In a move that has already sparked controversy, the South African treasury is to draw private business into the public health sector as a way of upgrading the services provided by state hospitals. In his budget speech, Finance Minister Pravin Gordhan referred to broadening the implementation of public-private partnerships (PPPs) in the health sector to improve hospitals system as a “prerequisite for the introduction of a national health insurance system”. A flagship PPP project is proposed as Chris Hani Baragwanath Hospital in Johannesburg, for which a feasibility study is now complete. However the Congress of South African Trade Unions (Cosatu), the largest union in the country, has opposed PPPs as a vehicle for privatisation, which is argued to lead to higher costs, poorer services and the loss of jobs.
Public-Private Mix
This sheet provides information on financing in the public and private health sectors in South Africa. It notes that medical schemes cover 16% of the population, on whom about R11,300 is spent per person (this includes both medical scheme spending and out-of-pocket payments), while the public sector covers most of the rest of the population, particularly the 68% who do not use any private care – government spends about R1,900 per person on this group. Sixteen percent of the population use the private sector on an out-of-pocket basis for primary care but are almost entirely dependent on the public sector for hospital care; for this group nearly R2,500 is spent per person. Medical scheme spending has been increasing, while public sector health spending has been largely stagnant until recently. Most health professionals (except enrolled nurses) work in the private health sector.
The Bill & Melinda Gates Foundation has given a grant of US$7 million over five years to the American Cancer Society to lead and coordinate the African Tobacco Control Consortium, a global coalition of public health-oriented organisations focusing on using evidence-based approaches to stem the tobacco epidemic in Africa. According to the International Agency for Research on Cancer, much of the rise in cancer in Africa can be attributed to widespread tobacco use and exposure to secondhand smoke. Tobacco is the leading cause of preventable death in the world, and according to the World Health Organization, if current trends continue, tobacco use will cause one billion deaths worldwide during this century. As the managing organisation, the Society will collaborate with consortium partners to implement an ambitious tobacco control program across the 46 countries of sub-Saharan Africa. The overall goal will be to reduce tobacco use in these countries by implementing proven strategies at the national and local level.
The South African Government Treasury is reported to have set aside an extra R8,4bn for HIV and AIDS over the next three years, reflecting its commitment to improving the quality of services for people affected by the disease and to doubling the number of patients getting life-saving antiretroviral therapy. An increase in funds flowing to provinces through conditional grants for HIV and AIDS and increased budget allocations to to wage increases for doctors, dentists, pharmacists and emergency services personnel, and for therapeutic practitioners such as physiotherapists intend to retain vital skills in the public sector, while a hospital revitalisation grant covers costs of refurbishing public hospitals. Citing Finance Minister Pravin Gordhan, the report notes that these investments seek to improve the public health care sector as part of building a closer partnership between the public and private healthcare systems.
This report highlights how changes in the legal and regulatory environment can facilitate expanded access to family planning and reproductive health services through Africa’s private health sector. Using laws and regulations from three Africa countries - Ethiopia, Kenya and Nigeria - this report presents a road map on how to review the most important laws governing the private sector, as well as key issues to assess.
The private health sector in the developing world is poorly understood, best practices are not documented, promising initiatives are not scaled for broader application, and there is mistrust between the public and private sectors. Yet all acknowledge a comprehensive approach to the critical health worker shortage must involve the private sector. The private health sector in resource-poor settings relies on an enabling environment of civil society, financial and operational resources. How that interrelationship between society and the private sector operates and potentiates greater scaling of innovative responses to the HRH crisis is not understood. Scaling and implementation of innovative private sector responses will require greater understanding of this relationship. The Alliance has agreed to support the development of a Task Force on private sector involvement in human resources for health to ensure that identified innovative private sector models will gain broader attention and implementation and scaling up of these models into other locales can be facilitated. The overarching goal is to accelerate the scaling and cross-border movement of initiatives in the private health sector, which can increase the supply of new workers, improve the efficiency and effectiveness of existing health workers and reduce the attrition of health workers out of the field of practice or movement out of region.
The International Finance Corporation (IFC), a member of the World Bank Group, the African Development Bank, the Bill & Melinda Gates Foundation and the German development finance institution, Deutsche Investitions und Entwicklungsgesellschaft (DEG), announced that it has created a new private equity fund that will invest in Africa’s health sector. The Health in Africa Fund, managed by Aureos Capital, will invest in small- and medium-sized companies in sub-Saharan Africa with the goal of helping low-income Africans gain access to affordable, high-quality health services. The fund will be measured not only by fiscal performance but also by its ability to cultivate businesses serving the poor. It will target commitments between US$100 to 120 million over two closings. The fund will make long-term equity and quasi-equity investments in socially responsible and financially sustainable private health companies with the aim of scaling up successful businesses, taking proven business models into new regions, and identifying and investing in areas where there are critical gaps. It will invest in a wide range of companies that deliver, among others, health services (clinics, hospitals, diagnostic centres and laboratories); pharmaceutical and medical-related manufacturing companies; medical education; and providers of medical education.
The main objectives of this study were to document the role of the private for-profit sector in voluntary counseling and testing (VCT) service delivery and to establish whether there are significant differences in the quality of VCT services, particularly in counseling and referral practices, between public, private for-profit, non-governmental (NGO) and mission health providers. Copperbelt and Luapula were selected, which are urban and rural provinces. HIV prevalence among adults is approximately 17% in Copperbelt and 13% in Luapula. Geographic proximity and the cost of transportation were found to be important factors for clients in selecting a facility, as well as the specialised reputations of NGOs. Clients were drawn to the private sector because of its ability to offer high-quality general health services, in comparison with other medical sectors. This finding suggests that the private sector may be uniquely positioned to pilot more extensive integrated HIV services. However, no one sector emerged as providing overwhelmingly higher quality services than another and, overall, rural sites performed on par in quality with the urban sites. However, the findings revealed less than optimal counseling practices across the sectors.
This paper describes the changes in utilisation of health services that occurred among the poor and those in rural areas in Uganda between 2002/3 and 2005/6 and associated factors. Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset-based index derived from principal components analysis (PCA). The study found that the rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access. The risk of not seeking care due to high costs did not change significantly. Poor people, females, rural residents and those from elderly headed households were more likely to use public facilities relative to private for-profit (PFP) providers. Although overall utilisation of public and private not-for-profit (PNFP) services by rural and poor populations had increased, PFP providers remained the major source of care. Policy makers should consider targeting subsidies to the poor and rural populations. Public-private partnerships should be broadened to increase access to health services among the vulnerable.
This paper examines the experiences of private sector participation (PSP) in the water supply and sanitation (WSS) sector. The paper argues that publicly owned water utilities have not always been successful in both developed and developing economies. However, non-market failures in supplying water are much more severe in developing economies. On grounds of efficiency, public WSS services have remained wanting. Large proportions of the population remain with little or no access to public services, and the quality of services for those who receive them are often poor, characterised by frequent breakdowns and unreliable supply. The author argues that while private sector participation has made more progress in high-income and middle-income countries, it has failed considerably in low-income developing countries. Success in wealthier countries is attributed to investment by private capital. The report concludes by recommending that private sector participation in the WSS sector in developing countries should not be introduced without rigorous prior assessment of its feasibility. When prevailing conditions are not suitable for introducing PSP, reforming the public utility should be given due consideration as a viable alternative.