The authors write from the 68th World Health Assembly, where a drafting group of Member States are discussing the Framework of Engagement With Non-State Actors (FENSA). This process aims to determine the rules of engagement between WHO and non-State actors (NSAs), a moniker encompassing academia, nongovernmental organizations, philanthropic foundations, and the private sector. Many from civil society view this process as a way of safeguarding WHO's independence from private interests. The authors outline the fault lines in the proposals of contentious issues. During the open-ended process, India supported including language in paragraph 44 that named specific industries WHO should exercise caution in engaging with, such as the food, beverage, alcohol, and infant formula industries. India further proposed, "WHO's engagement will be strictly limited to assisting such industries to comply with WHO's norms and standards or guideline or policy." On behalf of the African group, Zimbabwe asserted that the "framework should explicitly list the types of industries that WHO will deal cautiously with and the reasons for the cautious engagement," also naming alcohol, food, and beverage. Greece argued, "strict rules should govern its [WHO] engagement with the pharmaceutical industries." Finland recommended a "high level of restriction" for engagement with industries that have "clear interests in health policies," referencing non-communicable disease control. Yet these calls were rejected by Canada, Denmark, Norway, and the United States. U.S. sought to eliminate the line concerning "other industries affecting human health" altogether. Other issues up for debate have been secondments from the private sector, as well as restrictions and/or ceilings on financial contributions from non state actors. The authors urged member states to ensure that FENSA creates a strong enough "fence" to safeguard public health.
Public-Private Mix
Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, the authors present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders, community leaders and men in the community. The authors observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organisation, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders was reported to have turned into resistance.
Over the last five years, universal health coverage (UHC) has become an agreed goal of global health policy and planning initiatives. However, scholars and health policy-makers have noted that attaining this goal will require a sufficient number of prepared and motivated health workers. The World Health Organization (WHO) is developing a global strategy on human resources for health. A consultation has concluded that progress towards UHC will require integrated, people-centred health services, a motivated health workforce and adequate financing from domestic and other sources. While the importance of human resources in UHC and the SDG agenda has been recognized, the extent and impact of health workers’ dual practice – that is, concurrent clinical practice in public and private sectors – has not received much attention. However, given the pervasiveness of dual practice and the growing prominence of the private sector in the provision of health services worldwide, its dynamics and impact on the attainment of UHC should not be ignored. Failure to understand why, how and to what extent health workers engage in dual practice may compromise attempts to regulate it and undermine progress. This paper presents dual practice examples, focusing on UHC-associated policy relevance of the available evidence, especially in low- and middle-income countries. It presents regulatory options in a range of contexts and future research needs.
In the wake of recent widespread failures of privatisation efforts, many communities in the global south now seek new, progressive ways to revitalise the public sector. From rural Guatemalan towns holding the state accountable for public health to an alliance of waste pickers in India and decentralised solar electricity initiatives in Africa, people worldwide are rising up with innovative public service solutions to difficult issues. Making Public in a Privatised World explores such cases, with essays that uncover the radically different ways grassroots movements have proved themselves as successful alternatives in providing essential public services where privatised efforts have failed. Using numerous in-depth case studies, this book offers probing insights from a diverse range of contributors from across the world, including academics, activists, unionists, and social movement organisers. Making Public in a Privatised World addresses the growing worldwide interest in exciting alternatives to privatisation in both developed and developing countries.
Governments around the world are increasingly turning to the use of stand-alone, state-owned utilities to deliver core services such as water and electricity. This article reviews the history of such ‘corporatisation’ and argues that its recent resurgence has been heavily influenced by neoliberal theory and practice, raising important questions about whether it should be adopted as a public service model. Not all corporatisations promote commercialisation, however. The article also discusses stand-alone utilities that have managed to stave off market pressures and develop in more equity-oriented directions. The scope for non-commercialised corporatisation is narrow, but given the expansion of this organisational model, the author argues that it is important that we understand both its limitations and potentials, particularly in low-income countries where service gaps are large and equity is a major challenge.
