Public-Private Mix

OPEN LETTER: Uniting Behind A People’s Vaccine Against COVID-19
Heads of state and Oxfam International: May 2020

This open letter signed by presidents, ministers of state, professors and heads of institutions calls for a people’s vaccine against COVID-19, available to all, in all countries, free of charge. The signatories argue that the World Health Assembly must forge a global agreement that ensures rapid universal access to quality-assured vaccines and treatments with need prioritized above the ability to pay. Access to vaccines and treatments as global public goods are in the interests of all humanity. Signatories call for a global agreement on COVID-19 vaccines, diagnostics and treatments — implemented under the leadership of the World Health Organization — that ensures mandatory worldwide sharing of all COVID-19 related knowledge, data and technologies with a pool of COVID-19 licenses freely available to all countries. Further, signatories call for a global and equitable rapid manufacturing and distribution plan — that is fully-funded by rich nations — for the vaccine and all COVID-19 products and technologies that guarantees transparent ‘at true cost-prices’ and supplies according to need. The signatories call for an agreement to guarantee COVID-19 vaccines, diagnostics, tests and treatments are provided free of charge to everyone, everywhere.

“Get us partnerships!” - a qualitative study of Angolan and Mozambican health academics’ experiences with North/South partnerships
Craveiro I; Carvalho A; Ferrinho P; et al: Globalization and Health 16(33), 1-10, 2020

This paper examines how Angolan and Mozambican health sciences researchers experience international collaborations, using evidence from semi-structured interviews and focus group discussions. Participants shared a sense of asymmetry between African researchers and European trainers in processes that did not fully acknowledge their local contexts, compromising the prospective development of partnerships in health. They argue that more attention be devoted to understanding how participants experience capacity building processes, integrating the diversity of their aspirations and perceptions.

Crowdfunding and global health disparities: an exploratory conceptual and empirical analysis
Kenworthy N: Globalisation and Health 15(70, Suppl 1), 1-10, 2019

The use of crowdfunding platforms to cover the costs of healthcare is growing rapidly within low-, middle-, and high-income countries as a new funding modality in global health. To map and document how medical crowdfunding is shaped by, and shapes, health disparities, this article offers an exploratory conceptual and empirical analysis of medical crowdfunding platforms and practices around the world. Data are drawn from a mixed-methods analysis of medical crowdfunding campaigns, as well as an ongoing ethnographic study of crowdfunding platforms and the people who use them. Drawing on empirical data and case examples, this article describes three main ways that crowdfunding is impacting health equity and health politics around the world: 1) as a technological determinant of health, wherein data ownership, algorithms and platform politics influence health inequities; 2) as a commercial determinant of health, wherein corporate influence reshapes healthcare markets and health data; 3) and as a determinant of health politics, affecting how citizens view health rights and the future of health coverage. Rather than viewing crowdfunding as a social media fad or a purely beneficial technology, researchers and publics must recognize it as a complex innovation that is reshaping health systems, influencing health disparities, and shifting political norms, even as it introduces new ways of connecting and caring for those in the midst of health crises. More analysis, and better access to data, is needed to inform policy and address crowdfunding as a source of health disparities.

NGOs, austerity, and universal health coverage in Mozambique
Pfeiffer J; Chapman R: Globalization and Health 15(Suppl 1) 1-6, 2019

In many African countries, hundreds of health-related non-government organisations (NGOs) are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage. In the 1990s, NGOs multiplied across post-war Mozambique: the country’s structural adjustment program constrained public and foreign aid expenditures on the public health system, while donors favoured private contractors and NGOs. In the 2000s, funding for HIV/AIDS and other vertical aid from many donors increased dramatically. In 2004, the United States introduced PEPFAR in Mozambique at nearly 500 million USD per year, roughly equivalent to the entire budget of the Ministry of Health. PEPFAR funding has helped thousands access antiretroviral treatment, but over 90% of resources flow “off-budget” to NGO “implementing partners,” with little left for the public health system. After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795. Achieving UHC will require rejection of austerity constraints on public sector health systems, and re-channelling of aid to public systems building rather than to NGOs.

The pharmaceutical industry in Sub-Saharan Africa: A guide for promoting pharmaceutical production in Africa (UNIDO)
White S; Banda G; Chaudhuri S; Chen L; et al.: United Nations Industrial Development Organisation (UNIDO), 2019

The authors report that there is consensus that local pharmaceutical production in sub-Saharan Africa in close proximity to where medicines are needed can reduce dependence and improve health outcomes for the population. Many African governments, regional economic communities and the African Union have recognized the need for active support to the development of the sector if these benefits are to be realized. However, concrete action on the ground is reported to have remained hesitant and piecemeal to date. This document contains advice for government policy makers, the private sector especially pharmaceutical manufacturers in sub-Saharan African countries, development partners and finance institutions on how to promote pharmaceutical production. The guide focuses on the key areas of competitiveness, market access, technology and access to finance. It further proposes a path of how governments could embark on and steer a policy development process as well as giving guidance on policy interventions. The document especially emphasizes the interconnectedness of key intervention areas and recommends that promotional measures from key areas should be combined to increase impact.

