This study reviewed peer-reviewed and grey literature on examples of innovation in pruvate sector health care. From 46 studies, 10 case studies were selected spanning different countries and health service delivery models. The cases included social marketing, cross-subsidy, high-volume, low cost models. They tended to have a narrow clinical focus, facilitating standardised care models but allowing experimentation with delivery models. Information on the social impact of these innivations was variable, with more data on availability and affordability and less on quality of care. More rigorous evaluations are needed to investigate the impact and quality of private health service innovations and to determine the effectiveness of the strategies used.
Public-Private Mix
According to this article, developing countries are put under increasing pressure to promote the private sector. It investigates how aid impacts on health in poor countries and the pressure donors put on developing countries to promote the private sector. Proponents of privatisation argue that, because the private sector is already significant, it will be key in scaling up, but this article indicates that privatisation says nothing about the right to health. Likewise, no evidence exists that conclusively demonstrates that the private sector is more efficient and can help reduce costs, and improvements in quality of care and accountability to patients have yet to be proven. A further evidence gap emerges when proponents claim that the private sector can help reach the poor. Public sector success stories, such as those of Bostwana, Cuba, Uganda and Eritrea still need to be studied further. Oxfam demands that external funders be honest, stop promoting unproven and risky private sector approaches, learn from countries that have achieved universal and equitable access, and prioritise rapidly expanding and strengthening free government healthcare.
This paper aimed to gauge the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Most of the doctors were male GPs aged 30–50 years who had been in practice for more than ten years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. The paper concluded that many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, which could potentially remove some of the current burden on the public health sector.
This research project aimed to assess current attitudes of major global and national stakeholders on the role of the private sector in low- and lower-middle-income countries in health service provision and financing. The research team used qualitative and quantitative methods to gather data on attitudes toward the private sector. The research found that there was no agreement about what the 'private sector' or a 'public-private partnership' was. Most respondents gave qualified responses in their views of the private sector, although their perceptions varied depending on their personal ideology and history, type of intervention, area of focus, and country context. Negative views were deeply rooted. The public sector viewed the private sector as a means to an end. At the national level, the private sector feared government interference, while the public sector feared a loss of control. There was significant experience with many different forms and models of public-private interaction.
The Municipal Services Project and Focus on the Global South held a one-day workshop on building alternatives to the privatisation of basic services on 31 March 2010 in New Delhi, India. This presentation on health in Africa was given at the workshop. The presenter discussed some alternatives to privatisation, such as community-based health insurance and mutual health organisations. Functional national health insurance schemes are already in operation in Ghana and Nigeria, while South Africa is busy putting together its own scheme and a similar scheme is in its initial stages in Uganda. Community-based alternatives to the privatisation of health services were considered but measures are needed to promote equity through cross-subsidisation provisions for democratic participation and improved quality of health services. However, the presenter pointed out that administrative efficiency and the cost effectiveness of collecting the premiums in community-based approaches were often problematic and sustainability was also a challenge, and faced dwindling membership due to low income. Benefits, including improved accountability through greater member involvement, were more likely if these approaches were integrated with national health systems, as shown in Rwanda, Tanzania and Ghana.
This report points out that the private health sector is growing rapidly in low- and middle-income countries, while the debate about the purported advantages and drawbacks of the reliance on public, private not-for- profit and private for-profit providers has suffered from a distinct lack of factual documentation and evidence. It indicates a need for better empirical information, over a range of contexts, on the characteristics, extent, growth and consequences of unregulated commercial care provision. Such information should cover short- and long-term impact on safety, access, quality of care, health outcomes, health equity and social outcomes, as well as the level of trust in health systems and health authorities. An improved evidence base would also allow for a more productive exchange of experience between countries on best practices regarding constructive engagement with and regulation of different types of health-care providers. In many low- and middle-income countries reduced institutional capacity constrains constructive engagement with the wide range of actors involved in health-care provision. The World Health Organization aims to consolidate experience, document best practice and facilitate exchange and joint learning about ways to strengthen government capacity for constructive engagement and effective oversight of the full range of health-care providers.
This article outlines the measures that European Union (EU) and African countries are planning through the economic partnership agreements to address public and private corruption, including non-compliance with promised off-sets in public contracts, in both African and EU governments and companies. Corruption is argued to distort fair competition, as companies gain competitive advantages and increase profitability and share value through illegal and unethical behaviour, while those companies that choose to be responsible find themselves at a disadvantage. Africa is argued to be no more corrupt than any other region, with alleged costs to African economies of US$148 bn per year, according to estimates by the Commission of the African Union. Corruption is argued to be responsible for losses of up to 50% of countries’ tax revenue, in many cases more than foreign debt.
Health equity remains a major challenge to policymakers despite the resurgence of interest to promote it. In developing countries, especially, the sheer inadequacy of financial and human resources for health and the progressive undermining of state capacity in many under-resourced settings have made it extremely difficult to promote and achieve significant improvements in equity in health and access to healthcare. In the last decade, public-private partnerships have been explored as a mechanism to mobilise additional resources and support for health activities, notably in resource-poor countries. While public-private partnerships are conceptually appealing, many concerns have been raised regarding their impact on global health equity. This paper examines the viability of public-private partnerships for improving global health equity and highlights some key prospects and challenges. The focus is on global health partnerships and excludes domestic public-private mechanisms such as the state contracting out publicly-financed health delivery or management responsibilities to private partners. The paper is intended to stimulate further debate on the implications of public-private partnerships for global health equity.
In a move that has already sparked controversy, the South African treasury is to draw private business into the public health sector as a way of upgrading the services provided by state hospitals. In his budget speech, Finance Minister Pravin Gordhan referred to broadening the implementation of public-private partnerships (PPPs) in the health sector to improve hospitals system as a “prerequisite for the introduction of a national health insurance system”. A flagship PPP project is proposed as Chris Hani Baragwanath Hospital in Johannesburg, for which a feasibility study is now complete. However the Congress of South African Trade Unions (Cosatu), the largest union in the country, has opposed PPPs as a vehicle for privatisation, which is argued to lead to higher costs, poorer services and the loss of jobs.
This sheet provides information on financing in the public and private health sectors in South Africa. It notes that medical schemes cover 16% of the population, on whom about R11,300 is spent per person (this includes both medical scheme spending and out-of-pocket payments), while the public sector covers most of the rest of the population, particularly the 68% who do not use any private care – government spends about R1,900 per person on this group. Sixteen percent of the population use the private sector on an out-of-pocket basis for primary care but are almost entirely dependent on the public sector for hospital care; for this group nearly R2,500 is spent per person. Medical scheme spending has been increasing, while public sector health spending has been largely stagnant until recently. Most health professionals (except enrolled nurses) work in the private health sector.