Public-Private Mix

Produced by: Bulletin of the World Health Organisation (WHO): the International Journal of Public Health (2003)

The use of private health care providers in low- and middle-income countries is widespread and is the subject of considerable debate. This article, produced by the Bulletin of the World Health Organisation, reviews a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardised primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In addition, implications for public health policy of the emergence of this new model of private provider are discussed.

A pilot study on quality of artesunate and amodiaquine tablets used in the fishing community of Tema, Ghana
Affum AO, Lowor S, Osae SD, Dickson A, Gyan BA and Tulasi D: Malaria Journal 12(220), 28 June 2013

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.

A Public-Private Partnership for Sustainable Malaria Prevention
USAID, 14 November 2006

In 1999, the U.S. Agency for International Development launched the NetMark, in partnership with the Academy for Educational Development, to reduce the human cost caused by malaria. Since its launch, NetMark has developed partnerships with 37 African and 9 international commercial partners. NetMark's mission is to reduce malaria cases and deaths in Africa by increasing the availability, affordability and use of insecticide-treated bednets (ITN) through partnerships with commercial net and insecticide manufacturers, their African distributors, ministries of health, and NGOs. To accomplish this goal, NetMark works through public-private partnership to achieve both short and long-term public health impact. NetMark's model, based on efficient and effective delivery of ITNs, could easily be applied to other areas of malaria prevention.

A Survey of Prescribing Practices of Health Care Workers in Kibaha District in Tanzania
Massele AY, Nsimba SE, Fulgence J: Tanzania Medical Journal 22 (1): 31-33, 2007

Previous studies in the public sector in Tanzania, have demonstrated major prescribing problems due to poly-pharmacy and irrational use of antibiotics and injections. Little is understood about prescribing in the private sector. This paper measures and compares prescribing practices in public and private dispensaries in Kibaha District Tanzania. Prescribing of antibiotic and injections was significantly higher in private than in public dispensaries (P<0.05). The extent of prescribing in private dispensaries calls for intervention to reduce overuse of antibiotics and injections.

A Trojan horse of the private sectors interests at the World Health Organisation
People’s Health Movement; Medicus Mundi International: 26 January 2016

A January 2016 statement of the People's Health Movement (PHM) and Medicus Mundi International (MMI) identified that the Framework of Engagement with Non-State Actors (FENSA) currently under discussion at the World Health Organisation (WHO) fails to provide a robust framework against undue influence of the corporate sector and its philanthropies. In the statement the PHM and MMI argue that FENSA is symbolic of a more fundamental issue of the compromise to WHO’s independence due to its under-funding and tightly earmarked voluntary contributions making it vulnerable to such influence. They argue for an end to the dual freeze on the WHO Programme Budget and on assessed contributions which severely limits WHO’s functioning. "Until and unless this is addressed, WHO stands at risk of private sector capture and further loss of its integrity, independence, and credibility", the statement warned.

Abolishing user fees for child health

This Save the Children brief shows that abolishing user fees and covering the relatively small cost of abolition would immediately save nearly a quarter of a million children under five. It argues that user fees for basic healthcare, paid in the poorest countries around the world, are in reality "killer bills". Children and their families either don’t go to the health clinic when they are sick or when they do, and have to pay, they are forced further into poverty and sometimes have to go without food. Some families remove children from school in order to pay for health care.

Access to Health and Public-Private Partnerships
Krebs V: Geneva Health Forum, 30 August 2006

As a medical doctor, working in the field of maternal and neonatal health, Dr. Imtiaz Jehan sees public-private partnerships and the challenges related to access to health from a Southern perspective. She shares with us how she believes progress can be made for the public and the private sectors to working together.

Accrediting private providers with National Health Insurance to better serve low-income populations in Kenya and Ghana: a qualitative study
Suchman L: International Journal for Equity in Health 17(179) 1-18, 2018

This paper pulled together data collected from private providers, patients, and social health insurance (SHI) officials in Kenya and Ghana to answer the question: does participation in an SHI scheme affect private providers’ ability to serve poorer patient populations with quality health services? In-depth interviews were held with 204 providers over three rounds of data collection in Kenya and Ghana. The authors also conducted client exit interviews in 2013 and 2017 for a total of 106 patient interviews. Ten focus group discussions were conducted in Kenya and Ghana respectively in 2013 for a total of 171 FGD participants. A total of 13 in-depth interviews also were conducted with officials from the Ghana National Health Insurance Agency and the Kenya National Hospital Insurance Fund across four rounds of data collection. Provider interviews covered reasons for enrollment in the health insurance system, experiences with the accreditation process, and benefits and challenges with the system. Client exit interviews covered provider choice, clinic experience, and SHI experience. Focus Group Discussions covered the local healthcare landscape. Interviews with SHI officials covered officials’ experiences working with private providers, and the opportunities and challenges they faced both accrediting providers and enrolling members. Private providers and patients agreed that SHI schemes are beneficial for reducing out-of-pocket costs to patients and many providers felt they had to become SHI-accredited in order to keep their facilities open. The SHI officials in both countries corroborated these sentiments. However, due to misunderstanding of the system, providers tended to charge clients for services they felt were above and beyond reimbursable expenses. Services were sometimes limited as well. Significant delays in SHI reimbursement in Ghana exacerbated these problems and compromised providers’ abilities to cover basic expenses without charging patients. While patients recognized the potential benefits of SHI coverage and many sought it out, a number of patients reported allowing their enrollment to lapse for cost reasons or because they felt the coverage was useless when they were still asked to pay for services out-of-pocket at the health facility.

Achieving universal health coverage in East and Southern Africa: what role for for-profit providers?
Doherty J: Paper presented at the Panel session T03P13: Private sector and universal health coverage - examining evidence and deconstructing rhetoric International Conference on Public Policy, 1-4 July 2015, Milan, Italy

This paper considers evidence on the effectiveness, equity and sustainability of for-profit private provision, and the effectiveness of government’s stewardship of the sector, in East and Southern Africa. It draws conclusions about policy and regulatory requirements to encourage for-profit providers to make a more useful contribution towards achieving universal health coverage in the region. The author observes a recent increase in the size of a formerly relatively small for-profit private sector in some countries in the region, but also the emergence of 'boutique’ hospitals (targeted at the high-income local market, expats and foreign NGO workers, as well as medical tourism) in otherwise underdeveloped settings. As warned by the international literature that critiques the commercialisation of health care, such developments could worsen inequity and destabilise national health systems if inadequately regulated.

Activists call on NCD Alliance to protect public health from private interests
Rundall P: Baby Milk Action, 19 May 2012

In the run up to the 65th World Health Assembly (21-26 May 2012) the NCD Alliance, a major international alliance of organisations working in the field of non-communicable diseases (NCDs) revised its statement calling on its Member States to support the creation of a Global Platform on NCDs. After the Conflict of Interest Coalition expressed its concerns to the Alliance over private sector involvement in health policy and planning in such a platform, the Alliance added the clause ‘with appropriate safeguards for public interest over private profit’ and issued a new statement in May 2012. Rundall argues that this amendment does not adequately address the need for a clear differentiation between policy, norms and standards development and involvement in implementation. She warns that lack of clarity will play into the hands of those who favour slow, industry-friendly, voluntary approaches rather than legally binding measures that hold the private sector accountable for their practices.