What chance do poor countries have of reducing child mortality by two thirds between 1990 and 2015? What contribution can public spending make to meeting this Millennium Development Goal (MDG)? Research by the Overseas Development Institute suggests the need for a greater pro-poor focus in public health expenditure. Over the last 40 years child mortality has halved in low-income countries. However, it is increasing in sub-Saharan Africa and there are also large differences between the health status of poor and non-poor children within countries. What can governments do to improve child survival?
Public-Private Mix
The role of public funds in reducing child mortality
WAIVERS AND EXEMPTIONS FOR HEALTH SERVICES IN DEVELOPING COUNTRIES
World Bank 2003
This paper asks how to make a much needed system of user fees for government health services compatible with the goal of preserving equitable access to services. It demonstrates that different countries have tried different approaches and that those which have carefully designed and implemented waiver systems have had much greater success in terms of benefits incidence than countries that have improvised such systems.
FROM SOCIAL CONTRACT TO PRIVATE CONTRACTS: THE PRIVATISATION OF HEALTH, EDUCATION AND BASIC INFRASTRUCTURE
Privatisation is being pushed by international governance institutions, the governments that control them, and the corporations that lobby both groups, even though the dangers that privatisation entails can seriously - and permanently - harm the livelihoods of the world's poorest people. The position of "privatise first and ask questions later" and the naïve confidence in the processes and outcomes of market reform have imposed hardship on precisely the groups those organisations are entrusted to protect. It is time to shift the burden of proof from those who question risky solutions to those who propose them, says this article.
Waivers and Exemptions for Health Services in Developing Countries
The World Bank, 2003
In response to shortages in public budgets for government health services, many developing countries around the world have adopted formal or informal systems of user fees for health care. In most countries user fee proceeds seldom represent more than 15 percent of total costs in hospitals and health centres, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial or full waivers to the poor often results in inequity in access to medical care. The dilemma, then, is how to make a much-needed system of user fees compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence than countries that have improvised such systems (Ghana, Kenya, Zimbabwe).
A NEW FACE FOR PRIVATE PROVIDERS IN DEVELOPING COUNTRIES: WHAT IMPLICATIONS FOR PUBLIC HEALTH?
Produced by: Bulletin of the World Health Organisation (WHO): the International Journal of Public Health (2003)
The use of private health care providers in low- and middle-income countries is widespread and is the subject of considerable debate. This article, produced by the Bulletin of the World Health Organisation, reviews a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardised primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In addition, implications for public health policy of the emergence of this new model of private provider are discussed.
Franchising in Health: Emerging Models, Experiences, and Challenges in Primary Care
Note No.263 - June 2003 World Bank
In the past decade a growing number of health franchising schemes have emerged in developing countries. Often reaching tens of thousands of poor households, these private schemes currently provide logistical, managerial, and sometimes financial support to small-scale providers (franchisees) of preventive care, such as family planning and maternal and child health services. While franchising has attracted growing interest among governments and donors as a possible way to achieve health objectives, there is some debate about the ability of the model to reach the poorest people and the ability of franchisers to sustain themselves financially.
Policy and Regulatory Options for Private Participation in developing countries
Many developing countries face a critical gap between the demand for health care services and their supply. Public resources often fall short of what is needed to provide universal health care, and the typical incentive structure in the public sector may not always be conducive to expanding access, improving the quality of care, and ensuring efficient use of limited funding and expertise. This World Bank Note defines options for mobilizing private resources to achieve public health objectives.
the Drugs for Neglected Diseases Initiative: A global initiative to develop drugs for those in need
Recent international efforts to revive pharmaceutical R&D for neglected diseases have focused mainly on malaria, tuberculosis and HIV/AIDS. These have relied heavily on market-based incentive mechanisms, including public-private partnerships. The DND-WG's analysis clearly shows that this strategy will have limited impact for what we describe as the "most neglected diseases". One strategy to address this fatal imbalance that is currently being pursued is the creation of a needs-driven global drug development network - the Drugs for Neglected Diseases Initiative (DNDi). The DNDi is a not-for-profit research and development organisation that will manage global R&D networks with the goal of producing new, effective, affordable and field-relevant drugs for neglected diseases. The Drugs for Neglected diseases Initiative is the brainchild from Médecins Sans Frontières' Drugs for Neglected Diseases Working Group. The DNDi aims to take the development of drugs for neglected diseases out of the marketplace and encourage the public sector to assume greater responsibility.
Competing for business? Improving hospital services in Zambia with market forces
Does competition improve hospital services? Do market forces in healthcare benefit the poorest members of society? Reforms which involve exposing hospitals to market forces are being introduced in many developing countries. However, very little is known about how these markets operate, particularly in developing countries. The University of Zambia, together with the London School of Hygiene and Tropical Medicine, considered the effect of competition among hospitals in Zambia. The study concludes that there is potential for competition in the hospital market to have beneficial effects in terms of prices, quality and efficiency. However, there is also the risk that faced with this competition, hospitals will be less able to charge private prices which allow them to cross-subsidise public patients.
Free Government Health Services: Are They the Best Way to Reach the Poor?
Davidson R. Gwatkin, March, 2003, World Bank
Equity is a frequently stated justification for government involvement in the health care market. This is often taken to mean directly providing all segments of the population with a wide range of government-operated health services at no cost: free universal care. Yet a look at the record suggests that this goal all too often remains elusive, especially in poor countries; that governments in fact serve only some of the population; and that the people served are disproportionately concentrated among the better-off. When this happens, government health services, far from promoting equity, work against it. The purpose of this chapter is to illustrate that there are many ways for governments to pursue the goal of ensuring that the poor receive adequate, affordable services through alternative approaches to resource allocation and purchasing. The first section summarizes the information known about the distribution of benefits from government health services across social groups in order to document the regressive pattern that now frequently exists and the need for significant changes in approach if the poor are to benefit. The second and third sections illustrate the kinds of changes that might be considered.