South Africa’s Health Minister Aaron Motsoaledi has signed a "social compact" with the private sector, describing it as a "historic" step towards closer collaboration between the government and private enterprise. Such collaboration was vital for the success of the government’s ambitions for introducing National Health Insurance (NHI), the minister said. The minister and the CEOs of 23 companies have agreed to meet at least twice a year to discuss issues that affect them, and have established the Public Health Enhancement Fund to address the skills shortages facing the healthcare sector. The fund pools donations from 23 companies from the pharmaceutical, private hospital and medical scheme administration industries, who have committed to providing financial support for the next three years. The money will be used to train more doctors, improve the skills of healthcare managers, and ensure more doctors get specialised training in HIV and AIDS. Forty million rand (US$4.5 million) has been committed for the first year.
Public-Private Mix
The Council for Medical Schemes and the Department of Health are planning new amendments to the Medical Schemes Act to beef up governance on medical scheme boards and stop unscrupulous trustees enriching themselves at members’ expense. In the past decade, 10 medical schemes have been placed under curatorship after trustees milked their reserves to line their own pockets and dish out contracts to friends and family. The most recent examples include Medshield and Sizwe. To date, not a single trustee from a scheme placed under curatorship had been convicted, and many of those identified by the council as behaving inappropriately were at liberty to circulate in the industry and join other schemes, said its head of compliance and investigations, Stephen Mmatli. Mmatli said member apathy, combined with weaknesses in the Medical Schemes Act, meant there was insufficient control over the skills and qualifications of the people elected as trustees and too few checks and balances. While many schemes have highly qualified trustees, some of whom take home modest remuneration (or none at all), the converse is also true: the Council’s latest annual report (in last month’s newsletter) shows trustees awarding themselves massive fees of up to R700,000 (US$81,000) a year.
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.
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.