Each year, diarrhoeal diseases claim the lives of nearly two million people – 90% of them children under the age of five. The problem is especially critical in Africa, a continent that contains 10% of the world's population, but accounts for 40% of the deaths of children under age five. This paper uses panel data on the sub-national regions of 26 African countries over 1985-2006, a period of expanded private sector participation in water supplies to explore the impact on child health. Using a fixed effects analysis the author suggests that an expansion in piped water after PSP was associated with a 5% decrease in diarrhoea in children under-five. The author notes, however, that PSP In Africa was often pursued as a remedy to a severely distressed water sector with government under-investment for years.
Public-Private Mix
This reference guide on public-private partnerships (PPP) theory and practice is intended for senior policy-makers and other public sector officials in developing countries. The guide, available on order from the Commonwealth Secretariat, focuses on the key lessons learned and emerging best practice from successful and failed PPP transactions over the past thirty years. The guide provides a background to PPPs: concepts and key trends; the infrastructure PPP project development process; constraints to infrastructure PPPs and measures to alleviate them; donor initiatives to support infrastructure PPPs; recent PPP experience in Commonwealth developing countries and lessons learned and emerging best practices on PPPs.
This study examined peer-reviewed and grey literature on examples of innovation in private 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 innovations was variable, with more data on availability and affordability and less on quality of care. The study calls for more rigorous evaluations to investigate the impact and quality of private health service innovations and to determine the effectiveness of the strategies used.
Global health problems require global solutions, and public-private partnerships are increasingly being called upon to provide these solutions. These partnerships involve private corporations in collaboration with governments, international agencies and non-governmental organisations. According to this book, they can be very productive, but they also bring their own problems. The book examines the organisational and ethical challenges of partnerships and suggests ways to address them. It considers issues such as creating shared objectives and shared values in a partnership, and fostering and sustaining trust among partners in times of conflict and uncertainty. It focuses on public-private partnerships that seek to expand the use of specific products to improve health conditions in poor countries and includes case studies of partnerships involving specific diseases such as trachoma and river blindness, international organisations 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, to help guide efforts to reduce global health disparities.
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.
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.