The National Cancer Registry (NCR) was established as a pathology-based cancer reporting system. From 2005 to 2007, private health laboratories withheld cancer reports owing to concerns regarding voluntary sharing of patient data.The study aimed to estimate the impact of under-reported cancer data from private health laboratories. A linear regression analysis was conducted to project expected cancer cases for 2005 - 2007. Differences between actual and projected figures were calculated to estimate percentage under-reporting. The projected NCR case total varied from 53 407 (3.8% net increase from actual cases reported) in 2005 to 54 823 (3.7% net increase) in 2007. The projected number of reported cases from private laboratories in 2005 was 26 359 (19.7% net increase from actual cases reported), 27 012 (18.8% net increase) in 2006 and 27 666 (28.4% net increase) in 2007. While private healthcare reporting decreased by 28% from 2005 to 2007, this represented a minimal impact on overall cancer reporting (net decrease of <4%).
Dual practice or multiple job holding, generally involves public sector-based health workers taking additional work in the private sector. This form of the practice is purported to help retain public health care workers in low and middle-income countries’ public sectors through additional wage incentives. There has been little conceptual or empirical development of the relationship between dual practice and retention. This article helps begin to fill this gap, drawing on empirical evidence from a qualitative study focusing on South African specialists. Fifty-one repeat, in-depth interviews were carried out with 28 doctors (predominantly specialists) with more than one job, in one public and one private urban hospital. Findings suggest dual practice can impact both positively and negatively on specialists’ intention to stay in the public sector. This is through multiple conceptual channels including those previously identified in the literature such as dual practice acting as a ‘stepping stone’ to private practice by reducing migration costs. Dual practice can also lead specialists to re-evaluate how they compare public and private jobs, and to overworking which can expedite decisions on whether to stay in the public sector or leave. Numerous respondents undertook dual practice without official permission. The idea that dual practice helps retain public specialists in South Africa may be overstated. Yet banning the practice may be ineffective, given many undertake it without permission in any case. Regulation should be better enforced to ensure dual practice is not abused. The conceptual framework developed in this article could form a basis for further qualitative and quantitative inquiry.
Ownership of healthcare providers has been considered as one factor that might influence their health and healthcare related performance. The authors provide an overview of what is known about the effects on economic, administrative and health related outcomes of different types of ownership of healthcare providers -namely public, private non-for-profit (PNFP) and private for-profit (PFP)- based on the findings of systematic reviews (SR). Of the 5918 references reviewed, fifteen SR were included, but six of them were rated as having major limitations, so they weren't incorporated in the analyses. According to the nine analysed SR, ownership does seem to have an effect on health and healthcare related outcomes. In the comparison of PFP and PNFP providers, significant differences in terms of mortality of patients and payments to facilities have been found, both being higher in PFP facilities. In terms of quality and economic indicators such as efficiency, there are no conclusive results. When comparing PNFP and public providers, as well as for PFP and public providers, no clear differences were found. PFP providers seem to have worst results than their PNFP counterparts, but there are still important evidence gaps in the literature that needs to be covered, including the comparison between public and both PFP and PNFP providers. More research is needed in low and middle income countries to understand the impact on and development of healthcare delivery systems.
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.
The demand for nurses is growing and has not yet been met in most low and middle-income countries. In India, Kenya, South Africa and Thailand, there has been a rapid proliferation of private training institutions to increase the supply of nurses. This infogram summarises evidence from RESYST research examining the role of these private institutions, their contribution to the wider health systems, and how governments in these countries have managed the opening of markets to the private sector. Private nurse training institutions are reported to be playing an increasingly important role in producing nurses in many low and middle income countries. Governments need to ensure that graduates from both private and public institutions are of sufficient quality to meet the health needs of their populations, and that training institutions have the capacity to train more nurses. In some countries including India and Kenya, the benefits of expanding nurse production through the private sector have been hindered by high levels of international migration. A balance needs to be struck between producing nurses for export, and ensuring sufficient supply and skill-mix for domestic markets.