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.
Public-Private Mix
Does contracting-out improve health services?
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.
Global health-related public-private partnerships and the United Nations
This brief examines the policy implications of increased activity between the UN and the corporate sector, specifically focusing on the increased collaboration between the corporate sector and the World Health Organization (WHO), UNICEF and UNFPA. The brief also explores the major global health-related public-private partnerships (GHPPPs) which operate primarily outside the UN, such as the Global Alliance for Vaccination and Immunisation (GAVI). The brief concludes that, although guidelines and procedures to address public-private interactions (PPIs) have been developed within UN agencies, they are inadequate to ensure UN integrity.
Making health systems more equitable
Lancet 2004; 364: 1273-80
If access to health services were distributed according to need, the poor would come first. But they do not. Within developing countries disparities are less pronounced, and they vary greatly from place to place and from sector to sector within the health system. However, these disparities are almost always regressive, or pro-rich. This fact can be seen from the information available about the public and private components of health systems, and about specific services that health systems deliver. (requires registration)
Providing Antiretroviral Treatment in Southern Africa
This report from the Health Systems Trust outlines experience with Antiretroviral Treatment (ART) in a number of sub-Saharan countries. ART is provided through a number of different avenues, which include the public sector, the non-profit sector, the corporate sector and the private sector. ART programmes may involve collaboration between two or more sectors with such partnerships being encouraged in recognition that the magnitude of the task may exceed the capacity of any one sector. Particular attention is paid to Botswana, the first sub-Saharan country to provide ART on a wide-scale through the public sector.
Pressure mounts on private health care in South Africa
With the dust not yet settled on the health department's bid to regulate medicine prices, another messy conflict over state regulation of private health care looms large. A decade-long attempt to provide a unified health system that includes both public and private sector providers took concrete form on Friday, when President Thabo Mbeki signed the long awaited National Health Bill into law. The move is set to spark loud protest from doctors and private hospital groups, anxious about clauses in the legislation designed to regulate their services.
Public – private 'partnerships' in health – a global call to action
The need for public-private partnerships arose against the backdrop of inadequacies on the part of the public sector to provide public good on their own, in an efficient and effective manner, owing to lack of resources and management issues. Though such partnerships create a powerful mechanism for addressing difficult problems by leveraging on the strengths of different partners, they also package complex ethical and process-related challenges. Participation of international agencies warrants that they be set within a comprehensive policy and operational framework within the organizational mandate and involvement of countries requires legislative authorization, within the framework of which, procedural and process related guidelines need to be developed. This paper outlines key ethical and procedural issues inherent to different types of public-private arrangements and issues a Global Call to Action.
Contracting out: the case of primary care in South Africa
Contracts can be used to govern the relationship between the public and the private sectors where the private sector delivers services on behalf of the state. On occasion, this allows the state to offer services such as basic medical provision where public sector provision does not reach. Researchers examine the case of primary care in South Africa where such contracts are being utilised. They argue that understanding the relationship between client and contractor requires a thorough understanding of some of the factors that govern the relationship, such as the role played by individual motivation.
Learning from the private sector: lessons for public health policy from South Africa
The market for primary health care in South Africa represents a growing opportunity for private providers targeting lower income employed workers, who often prefer not to use the public sector. A new model of service provision is emerging in the form of private companies providing fixed price primary care services in urban areas. Whilst the range of services delivered was quite limited compared to the public sector, apparently effective delivery, clearly better patient experiences, and a similar cost to the public sector, all suggest that the public sector can learn about some aspects of service delivery from these companies.
The way forward: prioritising district health care services in developing countries
The growing movement in favour of the privatisation of public services and the reliance on market forces in many developing countries suggests that the critical role of the district health system needs to be restated. Research by the Institute of Development Studies, UK, indicates that district health services are the best means of delivering primary health care and basic hospital care and should be made a priority for public funding. The most important task is to develop a special programme of rehabilitation for a demoralised workforce, including improved management of staff mix and distribution, incentives for good performance, support and training as well as better pay.