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.
Public-Private Mix
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.
In June 2009, a new Health in Africa Fund was launched by the International Finance Corporation (IFC), the branch of the World Bank group mandated with supporting and expanding the private for-profit sector. This Fund will be managed by Aureos Capital, a private equity fund manager focusing on emerging markets. Through investment in small- and medium-sized private providers, the Fund will attempt to’[help] low-income Africans gain access to affordable, high-quality health services.’ The Fund targets initial commitments of US$ 100–120 million and intends harnessing private capital and private sector providers to improve quality and coverage of health services. But it is unlikely to improve access or quality of care unless it is complemented by initiatives to strengthen the public sector capacity to regulate, train, oversee and sub-contract (where appropriate) private providers. In addition, the Fund would also require the development of risk-pooling and subsidy mechanisms, so that privately-provided services can be offered free at the point of delivery. If it fails to do so, there is a concrete risk that, contrary to its objectives, it will contribute to the entrenchment of two-tier health-care systems and to a further concentration of human and financial resources in services catering to affluent urban dwellers.
The question of why privatisation and commercialisation of public services is taking place is a hotly contested one. Neoliberal analysts have argued that privatisation occurs because states fail: state officials are rent-seeking, inefficient, unaccountable, inflexible and unimaginative. Privatisation is seen as a rational and pro-poor policy choice, obvious to anyone willing to look at the track record of public versus private sector delivery: The authors here argue, by contrast, that the privatisation of public services has not happened because it has been inspired by some renewed sense of cultural enthusiasm for the market, but rather that it has become a necessity imposed on the state by economic circumstances: reduced public borrowing; cuts in state spending; liberalisation; and the opening up of new economic fields for intensified capital accumulation. Not surprisingly, some of the biggest boosters of privatisation are the private companies themselves, which have spent considerable time and effort trying to secure new market opportunities. They have actively sought contracts around the world, and consultancy firms, such as PriceWaterhouseCoopers and KPMG, have been actively promoting privatisation efforts and lobbying for the expansion and acceleration of the General Agreement on Trade and Services (GATS).