A group of international civil society organisations (CSOs) have called on the World Bank to implement smart procurement guidelines that support the development of the domestic private sector of developing countries. This submission calls on the World Bank to review its procurement guidelines so that they become an economic policy tool which is pro-poor, promotes domestic industry development and empowerment, reduces asymmetries between local and foreign companies in order to create a truly level playing field, focusing in particular on SMEs and works towards poverty eradication, sustainable development and mitigating climate change. The Bank should become a development tool, considers social and environmental criteria, and creates incentives for all private actors to behave in a socially and environmentally responsible fashion. It should also respect transparency and accountability, emphasising that accountability to citizens in developing countries matters most. The Bank can play a catalytic role in strengthening domestic accountability through its procurement practices, the CSOs argue. Finally the Bank should increase the effectiveness and developmental impact of aid and ensures that the larger share of aid inflows remain in the recipient countries.
Public-Private Mix
In this annual report, the South African Council for Medical Schemes details its support for the Department of Health in its efforts to strategically review the entire health system of South Africa. Council provided input to the technical sub-committees of the Ministerial Advisory Committee on the proposed National Health Insurance (NHI) system, and submitted a formal document on the NHI policy paper. Ever-escalating costs in the industry, which are driven by private hospitals and medical specialists, have always been one of Council’s concerns, and this financial year proved no different. This worrying trend of inflation-exceeding price increases in the private health sector has serious and negative implications for the well-being and sustainability of the entire health system. Council therefore continued to motivate for the establishment of a regulator to oversee the price determination of private healthcare provision. Council believes that a real need exists for a platform where medical schemes and healthcare providers can meet and negotiate prices for the benefit of all South African consumers. Private healthcare providers should also be regulated, specifically the hospitals and specialists. The practice where beneficiaries are exposed to unfair billing practices must be addressed.
The authors identify two types of capital for foreign investment: capital of type K and capital of type N. While capital of type K is used in production of all the sectors of the economy, capital of type N is specific to the healthcare sector. Their analysis finds that an FDI of capital of type N although it raises the human capital formation may lower social welfare. On the contrary, an inflow of foreign capital of type K is likely to be welfare-improving. Although these effects crucially hinge on different structural factors e.g. the degree of
labour market imperfection, trade-related and technological factors these can at least question the desirability of allowing the entry of foreign capital in the healthcare sector directly.
To investigate medicine retailer knowledge about anti-malarials and their dispensing practices, a survey was conducted of all retail drug outlets that sell anti-malarial medications and serve residents of the Webuye Health and Demographic Surveillance Site in the Bungoma East District of western Kenya. Results indicated that most (65%) of the medicine retailers surveyed were able to identify artemether-lumefantrine (AL) as first-line anti-malarial therapy for uncomplicated malaria recommended by the Kenyan Ministry of Health. Retailers who correctly identified this treatment were also more likely to recommend AL to adult and paediatric customers. Retailer training and education were found to be correlated with anti-malarial drug knowledge, which in turn was correlated with dispensing practices. While the Kenya Ministry of Health (MoH) guidelines were found to influence retailer drug stocking and dispensing behaviours, the authors argue that knowing the MoH recommended anti-malarial medication does not always ensure it is recommended or dispensed to customers. Retailer training and education are both areas that could be improved. Considering the influence that patient demand has on retailer behaviour, future interventions focusing on community education may positively influence appropriate dispensing of anti-malarials.
In addressing the problem of global obesity, our greatest failure may be collaboration with and appeasement of the food industry, argues the author of this article. She warns against current initial steps in this direction in the form of so-called ‘public–private partnerships' with health organisations, ‘healthy eating’ campaigns and corporate social responsibility initiatives. These occur at the same time as the private sector food and beverage sectors fight against meaningful change such as limits on marketing food to children, taxes on products such as sugared beverages, and regulation of nutritional labelling. The food industry distorts science, creates front groups to do its bidding, compromises scientists, professional organisations and community groups with contributions, and blocks needed public health policies in the service of shareholder, the author notes. This is normal ‘business as usual’. While respectful dialogue with industry is desirable, she argues that there must be recognition that this will bring small victories only and that to take the obesity problem seriously will require courage, leaders who will not back down in the face of harsh industry tactics, and regulation with purpose.
