Public-Private Mix

Malaria vaccine shortfall, heavy cost of Africa’s child deaths all thanks to global complacency
Kafuko Z: Daily Maverick, South Africa, 2024

The RTS,S/AS01 malaria vaccine produced by GSK was recommended by the World Health Organization in 2021. In October 2023, WHO recommended the second malaria vaccine, R21/Matrix-M, developed by Oxford’s Jenner Institute and manufactured by the Serum Institute of India. Both the RTS,S and R21 vaccines have been shown to be effective and safe. Yet for months it was unclear how many doses of R21 would be ordered and delivered; and only recently just 10 million were reported as ordered and delivered at a time when the number of doses available stood at 25 million. The solution to this shortfall is argued to require African action, to prioritise these lifesaving vaccines and push Unicef and GAVI to procure supply. Respective countries aiming to roll out the vaccines also need to authorise R21 through their regulatory authorities, a process that can take about 6 months. So far, only Nigeria, Ghana and Burkina Faso have done so. Applications to GAVI go through the ministries of health and finance and can be submitted only once every three months. The authors propose allowing a rolling window for applications to be submitted as soon as they are ready to save time, but also see the situation as .a wake-up call to Africa to build its own capacity for pioneering research and development of countermeasures against endemic diseases.

Africa’s High Cancer Deaths Can Be Addressed by Improved Access to Key Medicines
Cullinan K: Health Policy Watch, 2023

Africa has one of the highest cancer death rates in the world, yet this could be markedly improved by better access to treatments already widely available in high-income countries for the continent’s biggest killers – breast, cervical, lung and prostate cancers and Kaposi sarcoma. This is according to a recent study by the Botswana-Rutgers Partnership for Health, which researched which cancer treatments that are effective in other regions could have an impact in sub-Saharan Africa (SSA) – but are not available or hard to get. The partnership propose a framework for how to improve access to the life-saving and life-altering medications that are proven to work that are available elsewhere but not in Africa. While cost-effectiveness concerns are noted to be important in realistically increasing availability of a broad range of oncology drug therapies in SSA, they propose advancing therapeutics would reduce the significantly high case-fatality rates from cancer in SSA as a global imperative, combined with investment in diagnostic and laboratory infrastructure and in the oncology workforce.

R8bn and counting: That’s the cost of Covid-related corruption, says updated SIU report
Heywood M: Daily Maverick, South Africa, May 2023

The South African Presidency released the ‘Third Final Report’ of its investigations into Covid-related corruption in December 2022, probing 5,513 contracts given to 3,058 service providers. Irregularities were identified in 2,965 contracts to the tune of R8.8bn. Although the Special Tribunal has played a pioneering role since it was established, its work has often been hampered by legal challenges to its authority, although now empowered by an important decision in its favour by the Constitutional Court. The authors note that although irregularities to the value of R8.8-billion have so far been found by the SIU, the value of matters enrolled at the Tribunal is less than R2.5-billion and the rand value of cash and/or assets actually recovered so far is a mere R36-million. This is noted to be a vast disjuncture, amounting to less than half a percent, and that there is a lot of work to be done.

The Africa Care Economy Index
Femnet: African Womens development and communication Network, 2022

In Africa, the Care Economy has long been unrecognised. At least since the last pandemic — HIV-AIDS — caring work has been severely undervalued in the continent, and the redistribution of caring work, from females in the home and communities, next to non-existent. The COVID-19 pandemic has renewed attention to the care economy globally. The Africa Care Economy Index offers a concrete evaluation of African state performance in the recognition, support and redistribution of caring work. Based on a definition of care economy and related concepts relevant in Africa, the Index uses ten metrics to evaluate the 54 states of the continent. Demonstrating longstanding neglect of the care economy by all states in Africa, recommendations are made around broad policy and in depth research required to begin supporting and redistributing caring work. Social recognition and state support for caring work are shown to be central to building holistic development that benefits the majority in Africa.

Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda
Kabwama S N; Kiwanuka S N; Mapatano M A; et al: Globalization and Health 18(60), 1-10, 2022

This paper documented public and private sector partnerships in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 in responses to the COVID-19 pandemic, using literature review and key informant interviews. Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in service provision. The authors indicate that regulatory frameworks are needed in public–private engagements in pandemics, including of pricing, quality assurance and alignment with national plans and priorities.

