The World Bank and International Monetary Fund favour healthcare user fees. User fees offer revenue and may decrease inappropriate care. However, user fees may deter needed care, especially in vulnerable populations. A cross-sectional analysis of healthcare utilization in a large Zambian hospital was conducted for children 3-6 years of age during a one-month observation period. Trends suggest female children may be less likely to present for care when user fees are imposed. This paper concludes that user fees appear to decrease differentially utilization of inpatient care for female children in rural Zambia.
Public-Private Mix
User Fees and the impact on female children in rural zambia
What can be done about the private health sector in low-income countries?
Improving the quality of private health care provision in developing countries is of major importance to the livelihoods of poor people. This article was published in the ‘Bulletin of the World Health Organisation’ and summarises how the activities of the private health sector in low-income countries can be influenced so that national health objectives are met. The article begins with an overview of the characteristics of the private health sector in developing countries. It continues with a summary of how to improve both the supply and the demand for private health care. To close, the authors list the possibilities available to governments for improved stewardship of the private sector.
Leading by example: lessons for the Global Fund
Public-private partnerships are increasingly popular initiatives in international health. The Global Alliance for Vaccines and Immunisation (GAVI) was launched in January 2000 with a donation of US$ 750 million from the Bill and Melinda Gates Foundation. An assessment of its work by researchers at the London School of Hygiene and Tropical Medicine reveals important lessons for similar initiatives, including the new Global Fund to Fight AIDS, Tuberculosis and Malaria.
MALAWI: TOWARDS TOTAL PRIVATISATION
Often some government and donor officials have denied that Malawi will privatise nearly every lifeline. But progress indicates that the government intends to privatise institutions providing food security in Malawi, water, electricity and more. This will translate into the livelihood of the people being at the mercy of 'forces of the market'. This privatisation behaviour has been opposed by civil society, says this briefing from the Malawi Economic Justice Network.
africa: CONDOMS COUNT: MEETING THE NEED IN THE ERA OF HIV/AIDS
This report, produced by Population Action International, argues that condom promotion and provision is one of the most effective methods for preventing HIV/AIDS. They state that 8 billion would have been the minimum number of condoms to have made a difference to the spread of HIV in 2000, and that the 950 million provided by donors were therefore hugely inadequate. The report says that a number of different interventions are necessary for effective prevention programmes: the authors highlight the need for addressing poverty, gender inequity and promoting the 'ABCs' of abstinence, fidelity and condom use. However, they state that the mix of interventions must always include condoms. In calling for universal access to condoms, the report states that public/private partnerships will be necessary and that market segmentation, whereby those who can afford to pay more than the poorest, should be encouraged.
Social Reinsurance: A New Approach to Sustainable Community Health Financing
Edited by Alexander S. Preker , David M. Dror, World Bank
Traditional sources of health care financing are often inadequate leaving many of the 1.3 billion poor people in low- and middle-income countries without access to the most basic health services. Governments in these countries have tried to reach these excluded populations through public clinics and hospitals. To help pay for these services, governments often use a combination of broad-based general revenues, contributions from the formal labor force, and user fees, similar to the financing mechanisms used by Western industrial countries. However, these mechanisms are not always effective in many developing countries, leaving many of the poor without essential health care or financial protection against the cost of illness. Social Reinsurance details community-based approaches to insuring people against medical risk not based on individual risk rating as in private insurance, but rather using decentralized social insurance based on the average risk.
Private parts - treatment for STIs in Uganda
Effective treatment of curable sexually transmitted infections (STIs) is one of the few strategies available to reduce the spread of HIV in sub-Saharan Africa. Many people with STIs seek treatment from private practitioners. Why are patients turning to the private sector for help? Do they receive adequate care?
Civil society health caucus at the WSSD
The Civil society health caucus at the WSSD Global Forum hosted a Commission to discuss the Role of the of the state and water, sanitation and primary health care in the context of globalisation. The discussion included analysis of the situation which raised the following points.
• Debt and globalisation impact negatively on the distribution of all resources, including environment and health through their destruction and privatization.
• Environmental degradation increases the burden of ill health
• Lack of knowledge about environment and health and hygiene are sorely lacking amongst many citizens, especially children.
• Environmental services are a basic right which every citizen should enjoy
• Privatisation of services, including through public private partnerships, has been a very negative experience for many poor people, especially women and children, in countries as diverse as the UK and Argentina
• War and military occupation both severely restrict access to health and basic services, and conflict and psychological stress are also increasingly a result of struggles for access to these services.
Further details: /newsletter/id/29330
Patients or profits? Professional ethics, co-operation and competition in health systems
The concept of 'managed competition' to improve efficiency has been common in health sector reform in wealthy countries. It has also been exported to health systems in the South, involving privatisation and marketisation. Research from the UK Institute of Development Studies questions whether this competitive approach is appropriate in a sector where ethical behaviour, altruism and co-operation are essential for good quality services.
the ROLE OF THE STATE IN HEALTH
Presented to the commission on health hosted by civil society at WSSD by BUPENDRA MAKAN of The Equity Project.
Development is inextricably linked to social justice & equity. Health is a basic human right.
“It should never be that the anger of the poor, should be the finger of accusation pointed at all of us because we failed to respond to the cries of the people for food, for shelter, for the dignity of the individual” former President of South Africa, Nelson Mandela to US Congress in 1990. Poverty in a world of plenty is the greatest barrier to health as shown in the huge inequities in health status.
Further details: /newsletter/id/29331