Health Systems Trust will be publishing a couple of chapters and indicators covering this area in the upcoming South African Health Review (2001) - but this will only be available at the end of March. Meanwhile you may wish to look at previous editions which also cover the topic.
Public-Private Mix
November 2001
Richard Strouse, Barbara Carlson, John Hall, Center for Studying Health System Change, Washington, DC Peter Cunningham, Mathematica Policy Research, Inc. Princeton, NJ
In this report, the authors describe site selection, sample design, instrumentation and survey preparation, data collection methods, response rates, and sample weights. The Community Tracking Study (CTS) addresses two broad questions that are important to public and private health decision makers:
1. How is the health system changing? How are hospitals, health plans, physicians, safety net providers, and other provider groups restructuring, and what key forces are driving organizational change?
2. How do these changes affect people? How are insurance coverage, access to care, use of services, health care costs, and perceived quality of health care changing over time?
Governments and donor agencies increasingly recognise the need to provide protection for the poor against income fluctuations or livelihood shocks. In this context, ‘social protection’ is an umbrella term covering a range of interventions, from formal social security systems to ad hoc emergency interventions to project food aid (e.g. school feeding, public works). This paper synthesises current thinking and evidence on a number of issues around the design and impact of social protection programmes, including: the case for and against targeting resource transfers; alternative approaches to targeting; what form resource transfers should take (cash, food, agricultural inputs); the ‘crowding out’ debate; cost-efficiency of transfer programmes; whether these programmes meet the real and articulated needs of their ‘beneficiaries’; impacts on poverty and vulnerability, and fiscal and political sustainability.
Universal access to contraceptives is a key goal of sexual and reproductive health programmes. But what is the best way to supply them? Donated or subsidised contraceptive supplies raise questions of sustainability whereas there are concerns that market-based distribution has negative impacts on equity and access.
The perception that governments cannot efficiently provide water and sanitation (WSS) services has led to greatly increased private sector participation (PSP). Are regulatory regimes ensuring that service providers do not exploit their customers? Can PSPs save water and make it safer? Are the poor getting basic services?
Universal access to contraceptives is a key goal of sexual and reproductive health programmes. But what is the best way to supply them? Donated or subsidised contraceptive supplies raise questions of sustainability whereas there are concerns that market-based distribution has negative impacts on equity and access.
User fees are an increasingly common component of public health financing. The intention is to provide patients with a cheaper but high quality alternative to private healthcare. But does it work? What is the impact on the poorest households? Do poor people still use public health services when they have to pay fees?
David P. Fidler. Bulletin of the World Health Organization Volume 79, Number 9, September 2001
Global threats to public health in the 19th century sparked the development of international health diplomacy. Many international regimes on public health issues were created between the mid 19th and mid-20th centuries. The present article analyses the global risks in this field and the international legal responses to them between 1851 and 1951, and explores the lessons from the first century of international health diplomacy of relevance to contemporary efforts to deal with the globalization of public health.
DOUGLAS W BETTCHER and HEATHER WIPFLI - J Epidemiol Community Health 2001;55:617-8
In her article Fran Baum is correct in pointing out that the political complexities of our globalised world must be taken into account by public health professionals. Global health futures are directly or indirectly associated with the transnational economic, social, and technological changes taking place in the world. Issues such as poverty, equity, and justice must be firmly rooted in any discussions aimed at improving global public health. However, globalisation is a "janus faced" creature: the double face of globalisation, one promising and the other threatening, is a fact of life as humanity is being catapulted into a more interdependent future.
The Congress of South African Trade Unions' (Cosatu's) strike action against privatisation has placed a large question mark over the effectiveness of South Africa's efforts to privatise parastatals - or at least communicate to the broader community the need to restructure.