Public-Private Mix

Intellectual property rights, innovation and public health
World Health Organisation 2003

This backgrounder to a session of the WHO 56th World Health Assembly looks at issues surrounding innovation in public health particularly focusing on biotechnology, including genomics, pharmaceuticals, medical devices and other diagnostics. The report argues that innovation to address conditions which particularly affect the poor are often held back by market failure and/or under investment by the public sector. The report highlights a number of mechanisms to stimulate innovation. These include: Investment in basic science in developing countries; Public / private partnerships to address neglected diseases; IP mechanisms to promote private sector investment such as advance-purchase funds; Flexibility in the application of TRIPS as advocated in the Doha Declaration particularly with regard to licensing and exemptions; Improved technology transfer from North to South; Increased capacity building in developing countries; Greater international cooperation; Clear, co-ordinated setting of research priorities; and A sound regulatory environment.

Primary Health Care: More Action Less Words please

Neo-liberal economic policies and World Bank/IMF inspired 'health reforms' being pushed through in developing countries have resulted in: Privatisation of public health services; The introduction of user fees for patients; Lack of public investment in state-run primary health care systems; and Lack of attention to leadership and management development for PHC. "All this has obviously also resulted in the overall deterioration in quality and equitable delivery of public health services and had a devastating effect on the ability of the poor to access health care," says a recent press release from the People's Health Movement (PHM). PHM has called for wider consultation between the World Health Organisation and civil society mem-
bers.

Further details: /newsletter/id/29775
Public-Private Partnerships for Public Health
Harvard Series on Population and International Health

Global health problems require global solutions, and public-private partnerships are increasingly called upon to provide these solutions. Such partnerships involve private corporations in collaboration with governments, international agencies, and non-governmental organizations. They can be very productive, but they also bring their own problems. This volume examines the organizational and ethical challenges of partnerships and suggests ways to address them. How do organisations with different values, interests, and worldviews come together to resolve critical public health issues? How are shared objectives and shared values created within a partnership? How are relationships of trust fostered and sustained in the face of the inevitable conflicts, uncertainties, and risks of partnership? This book focuses on public-private partnerships that seek to expand the use of specific products to improve health conditions in poor countries. The volume includes case studies of partnerships involving specific diseases such as trachoma and river blindness, international organizations such as the World Health Organization, multinational pharmaceutical companies, and products such as medicines and vaccines. Individual chapters draw lessons from successful partnerships as well as troubled ones in order to help guide efforts to reduce global health disparities.

Competing for business? Improving hospital services in Zambia with market forces

Does competition improve hospital services? Do market forces in healthcare benefit the poorest members of society? Reforms which involve exposing hospitals to market forces are being introduced in many developing countries. However, very little is known about how these markets operate, particularly in developing countries. The University of Zambia, together with the London School of Hygiene and Tropical Medicine, considered the effect of competition among hospitals in Zambia. The study examined hospitals in Lusaka, Central and Copperbelt provinces. Data on hospital use, revenues and expenditure, and charges for services were collected for the period 1996 to 1999 from each hospital using routine hospital records. In addition, a patient questionnaire was used in facilities to elicit patients’ views of the quality of services. As well as private for-profit and mine hospitals (facilities operated by the mining industry), "private" services included the private fee-paying services provided in government hospitals (known in Zambia as "high cost" services").

PUBLIC-PRIVATE PARTNERSHIPS FOR PUBLIC HEALTH

Public-private partnerships (PPPs) are becoming a popular mode of tackling large, complicated, and expensive public health problems. However, little is known about the conditions when partnerships succeed, about the strategies for structuring partnerships, or about the ethical underpinnings of partnerships. This book from the Harvard Center for Population and Development Studies presents the results of a workshop examining questions about public-private partnerships in international public health, focusing on the organisational and ethical challenges of partnerships, and ways to address them. The essays in this volume offer some new perspectives on partnerships and provide empirical evidence of both benefits and challenges of PPPs.

Does duty call? Contracts and GPs in South Africa

Some experts argue that private healthcare providers are preferred by service-users, or are more efficient or accessible than the public sector, and hence that government should contract out services to them. However, factors such as institutional capacity to write and manage contracts and market competition affect how contracts with private providers function. This has major implications for contracting in low and middle-income countries (LMICs). Research by the London School of Hygiene and Tropical Medicine explored the operation of a long-standing contract with private GPs in South Africa.

Drug development for neglected diseases: a deficient market and a public-health policy failure

There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. This article from The Lancet analyses the outcomes of pharmaceutical research and development over the past 25 years, and reviews current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. It found that of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. The article concludes that private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.

Protecting the Vulnerable: The Design and Implementation of Effective Safety Nets

In response to shortages in public budgets for government health services many developing countries around the world have adopted formal or informal systems of user fees for health care. In most countries user fee proceeds seldom represent more than 15 percent of total costs in hospitals and health centres, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial or full waivers to the poor often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees compatible with the goal of preserving equitable access to services, says this paper from the World Bank.

Where there is no regulator

Until very recently, the healthcare sector in developed industrialised countries consisted largely of public services for curative and preventive care provided by governments and the regulated private sector. These services were organised into different levels from primary care facilities up to tertiary hospitals providing specialist care, with a referral mechanism from one level to the next. But in many low and middle income countries healthcare has moved away from this model. People, including many of the poor, use a wide range of different service providers, all of which they have to pay. The healthcare sector increasingly resembles an unregulated marketplace rather than an organised public service. How has this come about, what does this marketplace look like and what does it mean for health policy and planning?

Who profits? Private healthcare - opportunity or risk?

As evidence about the importance of the private sector in healthcare delivery accumulates, emphasis is being placed on better understanding the opportunities and risks it creates. Private providers are often key sources of treatment for diseases of public health importance, such as malaria, sexually transmitted infections (STIs) and tuberculosis (TB). They are also an important source of care for poor people, who may use private providers nearly as much as better-off groups. But there are concerns about their quality and affordability.

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