Many AIDS activists have been enraged by the export abroad of conservative American morality on sex, drugs and prostitution through HIV/AIDS programs funded by the U.S. government. Particularly galling is that it replaces accepted, evidence-based public health policies with ideology. But if there is one thing this U.S. government hates more than fags, junkies, hookers, condoms and clean needles, it's socialized medicine. Quietly, the President's Emergency Plan for AIDS Relief (PEPFAR) and other bilateral initiatives are exporting the HMO-ization of AIDS in Africa and elsewhere on the planet, in which a network of private institutions are being built up to provide antiretroviral therapy (ART) to the millions who need it.
Public-Private Mix
Private sector, human resources and health franchising in Africa
This article, from the Bulletin of the World Health Organization, outlines the available evidence on which sections of society benefit from publicly provided care and which sections use private health care. The authors assess use of public and private health services, as well as the use of franchise networks which supplement government programmes in the delivery of public health services. Examples from health franchises in Africa and Asia are provided to demonstrate the potential for franchise systems to increase services available to the public.
Improved government capacity needed for effective public-private partnerships
This document, from the Institute for Health Sector Development, examines a range of approaches to strengthening public-private sector partnerships in order to scale up affordable and quality-assured health services. The document summarises and assesses the evidence base for the impact of private sector interventions on the health of the poor and on the wider health systems. This includes both the supply side (contracting, social franchising and social marketing) and the demand side (vouchers, micro-credit and insurance schemes). This resource also includes four case studies involving Nicaragua, Cambodia, Pakistan and Tanzania.
Improving the quality of primary health care: public and private provision
The quality of primary health care (PHC) delivered to people in developing countries is often poor and coverage is not yet universal. This is despite a focus on the public delivery of comprehensive PHC over the past 20 years. People frequently consult private providers including qualified medical professionals and unqualified health practitioners. A better use of private care providers, therefore, might be a potential solution, including contracting them to provide services on behalf of the public sector. Research from the London School of Hygiene and Tropical Medicine, the University of Witwatersrand and the University of Cape Town examines the performance of various models of PHC provision in South Africa.
The Equity implications of health sector user fees in Tanzania
Research for Poverty Alleviation (REPOA) commissioned ETC Crystal to examine the equity implications of health sector user fees in Tanzania, with particular reference to proposed and actual charges at dispensary and health centre level. This year, Tanzania will review its Poverty Reduction Strategy. With the findings of the user fee study, REPOA aims at making a valuable contribution to the review process and provide country-specific insight into one of the most debated issues in health financing.
Improving the quality of primary health care: public and private provision
The quality of primary health care (PHC) delivered to people in developing countries is often poor and coverage is not yet universal. This is despite a focus on the public delivery of comprehensive PHC over the past 20 years. People frequently consult private providers including qualified medical professionals and unqualified health practitioners. A better use of private care providers, therefore, might be a potential solution, including contracting them to provide services on behalf of the public sector. Research from the London School of Hygiene and Tropical Medicine, the University of Witwatersrand and the University of Cape Town examines the performance of various models of PHC provision in South Africa.
Public private partnerships in health: a global call to action
Health Research Policy and Systems , 2004
This paper, produced by Health Research Policy and Systems, outlines key challenges in public-private arrangements in health care and makes a Global Call to Action to address these challenges. The author establishes several ethical challenges in public-private partnerships. These include: a lack of global norms and principals, threatened impartiality of health care due to poorly designed partnerships, the risk of abandoning social safety nets for vulnerable groups, and conflict of interest due to ‘for-profit’ demands of the private sector. Other ethical issues consist of redirecting national health policies, fragmentation of the health system, contribution to common goals and objectives, and lack of contributions to improvements in quality and efficiency.
Public-private partnerships and access to drugs
This Initiative on Public-Private Partnerships for Health report provides an overview from a series of studies of drug access programmes in Uganda, Botswana, Sri Lanka and Zambia. The report draws out three broad conclusions from the studies. Firstly, it highlights a fragmentation of initiatives, funding and conditionalities. Secondly, it points to a lack of understanding of the range of options regarding access to medicines, as well as a lack of capacity to compare and contrast alternatives best suited to national needs. Finally, the authors find that the decision to exclude the private sector from most initiatives lacked grounding in the reality of health service delivery in sub-Saharan Africa.
Does contracting-out improve health services?
This paper, produced by Partnerships for Health Sector Reform/plus, discusses the effectiveness of contracting out primary care services as a tool for health reform. The paper provides a short history of contracting out, a discussion of its advantages and disadvantages, and a review of the available literature on the impact of contracting out. The authors note that there is a lack of evaluation research on the success of contracting-out, and a lack of conclusive evidence that contracting out improves overall health sector efficiency.
Potential for public-private drug research 'untapped'
Wealthy governments trying to help develop drugs for poor counties have been slow to recognise the potential for public-private partnerships, according to the UK-based Pharmaceutical R&D Policy Group (PRPG). Since May 2004, the PRPG has been assessing different ways of funding drug development for 'neglected diseases' - such as malaria and sleeping sickness - that affect many people in poor countries but receive little attention from the global research community.