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.
Public-Private Mix
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.
South African competition authorities will launch an investigation into the private healthcare industry, where early evidence showed high prices and market distortions, according to Economic Development Minister Ebrahim Patel. Various stakeholders have raised concerns about pricing, costs and the state of competition and innovation in private healthcare. Patel said competition authorities had ruled previously that the practice of setting up common tariffs for medical procedures was uncompetitive. Instead he pointed to a growing trend of increasing healthcare costs and a massive asymmetry of power health markets. Patel said preliminary evidence showed that some that in some cases competition was "prevented, distorted or restricted." Private health providers in Africa's largest economy include Life Healthcare, Mediclinic International and Netcare Ltd, all of whom have benefitted from the growth of the middle classes. The Competition Commission, which can impose administrative fines, is expected to launch the "market inquiry" before September 2013.
This scoping systematic review was undertaken to assess the evidence for the role of private sector involvement in the production of nurses in India, Kenya, South Africa, and Thailand. The authors performed an electronic database search and also captured grey literature from the websites of relevant human resources organisations and networks. The review revealed that despite very different ratios of nurses to population ratios and differing degrees of international migration, there was a nursing shortage in all four countries, which were struggling to meet growing demand. All four countries saw the private sector play an increasing role in nurse production. Policy responses varied from modifying regulation and accreditation schemes in Thailand, to easing regulation to speed up nurse production and recruitment in India. There were concerns about the quality of nurses being produced in private institutions. The authors recommend that strategies must be devised to ensure that private nursing graduates serve public health needs of their populations. They call for policy coherence between producing nurses for export and ensuring sufficient supply to meet domestic needs, in particular in under-served areas. Further research is needed to assess the contributions made by the private sector to nurse production and to examine the variance in quality of nurses produced.
This policy brief examines the extent to which private medical scheme membership shields South African members from out-of-pocket payments. This is important for the design of the National Health Insurance system in the country. The Health Economics Unit (HEU) found that medical scheme members have significantly more private health care visits and pay substantial out-of-pocket payments to use health services, in addition to their contributions to the medical schemes. Consequently, there is a need to move away from fee-for-service payments, which often leads to over-servicing, cost escalation, and assessment and regulation of less effective medications and interventions. There is also a need to limit, as much as possible, out-of-pocket payments that adversely affect scheme members and also address the rising contribution rates. A form of insurance that ensures adequate use of health services is needed. Ideally, this should be a form that ensures universal access to health care, for example, the proposed National Health Insurance, the policy brief concludes.
South Africa’s National Department of Health (DoH) has embarked on an initiative to improve and expand access to healthcare services through the contracting of private General Medical Practitioners (GPs) to render sessional service in Primary Healthcare facilities. This initiative is in support of the National Health Insurance (NHl) pilot that aims to improve access to high quality public sector health care services. The initial phase of GP contracting for sessional services will take place in the 10 NHI pilot districts across the country. The DoH embarked on a consultation process started by the Minister of Health in his visits and road shows to the various districts; this was then followed by a letter from the Director-General of Health to GPs to test their levels of interest to participate in this project. Government has advertised for candidates and will soon begin the selection process.