Product development partnerships, non-profit research institutes and private sector groups have come together over the past years to conduct research and development (R&D) in the areas of the development of drugs, vaccines and diagnostics for neglected diseases, including tropical diseases and other major infectious diseases like HIV and AIDS, tuberculosis and malaria. However, arguments have been put forward that their efforts are disjointed and that funding flows inefficiently to individual research projects resulting in insufficient resources, funding volatility, poor resource allocation, and duplicated and unnecessary efforts. In response, several pooled funding mechanisms have been proposed to address what proponents see as the key problem(s) in the current system: the Industry R&D Facilitation Fund (IRFF) originally proposed by the George Institute; the Fund for Research in Neglected Diseases (FRIND) proposed by Novartis; and the Product Development Partnership Financing Facility (PDP-FF) proposed by the International AIDS Vaccine Initiative (IAVI). The goal of this paper is to provide insight into the extent to which these three proposed mechanisms would have a positive effect on accelerating R&D for neglected diseases. It considers how these proposals are likely to perform against two criteria: their capacity to raise additional money for neglected disease R&D and their capacity to improve the efficient allocation of those funds. The authors of the paper use a literature review, interviews with key stakeholders and illustrative modelling to assess the proposals against these two criteria. Most interviewees expressed doubts that common ground could be found with regard to the metrics on resource allocation if the fund were covering a large and diverse part of the R&D space. However, stakeholders overwhelmingly agreed that a pooled fund focused on late stage work only would be a more feasible and useful proposition.
Public-Private Mix
The World Health Organisation (WHO) includes regulatory system functions as one of the six core building blocks of health systems: access to medical products, vaccines, and technologies of assured quality, safety, and efficacy. However, little attention has been focused on regulatory systems in low- and middle-income countries. They have not featured prominently in global health and development assistance programmes, according to this paper, and few strategic documents of major global health initiatives, including the United States Global Health Initiative, reference regulatory systems. The global activities that do involve regulatory systems typically involve high-income countries, such as the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), which harmonises regulatory standards and processes for the pharmaceutical industry. ICH includes regulatory authorities from the European Union, Japan and the United States. The authors argue that lack of attention to medical product regulatory systems in low- and middle-income countries is a significant gap that needs to be bridged. They thus propose that strengthening regulatory systems in low- and middle-income countries must become a global health priority.
ECDPM organised an informal multi-stakeholder meeting in Brussels in December 2012 to highlight and share the different views of the opportunities and challenges, as well as potential ways forward, in measuring the impact of the private sector on development. Participants included European Union (EU) officials, research institutes, development agencies, African, Caribbean and Pacific (ACP) and EU ambassadors, civil society organisations and private sector actors and confederations. Despite the private sector’s often-cited move beyond corporate social responsibility, delegates agreed that the focus for some still seems to be predominantly placed within the (often marginal) add-on projects on the side of the core business. By choosing to not address this, private sector actors are avoiding the fact that their main business activities most likely are their main development impact. The author recommends that partnerships between public-private and/or civil society actors should be balanced and in the interest of all partners, and that assessment of these partnerships should not only capture corporate social responsibility-type activities, but also core business impacts.
Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to artemisinin-based combination therapy (ACT) for malaria in the private sector could be improved through the provision of a high level supply chain subsidy. Four intervention districts were purposefully selected to receive branded subsidised medicines, while the fifth district acted as the control. Researchers analysed the intervention's impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial. At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, it accounted for 69 % of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8 % at baseline to 26.2 % at evaluation in the intervention districts. These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda.
This policy brief aims to understand whether or how session work in hospitals could be expanded to help achieve universal health coverage. About 14% of private sector specialists work part-time in public hospitals, through what is known as ‘session work’. Private specialists undertake session work for a number of mainly non-financial reasons, such as to ‘give back’ to the public sector and to teach in academic hospitals. There are a number of private specialists who seem interested in working in the public sector in future, but the pay is very low for session work. The author argues that higher session wages may induce specialists to leave full-time public work to undertake private and session work. Thus it may be important to only give new session worker posts to those who have already left the public sector.
This report explores the shift from privatisation to corporatisation of urban water services in developing countries. The author calls for the water justice movement to adjust its strategy to take this into account. Corporatisation reform implies the implementation of commercial neoliberal management approaches within public sector water utilities. The author argues that the strategy of the water justice movement has largely focused on privatisation and that it needs to direct more attention towards resisting corporatisation.
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.
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.