South Africa’s Competition Commission is considering initiating a market inquiry into the private healthcare industry reminiscent of its probe into the banking sector a few years ago, which recommended lower banking costs. Health Minister Aaron Motsoaledi has condemned high healthcare costs and accused the private health sector of engaging in "uncontrolled commercialism" and "destructive, unsustainable practices". Tembinkosi Bonakele, deputy commissioner of the Competition Commission, said that the commission was "likely" to commence with an inquiry because of growing concern about the high cost of private healthcare and the effect this had on the public healthcare system.
Public-Private Mix
Competition Commission may probe healthcare
Visser A: Business Day, 30 December 2011
GAVI money welcome but could it be more wisely spent?
Medicins Sans Frontiers: 14 June 2011
Medicins Sans Frontiers (MSF) argues in this article that big pharmaceutical companies are charging too much for their vaccines used in the developing world. Price disclosures by GlaxoSmithKline (GSK) and Johnson & Johnson show that these companies have been selling some vaccines at premiums of up to 180%. According to MSF, GSK and Pfizer are selling 30 million doses of pneumococcal vaccines annually to GAVI at a reduced price of US$3.20 through a scheme called Advance Market Commitment, but are also each getting a subsidy of US$215 million. Emerging country suppliers like India’s Serum Institute have said they could sell similar pneumococcal vaccine products for US$2 a dose – a 40% reduction on the GSK and Pfizer price. Serum Institute said recently that if they had not faced patent restrictions, the vaccine could have been available by 2012 – now it is not expected until 2015. Technology transfer and product development grants to low-cost suppliers are being supported by the Bill and Melinda Gates Foundation, but these sums are dwarfed by the Advance Market Commitment subsidy to Big Pharma. MSF calls on GAVI to start thinking about more affordable vaccines and calls on government donors to pressurise GAVI to foster competition and to push for products especially adapted for developing countries.
Global Fund collusion with liquor giant is a clear conflict of interest
Matzopoulos R, Parry CDH, Corrigall J, Myers J, Goldstein S and London L: Bulletin of the World Health Organisation 90(1): 67-69, January 2012
Alcohol is the third leading contributor to death and disability in South Africa, where SABMiller is the major supplier of malt beer, the most popular beverage consumed. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has recently included SABMiller as a recipient of funding for an education intervention aimed at minimizing alcohol-related harm, including HIV prevention, among men in drinking establishments. Global Fund support for this initiative is cause for concern, according to the authors of this article. They argue that it is debatable whether these men are the best target group for the intervention, whether a drinking establishment is the best location, and whether the educational intervention itself is effective. The authors argue that the industry supports interventions that will not affect drinking rates at a population level. These interventions allow the industry to fulfil social and legal obligations to address the harmful use of alcohol while ensuring that sales and profits are maintained. Providing funding for an industry that could afford to fund its own interventions also reduces the funds available for less well-resourced organisations.
Advance market commitment for pneumococcal vaccines: Putting theory into practice
Cernuschi T, Furrer E, Schwalbe N, Jones A, Berndt ER and McAdams S: Bulletin of the World Health Organisation 89(12): 913-918, December 2011
Markets for life-saving vaccines do not often generate the most desired outcomes from a public health perspective in terms of product quantity, quality, affordability, programmatic suitability and/or sustainability for use in the lowest income countries, according to this paper. The perceived risks and uncertainties about sustainably funded demand from developing countries often leads to underinvestment in development and manufacturing of appropriate products. The pilot initiative Advance Market Commitment (AMC) for pneumococcal vaccines, launched in 2009, aims to remove some of these market risks by providing a legally binding forward commitment to purchase vaccines according to predetermined terms. To date, 14 countries have already introduced pneumococcal vaccines through the AMC with a further 39 countries expected to introduce before the end of 2013. The authors of this paper describe early lessons learnt on the selection of a target disease and the core design choices for the pilot AMC. They highlight the challenges faced with tailoring the AMC design to the specific supply situation of pneumococcal vaccines and points to the difficulty – and the AMC’s apparent early success – in establishing a long-term, credible commitment in a constantly changing unpredictable environment. One of the inherent challenges of the AMC is its dependence on continuous external funding to ensure long-term purchases of products. The authors examine alternative design choices and aim to provide a starting point to inform discussions and encourage debate about the potential application of the AMC concept to other fields.
Lesotho hospital public private partnership: new model or false start?
Lister J: Global Health Check, 16 December 2011
This paper examines the experuence of the the new Queen Mamohato Memorial Hospital, a US$120 million privately financed hospital in Lesotho's capital Maseru, the first in Africa to be built through a “Public Private Investment Partnership” (PPIP). According to the World Bank, the new hospital is supposed to operate as the national referral hospital as well as the district hospital for the greater Maseru area. It was built and is run by a consortium headed up by South African private medical giant Netcare, and replaced the Queen Elizabeth II Public Hospital. In return, the Lesotho government will pay a US$32.6m index-linked annual ‘unitary charge’ to Netcare for the hospital and services, representing a 100% increase in costs from the 2007/08 budget and despite the fact that the government had already invested $62 million in the project. The new hospital is expected to treat all patients who present, up to a maximum of 20,000 in-patient admissions and 310,000 outpatient attendances annually, against an estimated need of 64,000 patients annually. The annual charge for the hospital is a third of Lesotho’s recurrent health budget. The author suggests that this can distort national health spending, especially for the expansion of primary health care for Lesotho’s majority rural population. The unfavourable terms of the contract are traced back to an imbalance in expertise among those negotiating the contract terms. The authors questioned why the International Finance Corporation, who acted as consultants on the project, failed to support the Lesotho negotiators to prevent these unfavourable terms.
