The Health Sector Strategic Plan (HSSP) aims to ensure access to basic health care by the Ugandan population through the delivery of the National Minimum Health Care Package (NMHCP). This requires availability of well-trained health professionals. This study demonstrates that the Private-Not-For-Profit (PNFP) Health Training Institutions - the majority in Uganda - have remained grossly under-funded, which poses a threat to achievement of the HSSP. They are faced with decreasing income from fees, dwindling donor support and over-dependence on government grants which are both uncertain and erratic. Consequently, vital activities for students' training such as field trips, teaching and reading materials are left unsatisfied as a copying mechanism, but not without negative implications for quality. It is recommended that government increases and guarantees its support to these Health Training Institutions as a way of maintaining quality of health worker training. At the same time, the training institutions need to diversify their funding options to include designing short tailor-made courses, mobilising alumni contributions, research and consultancies, self-help projects like farming, canteens and stationeries as well as fund-raising activities as a way of bridging their funding gap. This should be coupled with more efficiency mechanisms and prudent management to avoid wastage of the already scarce financial resources.
Public-Private Mix
This paper traces the history of the public-private partnership for health (PPPH) in Uganda, giving its justification and mandate. It also gives its current state of the art, outlining the successes scored, the challenges still faced in its implementation and current efforts being made to make it comprehensively institutionalised. The successes include the bilateral acceptance of the principle and need for partnership by both the public and private partners, the overt gestures by the public partner through direct funding of the private providers, the ceding of some responsibilities to private players, the acceptance by the private players to take on some public responsibilities using their own resources etc. The challenges include the slow formalisation of the partnership, scepticism about autonomy, the stagnation of government funding, the poor understanding of the partnership at sub-national levels and poor sharing of information, among others. These challenges are now further compounded by the recent introduction of new policy reforms like fiscal decentralisation to the same local officials who do not fully appreciate the partnership and are therefore not likely to support it. The paper concludes with some useful suggestions on how these challenges may be tackled.
Using market mechanisms in the provision of health services and seeing health care as a private good are approaches that have featured prominently in health sector reforms across the world. The UNRISD research on global and local experiences of health care commercialization challenges this framework. It calls for reclaiming public policies that promote the purposes that health systems are set up to serve: population health and the provision of care for all according to need.
This report - presented at the African Civil Society Meeting of the Intergovernmental Working Group on Intellectual Property, Innovation and Health in Nairobi, Kenya, 28-29 August 2007 - found that there are over 30 registered local manufacturers in Kenya and at least two others under construction (foreign investments). It also analysed seven private-private partnership (PPP) projects (six in Kenya & one in Tanzania). The first PPP project passed its first inspection in August 2007 and the others are due for inspection by the end of the project. The main outcome of the report was that intellectual property rights do not stimulate research and development for medicines for diseases prevalent in developing countries simply because the market in poor countries is considered to be too small or too uncertain.
The owners of for-profit private hospitals have voted themselves to maintain high-cost-high profits health care system, in defiance of the modest call by the Minister to act in favour of health before profits. NEHAWU alleges that the refusal by private hospital companies to reduce the tariff increases, at least to the CPIX level, demonstrates once again why profit maximization in health care is incompatible with the needs of society as a whole. The organisatiion further observes in their report that much of the healthcare costs in the private health sector have nothing to do with provision of quality care, but spending on unnecessary and expensive equipment, hospital and office infrastructure and profits for their shareholders. NEHAWU does not believe however that the solution lies in another effort at regulation and calls for fundamental transformation of the sector, especially in the medical schemes and for-profit private hospital sector which command huge resources required for re-distribution in favour of the majority not the minority.
The South African Health Review (SAHR) is an annual publication of the Health Systems Trust (HST), which has been published since 1995. The SAHR seeks to provide a South African perspective on prevailing international public health issues, to stimulate debate and critical dialogue and to provide a platform for assessing progress in the health sector.
The private sector provides care for about 7 million people or close to 15% of all South Africans but consumes more than the total expenditure by the public health sector. The per capita expenditure in the private health sector is about 8 times more than that in the public health sector. Put another way, the public health sector spends about R1000 per patient per year whilst the private sector spends about R8000. The private sector spends an estimated 5.5% of gross domestic product. In addition, this sector employs more doctors, pharmacists and dentists than the public health sector. Clearly, this level of inequity cannot be left unchallenged.
The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting-out, which could be either positive or negative. Although the study results leave open the question of how contracting-out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success.
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.
Private health care has been specifically targeted for interventions by the health department in the coming year, according to South Africa Health Minister Manto Tshabalala-Msimang. She said the government was paying particular attention to 'improving accessibility and affordability of private health care.' The minister said that private hospitals were also agreeing to comply with the single exit price legislation with regard to the billing for anaesthetic gases which were previously overcharged. She said that the department was building on the progress made in regulating medicine prices to develop regulations that would allow the whole private health sector to be regulated.