The study is based on multiple rounds of Demographic and Health Survey data from four selected countries (Nigeria, Uganda, Bangladesh, and Indonesia) in which there was an increase in the private sector supply of contraceptives. The methodology involves estimating concentration indices to assess the degree of inequality and inequity in contraceptive use by wealth groups across time. The results suggest that the expansion of the private commercial sector supply of contraceptives in the four study countries did not lead to increased inequity in the use of modern contraceptives. In Nigeria and Uganda, inequity actually decreased over time; while in Bangladesh and Indonesia, inequity fluctuated. The study results do not offer support to the hypothesis that the increased role of the private commercial sector in the supply of contraceptive supplies led to increased inequity in modern contraceptive use.
Public-Private Mix
The main objective of this study was to conduct a baseline study of the private market for anti-malarials in Muheza town, an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and accreditation programme that will allow accredited drug shops to sell subsidised Artemether-lumefantrine (ALu). All drug shops selling prescription-only anti-malarials in Muheza voluntarily participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales volume. Results showed that all surveyed drug shops illicitly sold sulphadoxine-pymimethamine (SP) and quinine (QN), and legally amodiaquine (AQ). In community practice, the saleability of ACT was negligible. SP was best-selling, and use was not reserved for Intermittent Preventive Treatment (IPTp), as stipulated in the national anti-malarial policy. The authors express concern that such drug-pressure in the community equals de facto intermittent presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people other than pregnant women runs the risk of eventually jeopardising the effectiveness of the IPTp strategy.
The One Million Campaign’s petition to the President of the United Nations (UN) General Assembly urges the UN to re-consider proposed partnerships with the private sector for future work in prevention of non-communicable diseases (NCDs). The UN’s draft Political Declaration, developed in preparation for the High-level Summit on Non-communicable Diseases (NCDs) in September 2011, contained proposals to allow manufacturers of unhealthy foods - including infant foods and junk foods -to influence future global and national health strategies to control NCDs. The One Million Campaign asserts that strategies to prevent NCDs should emphasise support to women to continue breastfeeding up to two years, especially exclusive breastfeeding for the first six months and end promotion of all foods for infants, and children. Research indicates that this breastfeeding regimen significantly reduces the risk of NCDs. They argue that manufactures of unhealthy foods, breast milk formula and infant foods should not be allowed to participate in developing strategies or making decisions regarding healthy foods and prevention of NCDs, as there is a clear case of conflict of interest.
Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. The authors of this paper propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. They applied this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing independent private sector providers; social franchises of private providers; non-government organisation (NGO) providers; and government providers on these three factors. They found that franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. These results suggest that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific, the authors conclude.
The author of this paper examined the functioning of the informal transport markets in facilitating access to maternal health care in Eastern Uganda, to demonstrate the role that higher institutions of learning can play in designing projects that can increase the utilisation of maternal health services. Data were collected through qualitative and quantitative methods that included focus group interviews and a review of project documents and facility-level data. There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilising mothers to attend services, the authors found. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations. The findings indicate that locally existing resources such as motorcycle riders can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilisation of maternal health services. However, care must be taken to mobilise the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.
The authors of this paper reviewed and synthesised findings from eight independent evaluations of Global Health Partnerships (GHPs) as well as research projects they had conducted themselves. They present the major drivers of the current GHP trend, briefly review the significant contributions of GHPs to global health and set out common findings from evaluations of these global health governance instruments. The paper answers the question of how to improve GHP performance with reference to a series of lessons emerging from the past ten years of experience. These lessons cover the following areas: value-added and niche orientation; adequate resourcing of secretariats; management practices; governance practices; ensuring divergent interests are met; systems strengthening; and continuous self-improvement. The authors argue in favour of sustained critical reflection and independent evaluation of GHPs so as to ensure optimal results, given the high level of resources that collaboration demands. They call for the opening up of spaces for public debate so that the findings from evaluation can be frankly discussed, as well as highlight the need to apply lessons more widely across and within partnerships.
The chairman of South Africa’s Parliament’s health portfolio committee, Bevan Goqwana, is lobbying for a new, statutory body to oversee private hospitals. Members of his committee grilled the Hospital Association of SA (Hasa) on the prices charged by its members, which include more than 95% of private hospitals. The Council for Medical Schemes said a lack of competition was partly to blame for rising private hospital fees. They said that, in 1996 half the hospitals in metropolitan areas were independent but by 2006 this figure had fallen to 12,3%, due to market concentration in the hands of a few private health care providers, resulting in an oligarchy of providers. Private hospitals and healthcare professionals have faced constant criticism from the Health Minister, Aaron Motsoaledi, for the role he perceives them to be playing in driving up the cost of healthcare. In their defence, Hasa claims that the real cause of high hospital costs in the private sector is the cost of inputs and the expense of increasing hospital capacity with the purchase of expensive specialist equipment.
For human vaccines to be available on a global scale, complex production methods, meticulous quality control and reliable distribution channels are needed to ensure that the products are potent and effective at the point of use, the authors of this article argue. The technologies used to manufacture different types of vaccines can strongly affect vaccine cost, ease of industrial scale-up, stability and, ultimately, worldwide availability. The complexity of manufacturing is compounded by the need for different formulations in different countries and age-groups. Reliable vaccine production in appropriate quantities and at affordable prices is the cornerstone of developing global vaccination policies, the author argue. However, they emphasise that to ensure optimum access and uptake, strong partnerships are needed between private manufacturers, regulatory authorities, and national and international public health services. For vaccines whose supply is insufficient to meet demand, prioritisation of target groups can increase the effect of these vaccines.
This investigation by ActionAid used published financial information, interviews with government officials and research to follow up on corporate tax avoidance across Africa and India. They estimate that as much as £20 million per year may have been lost in the form of corporate taxes or a fifth of the corporate tax bill that could have paid for education, health and infrastructure. The authors argue for strengthened tax law and revenue administration capacity to deal with taxing multinational companies; improved transparency around corporate reporting; for countries to not give away their right to tax royalties, management fees and other foreign payments at source; and to examine and, where necessary, reform the way they tax multinationals.
In this article, the author presents global data on access to pharmaceuticals and discusses underlying barriers. Two are highly visible - pricing policies and intellectual property rights – while two are less recognised - the regulatory environment and scientific and technological capacities. Two ongoing transitions influence and even distort the problem of universal access to medications, the author argues, namely the epidemiologic transition to an increasing burden of chronic non-communicable diseases, and the growing role of biotechnology products (especially immunobiologicals) in the pharmacopeia. Examples from Cuba and Brazil are used to explore what can and should be done to address commercial, regulatory, and technological aspects of assuring universal access to medications.