Africa and the corrosive international tax system
Mukumba C; Etter-Phoya R: Tax Justice Network, 2021

Illicit financial flows are argued by the authors to punch holes in the public purse across the African continent. Over the past five decades Africa is reported to have lost in excess of US$ 1 trillion in illicit financial flows, dwarfing the continent's receipts of overseas development assistance during this period and the foreign direct investment into Africa. Based on research of national laws, policies and practice, each of the 70 countries included in the Corporate Tax Haven Index are given a score. African countries are found to contribute less to tax abuse than European Union and OECD member states and their dependencies, but have less robust transparency and anti-avoidance measures. The authors call for policy improvements in African countries to curb and protect against corporate tax abuse, and advocate for a UN Tax Convention.

Regulation of medicines advertisement in Zimbabwe: an assessment of the impact of pharmaceutical promotion on the prescribing behaviour of healthcare professionals
Semu T C; Ngara B and Mudzviti T: BMC Health Services Research 21(1337), 1-7, 2021

The authors present results of a cross sectional study the levels of knowledge, attitude and perception towards regulation of pharmaceutical promotion among 330 healthcare practitioners in Zimbabwe, using face-to-face interviews and a web-based online survey. The study found that healthcare practitioners in Zimbabwe have a favourable relative importance index score of knowledge (95%), attitudes (67%), and perceptions (90%). This outcome and a positive perception of the regulation of pharmaceuticals related to health care workers’ profession, gender, education level, the nature of the working institution and the number of prescriptions involved per week.

Challenges in health service delivery under public-private partnership in Tanzania: stakeholders’ views from Dar es Salaam region
Nuhu S; Mpambije CJ; Ngussa K: BMC Health Services Research 20, 765, 1-12, 2020

Public-private partnership in the health sector was introduced to improve the delivery of health services in Tanzania, but the expected outcomes have not been fully realised. This study investigated challenges encountered in implementing public-private partnership (PPP) institutional arrangements in health service delivery in Kinondoni Municipality, Dar es Salaam, Tanzania through interviews and document review. Findings revealed that although PPPs are hailed for supplementing the government’s efforts in the provision of health services, institutional arrangements for the smooth provision of these services are lacking. The challenges include inadequate resources, ineffective monitoring and evaluation, insufficient consultations between partners, inadequate legal and policy frameworks and ineffective implementation practices. The authors suggest that these areas need to be addressed in pursuing PPPs.

An assessment of the knowledge, practices and resources during the delivery of malaria health care services among private health care practitioners: a cross section study in the Mid-Western Region of Uganda
Wanzira H; Tumwine D; Bukoma P; et al: BMC Health Services Research 21(788), 1-12, 2021

This study documented the knowledge, practices and resources during the delivery of malaria care services, among private health practitioners in the Mid- Western region of Uganda, an area of moderate malaria transmission. The authors determined the proportion of health workers that adequately provided malaria case management according to national standards in interviews with 135-health facilities staff. The study revealed sub-optimal malaria case management knowledge and practices at private health facilities with only 14 % of health care workers demonstrating correct malaria case management cascade practices. To strengthen the quality of malaria case management, they recommend guidelines and tools, training; continuous mentorship and supervision; provision of adequate stock of essential medicines; and communication and data management at private health facilities.

The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems
Williams O; Chun Yung K; Grépin K: Global Public Health 16(8-9), 2021

For decades, governments and development partners promoted neoliberal policies in the health sector in many low and middle income countries, largely motivated by the belief that public services were too weak to meet population needs. Private health markets as a governance and policy solution to the delivery of health services enabled forms of market failure to persist in these countries. These were exposed during the COVID-19 pandemic, as analysed by the authors using data from an assembled database of COVID-19 related news items sourced from the Global Database of Events, Language, and Tone. They identify how pre-existing market failure and failures of redistribution have led to the rise of three urgent crises: a financial and liquidity crisis among private providers, a crisis of service provision and pricing, and an attendant crisis in state-provider relations. They note that COVID-19 has exposed important failures of the public-private models of health systems.