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.
Public-Private Mix
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.
Corporations across the globe are capturing more and more of the public sphere, encroaching on all aspects of people’s lives. This publication compiles analyses of different country experiences on public-private partnerships that in themselves have become a powerful tool to achieve what the authors observe is starting to look like the privatisation of life itself. Feminist researchers from the Global South have spent a year researching this theme in their home countries, including in Kenya and Zimbabwe. Together they present an analysis and critique of the state of PPPs today, and the consequences for women’s lives, communities’ wellbeing, and public health and social services.
From August to December 2019, the authors provided free HIV self-test kits, a new product, to 26 pharmacy shops in Shinyanga, Tanzania to sell to the local community. Sales volume, price, customer age and sex were measured using shop records, together with willingness-to-pay to restock test kits. Purchase prices ranged from 1000 to 6000 Tsh. Within shops, prices were 11.3% higher for 25 to 34 and 12.7% higher for 45+ year olds relative to 15 to19 year olds and 13.5% lower for men on average. Although prices varied between shops, prices varied little within shops over time, and did not converge over the study period or cluster geospatially. Shopkeepers charged buyers different prices depending on buyers’ age and sex and there was low demand among shopkeepers to restock at the end of the study. The authors propose that careful consideration is needed to align the motivations of retailers with public health priorities while meeting their private for-profit needs.
The authors reviewed the market strategies deployed by processed food manufacturers to increase and consolidate their power from a systematic review of public health, business, legal and media content databases and of grey literature. The market strategies identified related to six interconnected objectives: i) reducing competition with equivalent sized rivals and maintaining dominance over smaller rivals; ii) raising barriers to market entry by new competitors; iii) countering the threat of market disruptors and driving dietary displacement in favour of their products; iv) increasing firm buyer power over suppliers; v) increasing firm seller power over retailers and distributors; and vi) leveraging informational power asymmetries in relations with consumers. The authors note that analysing such market strategies promoting unhealthy foods helps to identify countervailing public policies, such as those related to merger control, unfair trading practices, and public procurement, as part of efforts to improve population diets.
All Risk and No Reward presents the findings of a two-year investigation into the right to health of miners and ex-miners in Botswana. It describes in vivid detail a series of critical issues for their health and the health of their communities. The report also considers the Government and mine companies' financial responsibilities to equitably generate, allocate and spend sufficient funds for health. The report is based on extensive desk research, and interviews and focus groups discussions with more than 50 miners, ex-miners, family and community members, doctors and nurses, and government and industry officials in Botswana.
This desk review provides an overview of the commercial determinants of health. The commercial determinants of health are reported to cover three areas. First, they relate to unhealthy commodities that are contributing to ill-health. Secondly, they include business, market and political practices that are harmful to health and used to sell these commodities and secure a favourable policy environment. Finally, they include the global drivers of ill-health, such as market-driven economies and globalisation, that have facilitated the use of such harmful practices. The discussion on the commercial determinants of health is argued to offer an opportunity to shift the dominant paradigm in public health, so ill-health, damages to the environment, and health and social inequalities, might be better understood through a commercial determinant lens.
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.
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.
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.