Public-Private Mix

Fiscal policy to improve diets and prevent non-communicable diseases: from recommendations to action
Thow A; Downs S; Mayes C; et al: Bulletin of the World Health Organisatio 96(3) 201–210, 2018

The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, the evidence base for diet-related interventions based on fiscal policies are described and the key questions that need to be asked by both health and economic policy-makers are considered. From the health sector’s perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. The authors highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions.

Focusing collaborative efforts on research and innovation for the health of the poor
Matlin SA, Francisco A, Sundaram L: Global Forum for Health Research, 2008

Data from every part of the world show that those that are least well off have shorter life expectancies and heavier burdens of disease than those that are relatively wealthy. Subsequently, public–private partnerships (PPPs) have gained growing popularity as mechanisms for increasing access to essential drugs. This series of papers examines the characteristics of PPPs that aim to improve the health of the world’s poorest people. The authors contribute to the debate about the future role of PPPs and provide pointers to key areas for urgent attention to sustain and increase the momentum to reach the goals towards which PPPs are striving. Issues highlighted include the roles of different actors in partnerships involving public sector and philanthropic donors, the private sector, nongovernmental organizations, communities and researchers in developed and developing countries.

Forced privatisation through Aid

This report from War on Want looks at how conditionalities and pressures from aid agencies and development banks force developing countries to adopt privatisation policies in public services. It focuses specifically on the sectors of water, electricity, and healthcare, in six countries: Colombia; El Salvador; Indonesia; Mozambique; South Africa; and Sri Lanka. It examines the impact of the requirements and policies of the International Monetary Fund (IMF), World Bank (WB), and other agencies including regional development banks, the European Commission (EC) and donor countries. It includes a specific examination of the various ways in which the UK’s Department for International Development (DFID) supports privatisation in these services.

Franchising in Health: Emerging Models, Experiences, and Challenges in Primary Care
Note No.263 - June 2003 World Bank

In the past decade a growing number of health franchising schemes have emerged in developing countries. Often reaching tens of thousands of poor households, these private schemes currently provide logistical, managerial, and sometimes financial support to small-scale providers (franchisees) of preventive care, such as family planning and maternal and child health services. While franchising has attracted growing interest among governments and donors as a possible way to achieve health objectives, there is some debate about the ability of the model to reach the poorest people and the ability of franchisers to sustain themselves financially.

Free Government Health Services: Are They the Best Way to Reach the Poor?
Davidson R. Gwatkin, March, 2003, World Bank

Equity is a frequently stated justification for government involvement in the health care market. This is often taken to mean directly providing all segments of the population with a wide range of government-operated health services at no cost: free universal care. Yet a look at the record suggests that this goal all too often remains elusive, especially in poor countries; that governments in fact serve only some of the population; and that the people served are disproportionately concentrated among the better-off. When this happens, government health services, far from promoting equity, work against it. The purpose of this chapter is to illustrate that there are many ways for governments to pursue the goal of ensuring that the poor receive adequate, affordable services through alternative approaches to resource allocation and purchasing. The first section summarizes the information known about the distribution of benefits from government health services across social groups in order to document the regressive pattern that now frequently exists and the need for significant changes in approach if the poor are to benefit. The second and third sections illustrate the kinds of changes that might be considered.

Free Government Health Services: Are They the Best Way to Reach the Poor?
World Bank publication

Equity is a frequently stated justification for government involvement in the health care market. This is often taken to mean directly providing all segments of the population with a wide range of government-operated health services at no cost: free universal care. Yet a look at the record suggests that this goal all too often remains elusive, especially in poor countries; that governments in fact serve only some of the population; and that the people served are disproportionately concentrated among the better-off. When this happens, government health services, far from promoting equity, work against it. The purpose of this chapter is to illustrate that there are many ways for governments to pursue the goal of ensuring that the poor receive adequate, affordable services through alternative approaches to resource allocation and purchasing. The first section summarizes the information known about the distribution of benefits from government health services across social groups in order to document the regressive pattern that now frequently exists and the need for significant changes in approach if the poor are to benefit. The second and third sections illustrate the kinds of changes that might be considered.

Free Zimbabwean contraceptives smuggled for sale in South Africa
K Mutandiro: Groundup, Times Live, March 2017

This article tells a story of Nancy (not her real name), who every month travels to Zimbabwe to stock up on Marvelon family planning pills distributed at hospitals‚ clinics and pharmacies through the Family Planning Council of Zimbabwe. She smuggles them back into South Africa‚ where she sells them at a healthy profit to other Zimbabweans who for various reasons don’t want the contraceptive pills dispensed in South African clinics. Nancy’s suppliers are hospital staff in Zimbabwean hospitals who sell the pills to her for R5 a blister pack. If she runs short of stock‚ she buys packets for R10 from a “wholesale” supplier in Johannesburg who also illegally imports the pills from Zimbabwe. Nancy says she has a 100 customers a month in Springs alone‚ and she sells the packets for R20 to bulk buyers or R30 to individuals. By contrast‚ Marvelon tablets were reported to be sold for about R130 per 28 tablets in Johannesburg pharmacies

From Kenya’s postelection violence, an online community forms to give aid
Habib J: The Christian Science Monitor, March 2018

Kenya’s post election violence has led to the founding of RescueBnB – a community with the mission to map the locations of those in need of shelter and connect them with volunteer hosts. With a core team of volunteers, a web developer set up the pro bono website, and Kenyans have spread the word on social media. Within 48 hours of this, they had assembled more than 100 volunteers across the country and had arranged multiple home stays with vetted hosts. To date, RescueBnB has supported 800 people across Kenya, and team members say that’s just the start. RescueBnB has since begun crowdfunding to provide care packages as well as to cover medical expenses. Its partnerships with community organizations and religious groups helped it reach more individuals, and companies stepped in to assist. A supermarket chain welcomed shoppers to drop off donations, and a boda boda (motorbike) delivery company volunteered to get the donations into the hands of people who needed them.

From privatisation to corporatisation and the need for a counter-strategy
Magdahl JE: Association for International Water and Forest Studies, Norway, 2012

This report explores the shift from privatisation to corporatisation of urban water services in developing countries. The author calls for the water justice movement to adjust its strategy to take this into account. Corporatisation reform implies the implementation of commercial neoliberal management approaches within public sector water utilities. The author argues that the strategy of the water justice movement has largely focused on privatisation and that it needs to direct more attention towards resisting corporatisation.

FROM SOCIAL CONTRACT TO PRIVATE CONTRACTS: THE PRIVATISATION OF HEALTH, EDUCATION AND BASIC INFRASTRUCTURE

Privatisation is being pushed by international governance institutions, the governments that control them, and the corporations that lobby both groups, even though the dangers that privatisation entails can seriously - and permanently - harm the livelihoods of the world's poorest people. The position of "privatise first and ask questions later" and the naïve confidence in the processes and outcomes of market reform have imposed hardship on precisely the groups those organisations are entrusted to protect. It is time to shift the burden of proof from those who question risky solutions to those who propose them, says this article.

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