The concept of ‘water operator partnerships’ (WOPs) has increasingly been promoted as a means to improving water services provision in developing countries. The International Water Association (IWA)defines WOPs as ‘any formal or informal collaboration or structured partnership aimed at capacity building on a not-for-profit basis. In the WOPs approach emphasis is on capacitating (rather than replacing) the public organisation. Researchers assessed the potential of such partnerships as a ‘model’ for contributing to the Millennium Development Goals (MDGs), by focusing on four water utilities in Mozambique. Although, the study found these partnerships to be successful, their replicability and potential for scale up was found to be quite limited. The study found that WOPs depended for success on the availability of investment funds, and the level of commitment to the partnership, both financial commitment and time and effort of the organisations involved.
Public-Private Mix
The Global Business Coalition for Health (GBCHealth), which took part in the United Nations Conference on Non-Communicable Diseases (NCDs) held in New York in September 2011, has argued that companies must have a place at the tables where their future is discussed. GBCHealth, which represents companies that manufacture unhealthy (junk) foods and tobacco products, believes that their expertise is essential to developing public health policy. But activists disagree, arguing instead that industries producing unhealthy products should not be viewed as trusted partners and should not have a seat at the table during public health negotiations. In this open letter, AIDS activist Gregg Gonsalves responds to GBCHealth’s article justifying their right to be part of the negotiations. Though GBCHealth has had a long history of working on HIV and AIDS, he argues that big business cannot be considered representative of civil society, which is largely composed of marginalised groups, civil society organisations and other interested parties whose fight for civil, social and economic rights are not part of big business, whose primary goals are profit oriented. He calls on big business to stop trying to halt generic production of anti-retrovirals and drugs for NCDs (such as Novartis' continuing attempts to alter Indian patent law), to stop selling and promoting cigarettes and to stop advertising and marketing of high-sugar and high-fat foods across the globe.
The United States (US) Department of State, the George W. Bush Institute, the US President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G Komen for the Cure, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have launched Pink Ribbon Red Ribbon (PRRR), a partnership to leverage public and private investment in global health to combat cervical and breast cancer, the leading causes of cancer death in women in Sub-Saharan Africa and Latin America. The partnership aims to expand the availability of vital cervical cancer screening and treatment and breast care education, notably for women most at risk of getting cervical cancer in developing nations because they are HIV-positive. With initial indications of interest, PRRR expects to have commitments of up to US$75 million across five years, which will grow to include additional participants and services. The goals are to reduce deaths from cervical cancer by an estimated 25% among women screened and treated through the initiative, significantly increase access to breast and cervical cancer prevention, screening and treatment programmes, and create innovative models that can be scaled up and used globally. This public-private initiative includes initial commitments from founding corporate participants Merck, Becton Dickinson, QIAGEN, Caris Foundation, Bristol-Myers Squibb, GlaxoSmithKline and IBM.
Fast food and alcohol advertisements in South Africa could soon be a thing of the past, according to the National Health Department. At a summit held in Johannesburg in September 2011, the Health Minister, Dr Aaron Motsoaledi, highlighted the importance of healthy lifestyles in the fight against non-communicable diseases (NCDs). An Inter-Ministerial Committee on alcohol use and abuse has been set up, aimed at banning alcohol advertising and, despite intense lobbying by the alcohol industry, the Minister has vowed not to change his position. The Minister also aims to target the fast food industry by banning their advertising during children’s television programmes. He says he is working with the relevant industries to make fruit and vegetables cheaper and more accessible, and intends to encourage regular exercise in schools in the form of physical education programmes, citing obesity levels among school children at 23%.
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.
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.