Public-private collaborations are increasingly being utilized to universalize health care. In Malawi, the Ministry of Health contracts selected health facilities owned by the main faith-based provider, the Christian Health Association of Malawi (CHAM), to deliver care at no fee to the most vulnerable and underserved populations in the country through Service Level Agreements (SLAs). This study examined the features of SLAs and their effectiveness in expanding universal coverage. The study involved a policy analysis focusing on key stakeholders around SLAs as well as a case study approach to analyse how design and implementation of SLAs affect efficiency, equity and sustainability of services delivered by SLAs. It used qualitative and quantitative research methods in five CHAM health facilities, with national and district level decision makers and providers and clients associated with the health facilities. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others. There was strong consensus and shared interest between the government and CHAM regarding SLAs. The free services provided by SLAs had an impact on the impoverished locals that used the facilities. However, lack of supporting systems, inadequate infrastructure and shortage of health care providers affected SLA performance.
Public-Private Mix
Tobacco products use is the leading cause of chronic diseases morbidity and mortality. This study explores an exposure to tobacco advertisements factors and knowledge, an association with snuff/pipe usage and cigarette smoking among rural children aged between 11 to 18 years in Ellisras, South Africa. A total of 1,654 subjects (854 boys and 800 girls) completed the questionnaire. Results showed that a significant number of boys (11.7%) compared to girls (8.8%) received free cigarettes from the members of the community. Bill boards were successful in advertising tobacco products among the Ellisras rural boys (17% boys and 12.8% for girls). The authors found significant association between cigarette smoking and advertisements of tobacco products on the TV screens, videos or movies. Though tobacco products legislation exists in South Africa, the authors argue that efforts should be taken by the health professionals to emphasise the danger of using tobacco products even among the illiterate. Teachers and parents should refrain from advertising tobacco products at schools and at homes.
The public health approach to regulatory intervention is normally very inclusive, bringing all stakeholders to the table to present their perspectives, to argue about the impacts of the interventions on their organisations, and to find compromises that work for the greater good of all those involved. However, the author of this paper argues against including the tobacco industry as a stakeholder in public health decisions, based on the reputation of the industry in obfuscating the truth about the harm of tobacco use, dividing the public health community over harm reduction approaches, and befuddling critically important regulatory processes. The profits from selling cigarettes and alternative tobacco products are simply too great for the tobacco industry to be a genuine stakeholder in public health, the author notes. Thus, the public health community needs to do what it does best: to rally popular support for strong, science-based approaches to prevention of tobacco use, to expose the truths about the harms of tobacco use to current users, and to support government agencies in carrying out their legislatively mandated duties to protect public health. The author highlights the irreconcilable conflict between the public health community and the global tobacco industry.
This pilot study on the quality of anti-malarial tablets for sale in retail outlets during the major fishing season was conducted in a malarious fishing village located along the coast of Tema in southern Ghana. Researchers randomly sampled blisterpacks of anti-malarial tablets and assessed them according to the International Pharmacopoeia and Global Pharma Health Fund Minilab protocols. When testing for genuine artesunate per tablet, 10% of one manufacturer’s tablets and 50% of the other’s passed the titrimetric test. While 100% of the first manufacturer’s tablets passed for genuine amodiaquine, 17% of a similar package by the second manufacturer failed spectrophotometric testing. The inadequate amounts of artesunate and amodiaquine detected in the tablets suggest that both pharmaceutical companies may not be following recommended drug formulation procedures, or the active pharmaceutical ingredients might have been degraded by improper storage conditions. The authors conclude that the drugs being sold at Kpone-on-Sea, Ghana may likely be classified as substandard drugs and are not suitable for malaria treatment.
Substandard and falsified medicines are major global health challenges that cause unnecessary morbidity and mortality around the world and threaten to undermine recent progress against infectious diseases by facilitating the emergence of drug resistance. According to this study, Rwanda has the lowest prevalence of poor quality tuberculosis drugs among African countries. This positive finding may be associated with Rwanda's efforts to ban the sale of monotherapies, ensure that private sellers of important medicines are qualified, and prioritise the prevention of falsified medicines entering the country, the authors argue. As policymakers in, and researchers of, Rwanda's health sector, they argue that the improvement of the country's supply chain and drug surveillance systems, combined with equity-oriented strategies for increasing geographic and financial access to high quality drugs through the public sector, has played an important role in the country's steep declines in mortality due to tuberculosis and malaria. In scaling up pharmacovigilance for malaria and tuberculosis, they call for a global treaty and leadership by the World Health Organisation to address manufacturing and trade in substandard and falsified medicines.
