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.
Public-Private Mix
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.
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?
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.
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.
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.
The British government and its EU allies were accused at the WSSD of pushing privatisation as a one size fits all model for delivery of vital basic services such as water, despite considerable evidence that it has failed to deliver affordable, clean water to poor communities around the world.
L Rychetnik, M Frommer, P Hawe and A Shiell
Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
Faced with the devastating impact of an HIV/AIDS epidemic compounded by abject poverty, Malawians have eased the pressure on state hospitals by caring for chronically ill family and neighbours at home. A home based care (HBC) project in Northern Malawi has assembled 225 young volunteers in the region's nine districts to provide community based support to homes and guardians looking after people living with AIDS (PWAs). The aim is to ease their suffering and prolong their lives.
What checks should municipalities make before signing up to public private partnerships (PPPs) in solid waste management (SWM)? How can they judge the merits of technologies touted by international operators? Can private operators be persuaded to target the poor? How can the poor be involved in the collection of solid waste?