In this report, Médecins Sans Frontières (MSF) notes that middle-income countries with large numbers of people living with HIV, such as South Africa, will no longer benefit from preferential pricing when buying antiretroviral drugs from large pharmaceutical companies. According to the report, pharmaceutical firm ViiV Healthcare - owned by Pfizer and GlaxoSmithKline - no longer offers reduced prices to middle-income countries, even when their programmes are fully funded by the Global Fund to fight HIV, Tuberculosis and Malaria. Merck has also ceased to offer discounted prices to all lower middle- and upper middle-income countries, proposing instead to negotiate discounts on a case-by-case basis. Previously, Merck offered middle-income countries discounts that were still up to ten times the price of generic versions. MSF warns that drug company discount programmes are not a long-term solution, and urges governments to start using Trade-related Aspects of Intellectual Property Rights (TRIPS) measures to override patents.
Despite the positive health effects of breast feeding, and adverse health effects of breastmilk substitutes, particularly in conditions of poverty, Nestlé is reported by Baby Milk Action to be continuing promotion of the use of formula. The authors report that Nestlé has backtracked on a past commitment not to advertise formula brands in ‘high risk’ developing countries. The authors report that the World Health Organisation's Guidelines for the safe preparation, storage and handling of powdered infant formula are not adequately included on labels of its products, that health workers in India are being included in sponsored events, and that it is pushing in Philippines, as part of an industry alliance, for a weakening of current law in this area. The World Health Assembly (WHA) has called for companies to bring their activities at every level into line with the International Code on Marketing of Breastmilk Substitutes and subsequent WHA Resolutions.
In the run up to the 65th World Health Assembly (21-26 May 2012) the NCD Alliance, a major international alliance of organisations working in the field of non-communicable diseases (NCDs) revised its statement calling on its Member States to support the creation of a Global Platform on NCDs. After the Conflict of Interest Coalition expressed its concerns to the Alliance over private sector involvement in health policy and planning in such a platform, the Alliance added the clause ‘with appropriate safeguards for public interest over private profit’ and issued a new statement in May 2012. Rundall argues that this amendment does not adequately address the need for a clear differentiation between policy, norms and standards development and involvement in implementation. She warns that lack of clarity will play into the hands of those who favour slow, industry-friendly, voluntary approaches rather than legally binding measures that hold the private sector accountable for their practices.
In this Statement of Concern, the Conflict of Interest Coalition calls for the development of a Code of Conduct and Ethical Framework to guide private sector involvement in public health policy development. The Coalition seeks clarity on the nature of recent government ‘partnerships’ with the private sector, and argues that public-private partnerships run the risk of counteracting efforts to protect and improve public health. The proposed framework should help protect the integrity of the United Nations’ public policy decision-making, to ensure it is transparent and to identify, safeguard against and manage potential conflicts of interest. The Statement argues that a clear distinction must be made between business-interest not-for-profit organisations (BINGOs) and public interest non-governmental organisations (PINGOs) and a clear differentiation between policy and norms and standards development and appropriate involvement in implementation. The Coalition calls on the World Health Organisation (WHO) to develop guidance for Member States to identify conflicts and eliminate those that are not permissible. WHO should perform thorough risk/benefit analyses on partnerships and provide surveillance on those considered acceptable.
On 6 December 2011, the East African Community Regional Pharmaceutical Manufacturing Plan of Action was launched in Arusha, Tanzania. The Plan of Action will guide the region towards evolving an efficient and effective pharmaceutical manufacturing industry that can supply national, regional and international markets with quality efficacious medicines. A number of recommendations were made at the end of the meeting. Participants agreed that, following discussion on the baseline survey, the draft report and the relevant questionnaire will be sent to national associations and regulatory authorities for corrections and further input, and then to national pharmaceutical manufacturers associations for input. They called on EAC Partner States to mobilise the necessary resources to ensure successful implementation of the Plan of Action. It was resolved that the EAC Secretariat will be responsible for putting in place clear coordination and management structures for the implementation, monitoring and evaluation of the plan.