African Governments Urged to move with Speed to Address Over-Dependence on Imported Medicines
United Nations Economic Commission for Africa: UNECA Addis Ababa, 2019

At the two-day Horn of Africa trade forum in Addis Ababa, organized by the ECA, the Government of Ethiopia, the African Union Commission (AUC), and the European Union, participants agreed that with the African Continental Trade Agreement (AfCFTA) in force, it was time for the continent to increase domestic production of pharmaceutical products and end over-dependence on imported medicines. The AfCFTA, they agreed, provides an opportunity for economies of scale necessary for African pharmaceutical production. The Economic Commission for Africa's (ECA) Director for Regional Integration and Trade, Stephen Karingi, in closing the forum said that domestic policies that can be used to support the industry, including through investment assurances, grants, fiscal incentives and local content requirements. Regional centers of excellence could be used to overcome constraints in human capacities and resources for research and development and testing. The forum also agreed on the need to strengthen regulatory frameworks to develop the pharmaceutical sector; to encourage domestic production with a regional focus; and to ensure efficient and safe logistic chains that can bring down the cost of medicines.

After the handover: Exploring MSF’s role in the provision of health care to migrant farm workers in Musina, South Africa
de Gruchy T; Kapilashrami A: Global Public Health, doi: https://doi.org/10.1080/17441692.2019.1586976, 2019

Non-state actors, including humanitarian agencies, play a prominent role in providing health care in low- and middle-income countries. Between 2007 and 2009, Musina, a South African municipality bordering Zimbabwe, became the site of several interventions by non-state organisations as an unprecedented number of Zimbabweans crossed the border, putting strain on already burdened local systems. After the initial need for humanitarian relief dissipated, organisations started to implement projects that were more developmental in nature. For example, Médecins sans Frontières developed a mobile clinic programme to improve health care access for migrant farm workers, a programme that was subsequently integrated into the Department of Health. Since the handover of the programme, it has faced multiple challenges. Using qualitative methodology and a case study approach, this paper traces the development of the programme, exploring the changing relationship between MSF and the state during this time. This research raises questions about the implications of short-term ‘innovative’ interventions targeting the access that migrants have to care, within a context in which policy and programmatic responses to health are not 'migration aware'. The authors highlight the ways in which the energies and resources of local health department employees were redirected by MSF's involvement in the area.

Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho
Hellowell M: BMJ Global Health 4(2), doi: http://dx.doi.org/10.1136/bmjgh-2018-001217, 2019

Many governments in sub-Saharan Africa are seeking to establish public–private partnerships (PPPs) to finance and operate new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, much less is known about their operation in low-income and middle-income countries. This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health. Governments may use budget-related incentives to promote the use of PPPs which may threaten financial sustainability in the long term. The authors suggest that future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.

Resolution on States’ Obligation to Regulate Private Actors Involved in the Provision of Health and Education Services
African Commission on Human and People’s Rights: ACHPR, Egypt, 2019

The African Commission on Human and People’s Rights calls on States Parties to the African Charter to take appropriate policy, institutional and legislative measures to ensure respect, protection, promotion and realization of economic, social and cultural rights, in particular the right to health and education and to fulfil their obligations on this. The Commission calls on States Parties to adopt legislative and policy frameworks regulating private actors in social service delivery and ensure that their involvement is in conformity with regional and international human rights standards. States Parties are invited to ensure that the involvement of private actors in the provision of social services is a result of a participatory policy formulation process and continues to be subject to democratic scrutiny and to the human rights principles of transparency and participation. The Commission considers carefully the risks for the realization of economic, social and cultural rights of public-private partnerships and ensure that any potential arrangements for public-private partnerships are in accordance with their substantive, procedural and operational human rights obligations, and do not violate the norms and principles of the rights contained in the African Charter; and to ensure through regular impact assessments that the involvement of private actors in the provision of health services and education does not create systemic adverse impacts on human rights. Further States Parties are to ensure access to an effective remedy for violations of the right to health and education or other human rights violations by private actors involved in the provision of health and education services. The Commission reminds private actors of their responsibility to respect economic and social rights, particularly the right to health and education and to refrain from infringing on human rights as they engage in the provision of these services.

Investing in health R&D: where we are, what limits us, and how to make progress in Africa
Simpkin V; Namubiru-Mwaura E; Clarke L; et al: BMJ Global Health 4(2), doi: http://dx.doi.org/10.1136/bmjgh-2018-001047, 2019

Global research and development (R&D) pipelines for diseases that disproportionately affect African countries appear to be inadequate, with governments struggling to prioritise investment in R&D. This article provides insights into the sources of investment in health science research, available research capacity and level of research output in Africa. Africa has 15% of the world’s population, yet only accounted for 1.1% of global investments in R&D in 2016. There were substantial disparities within the continent, with Egypt, Nigeria and South Africa contributing 65.7% of the total R&D spending. In most countries of the Organisation for Economic Co-operation and Development, the largest source of R&D funding is the private sector. R&D in Africa is mainly funded by the public sector, with significant proportions of financing in many countries coming from international funding. Challenges that limit private sector investment include unstable political environments and poor governance practices. Evidence suggests various research output and research capacity limitations in Africa in terms of university rankings, number of researchers, number of publications, clinical trials networks and pharmaceutical manufacturing capacity and substantial regional disparities within the continent. The authors propose that incentivising investment is crucial to foster current and future research output and research capacity. This paper outlines some of the initiatives under way for this, including through innovative and collaborative financing mechanisms that stimulate further investment.

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