Kenya to start production of generic ARVs
Plus News: 16 November 2011
A Kenyan pharmaceutical company, Universal Corporation, is reported to have been certified by the World Health Organisation (WHO) to start producing antiretroviral (ARV) drugs. The company alleges that the cost of its medicines will be at least 30% cheaper than those the government is currently buying from foreign manufacturers in countries like India, largely as it will avoid high importation costs. The authors note that whether or not the government will buy medicines locally depends on their pricing. Activists have called on WHO to certify more local manufacturers to produce high-quality generic drugs. Government officials have welcomed the development as a step in providing universal coverage to all HIV-positive Kenyans.
Water operator partnerships as a model to achieve the Millenium Development Goals for water supply? Lessons from four cities in Mozambique
Coppel GP and Schwartz K: Water SA 37(4): 575-584, October 2011
The concept of ‘water operator partnerships’ (WOPs) has increasingly been promoted as a means to improving water services provision in developing countries. The International Water Association (IWA)defines WOPs as ‘any formal or informal collaboration or structured partnership aimed at capacity building on a not-for-profit basis. In the WOPs approach emphasis is on capacitating (rather than replacing) the public organisation. Researchers assessed the potential of such partnerships as a ‘model’ for contributing to the Millennium Development Goals (MDGs), by focusing on four water utilities in Mozambique. Although, the study found these partnerships to be successful, their replicability and potential for scale up was found to be quite limited. The study found that WOPs depended for success on the availability of investment funds, and the level of commitment to the partnership, both financial commitment and time and effort of the organisations involved.
Big tobacco and the food and beverage industry are NOT civil society
Gonsalves G: Health-e News, 27 September 2011
The Global Business Coalition for Health (GBCHealth), which took part in the United Nations Conference on Non-Communicable Diseases (NCDs) held in New York in September 2011, has argued that companies must have a place at the tables where their future is discussed. GBCHealth, which represents companies that manufacture unhealthy (junk) foods and tobacco products, believes that their expertise is essential to developing public health policy. But activists disagree, arguing instead that industries producing unhealthy products should not be viewed as trusted partners and should not have a seat at the table during public health negotiations. In this open letter, AIDS activist Gregg Gonsalves responds to GBCHealth’s article justifying their right to be part of the negotiations. Though GBCHealth has had a long history of working on HIV and AIDS, he argues that big business cannot be considered representative of civil society, which is largely composed of marginalised groups, civil society organisations and other interested parties whose fight for civil, social and economic rights are not part of big business, whose primary goals are profit oriented. He calls on big business to stop trying to halt generic production of anti-retrovirals and drugs for NCDs (such as Novartis' continuing attempts to alter Indian patent law), to stop selling and promoting cigarettes and to stop advertising and marketing of high-sugar and high-fat foods across the globe.
New public-private partnership to combat breast and cervical cancer
United States Department of State: 13 September 2011
The United States (US) Department of State, the George W. Bush Institute, the US President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G Komen for the Cure, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have launched Pink Ribbon Red Ribbon (PRRR), a partnership to leverage public and private investment in global health to combat cervical and breast cancer, the leading causes of cancer death in women in Sub-Saharan Africa and Latin America. The partnership aims to expand the availability of vital cervical cancer screening and treatment and breast care education, notably for women most at risk of getting cervical cancer in developing nations because they are HIV-positive. With initial indications of interest, PRRR expects to have commitments of up to US$75 million across five years, which will grow to include additional participants and services. The goals are to reduce deaths from cervical cancer by an estimated 25% among women screened and treated through the initiative, significantly increase access to breast and cervical cancer prevention, screening and treatment programmes, and create innovative models that can be scaled up and used globally. This public-private initiative includes initial commitments from founding corporate participants Merck, Becton Dickinson, QIAGEN, Caris Foundation, Bristol-Myers Squibb, GlaxoSmithKline and IBM.
South African National Health Department to take stand against alcohol and fast food
Mkhwanazi A: Health-e News, 19 September 2011
Fast food and alcohol advertisements in South Africa could soon be a thing of the past, according to the National Health Department. At a summit held in Johannesburg in September 2011, the Health Minister, Dr Aaron Motsoaledi, highlighted the importance of healthy lifestyles in the fight against non-communicable diseases (NCDs). An Inter-Ministerial Committee on alcohol use and abuse has been set up, aimed at banning alcohol advertising and, despite intense lobbying by the alcohol industry, the Minister has vowed not to change his position. The Minister also aims to target the fast food industry by banning their advertising during children’s television programmes. He says he is working with the relevant industries to make fruit and vegetables cheaper and more accessible, and intends to encourage regular exercise in schools in the form of physical education programmes, citing obesity levels among school children at 23%.