the world except the U.S. and the U.K. The author argues that WHO has frequently fallen short of its goal to protect and promote health of all people, leading some to propose returning to a more philanthropy-focused model. That means private charities such as the Gates Foundation might play an even larger role in protecting public health, which calls for scrutiny of the role that philanthropy has played in recent years. When the Gates Foundation takes aim at a disease, it can elicit billions of dollars from governments and reshape the world’s agenda for scientific research, to the cost of other diseases. WHO reliance on voluntary contributions from countries and private donors, including the Gates Foundation, for around 80 percent of its budget is argued to make the organisation vulnerable to outside pressure and funder 'pet programs', which skews global health priorities. The author documents trends post 2014 and argues that the world remains grossly underprepared for outbreaks of infectious disease, which are likely to become more frequent in the coming decades, according to a meta-analysis of post-Ebola studies published in January 2017. The author indicates that public and state funding remains critical for international health efforts and cannot be left to private players to fill the void.

Blind optimism: Challenging the myths about private health care in poor countries
OXFAM briefing paper 125: February 2009

This paper shows there is an urgent need to reassess the arguments used in favor of scaling-up private-sector provision in poor countries. The evidence shows that prioritising this approach is extremely unlikely to deliver health for poor people. The paper recommends that donors should rapidly increase funding for the expansion of free universal public health-care provision in low-income countries, including through the International Health Partnership. Developing countries must resist donor pressure to implement unproven and unworkable market reforms to public health systems and an expansion of private-sector health-service delivery. Civil society must also act together to hold governments to account by engaging in policy development, monitoring health spending and service delivery, and exposing corruption.

Board of Healthcare Funders and Government: ‘I’ll change if you’ll change’
Bateman C: South African Medical Journal104(10), October 2014

While the South African government and private healthcare funders urged one another to make internal changes to enable faster progress towards a more equitable healthcare system, some concrete evidence of vitally needed partnership did emerge from the Board of Healthcare funders' conference held in August 2014. Government’s new Essential Drugs Committee will include representatives of the private healthcare funding industry to obtain consensus on just which essential medicines should be available to patients.
A blueprint on how the National Department of Health (NDoH) can partner
with the private healthcare funding sector in conducting economic evaluations of products to save both sectors time and money (and avoid
longstanding unnecessary duplication) has been drawn by NDoH. National Health Minister Dr Aaron Motsoaledi also pleaded with delegates to ‘embrace change’, warning that they would be hardest hit by the‘exploding’ epidemic of non-communicable diseases if they failed to introduce health promotion and disease prevention measures.

Bridging the gap in South Africa
Bulletin of the World Health Organization 88:798, November 2010

According to this article, South African government spending on health care comprises less than half of total health expenditure even though the public system serves more than 80% of the population (i.e. around 40 million South Africans) without private health insurance. Around 70% of all doctors and most specialists only work in the private sector, the remaining 30% serve the public sector. Sixteen per cent of the population use private doctors and hospitals which are covered by their health insurance, often with a monthly contribution from their employers. It is this stark public–private divide that the South African Government hopes its proposed National Health Insurance (NHI) scheme will deal with by providing universal access to health care based on need rather than ability to pay. Despite some reservations about whether government can afford to pay for the proposed national health insurance scheme, an integrated pool of funds has been offered as one way to ensure that all the public sector’s available human resources are used more effectively and efficiently.