South Africa’s health minister Aaron Motsoaledi has argued that consolidation of the private health care market has created a situation where the three largest private health care providers now dictate, not negotiate, prices to medical schemes. As listed companies, these providers aim to maximise profits, which, he argues, means they have little concern for affordable care. Cost escalation and overprovision in South Africa’s private sector is also seen as a consequence of the fact that regulation of the private sector has focused more on medical schemes and less on providers. Lawyers say that the imbalance in legislation puts medical schemes in a weaker position when negotiating with hospitals. One economist points to utilisation increases by 3% every year, which he argues are being driven by specialists and private hospitals that have profit sharing arrangements, with a high probability of collusion between the hospital groups because of the way in which they share profits and incentives. Specialists, on the other hand, blame the high costs of new drugs as responsible for price increases in private care. They say the pharmaceutical industry is hiking its prices significantly, presenting a barrier to care in both the private and public sectors, where even drugs coming off patent remain costly.
A new, pernicious epidemic is stalking the health care systems of the world, according to this book: the rampant spread of neoliberal, pro-market “reforms,” devised and promoted by a narrow policy-making academic and political elite in the wealthiest countries. The author argues that it can only be eradicated by the spread of information, political campaigning and critical thinking, with regular injections of evidence and social solidarity. The so called “reforms” are driven not by evidence, but by ideology – and behind the ideology is a massive material factor: the insatiable pressure from the private sector to recapture a much larger share of the massive $5 trillion-plus global health care industry, much of which only exists because of public funding. Since 1980 global agencies like the World Bank, new powerful players like the Gates Foundation, and even at times the World Health Organisation, have played a role in promoting these changes, along with academics whose loyalty appears to be to the giver of the research grant rather than to the evidence. Market-style reforms result in systems more unequal, more costly, more fragmented and less accountable – but which offer more profits to the private sector. The policies can be rejected and defeated by mass political action, argues the author. The question is to develop a political leadership with the courage to embrace them and fight for them.
The Australian government has urged other countries to also stand up to the tobacco industry, saying it was confident of victory in a new legal battle over its landmark plain packaging rules. Big tobacco will stop at nothing to intimidate countries to not take appropriate public health measures, said Australia’s health minister, Jane Halton, said at a recent meeting marking World No Tobacco Day. Australia’s new legislation, in force since December, aims to cut smoking rates by requiring tobacco products to be sold in drab green boxes with the same typeface and graphic health warnings. Halton addressed a session of the World Health Organisation (WHO), as the UN agency seeks tougher global measures to reign in tobacco use, which claims six million lives a year. Tobacco continues to cause enormous suffering and death which is totally avoidable, she told participants. New Zealand and Ireland are planning plain packaging rules, despite a tobacco industry-backed challenge to Australia’s law at the World Trade Organisation by cigar-producers Cuba, Honduras and the Dominican Republic, plus Ukraine. The plaintiff countries maintain that Australia’s law breaches international trade rules and intellectual property rights to brands – arguments that failed to convince Australia’s High Court in a case brought by tobacco firms.
Why are soft drinks and junk foods so popular? The author of this article discusses processes of product optimisation, and the balance of salt, sugar and fat content of a product aimed at in products to ensure that consumers crave and continue to buy a product. Complex formulas are reported that pique the taste buds enough to be alluring but that do not have a distinct, overriding single flavour that tells the brain to stop eating. With the current global epidemic of obesity and rising levels of non-communicable diseases, the author advocates legislation rather than self-regulation on these issues.
A high-level roundtable on Building Private Equity and Private Capital Markets in Africa met on 8 May 2013 to explore the promise and obstacles facing private capital investments in Africa. The report of this meeting highlights a discussion on the growth of private equity markets in Africa given rapid urbanisation and a growing middle-class, but questions whether the growth of Africa’s private equity will be based on a model that benefits local people.