Public-Private Mix

Gates Foundation gives boost to tobacco control in Africa
Health-e News: 4 February 2010

The Bill & Melinda Gates Foundation has given a grant of US$7 million over five years to the American Cancer Society to lead and coordinate the African Tobacco Control Consortium, a global coalition of public health-oriented organisations focusing on using evidence-based approaches to stem the tobacco epidemic in Africa. According to the International Agency for Research on Cancer, much of the rise in cancer in Africa can be attributed to widespread tobacco use and exposure to secondhand smoke. Tobacco is the leading cause of preventable death in the world, and according to the World Health Organization, if current trends continue, tobacco use will cause one billion deaths worldwide during this century. As the managing organisation, the Society will collaborate with consortium partners to implement an ambitious tobacco control program across the 46 countries of sub-Saharan Africa. The overall goal will be to reduce tobacco use in these countries by implementing proven strategies at the national and local level.

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.

Gender Dimensions of User Fees: Implications for women's access to health care

In the current environment of shrinking global and domestic resources for health care, there is an overwhelming pressure to achieve financial sustainability in the health sectors of developing countries. Within this context, there seems to be increasing acceptance of the view that individuals need to contribute to some of the costs of public health care through charges such as user fees and other cost-recovery mechanisms. This paper looks at the implications of user fees for women's utilization of health care services, based on selected studies in Africa. Lack of access to resources and inequitable decision-making power mean that when poor women face out-of-pocket costs such as user fees when seeking health care, the cost of care may become out of reach. Even though many poor women may be exempt from fees, there is little incentive for providers to apply exemptions, as they too are constrained by restrictive economic and health service conditions. If user fees and other out-of-pocket costs are to be retained in resource-poor settings, there is a need to demonstrate how they can be successfully and equitably implemented. The lack of hard evidence on the impact of user fees on women's health outcomes and reproductive health service utilization reminds us of the urgent need to examine how women cope with health care costs and what trade-offs they make in order to pay for health care.

Gender Dimensions of User Fees: Implications for Women's Utilization of Health Care

This paper from Reproductive Health Matters looks at the implications of user fees for women's utilization of health care services, based on selected studies in Africa. Lack of access to resources and inequitable decision-making power mean that when poor women face out-of-pocket costs such as user fees when seeking health care, the cost of care may become out of reach. Even though many poor women may be exempt from fees, there is little incentive for providers to apply exemptions, as they too are constrained by restrictive economic and health service conditions. If user fees and other out-of-pocket costs are to be retained in resource-poor settings, there is a need to demonstrate how they can be successfully and equitably implemented.

Global Alliance for Vaccines and Immunization and Gates Foundation deploy industry-favoured incentive for vaccines to poor countries
New W: Intellectual Property Watch, 12 June 2009

Major public health funders have alighted upon an industry-favoured approach of guaranteeing certain prices to industry to make vaccines available to least-developed country markets. The pilot project, the AMC Approach, announced on 12 June, provides nearly US$3 billion to make (presumably patented) vaccines against pneumococcal disease available sooner to the world’s poorest countries. There will be a commitment by industry to continue offering the vaccines at “lower and sustainable” prices after the funding runs out, the Global Alliance for Vaccines and Immunization (GAVI) said. The current pneumococcal vaccine is sold for more US$70 per dose in industrialised countries, while the new project will make the ‘long term’ price for developing countries US$3.50, GAVI added. It hopes to assist up to 60 of the world’s poorest countries to introduce these vaccines by 2015, well ahead of the time it might take without subsidising industry. A World Health Organization working group is set to discuss the issue from 29 June to 1 July.

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.

Global Health Initiative of the World Economic Forum calls on business to partner with public sector to improve healthcare systems in sub-Saharan Africa
World Economic Forum, 1 June 2006

Business is being urged to use its resources and expertise in partnership with the public sector to improve sub-Saharan Africa’s weak healthcare systems in a White Paper, From Funding to Action: Strengthening Healthcare Systems in Sub-Saharan Africa, launched today by the Global Health Initiative at the World Economic Forum on Africa in Cape Town.

Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed?
Stuckler D, Basu S and McKee M: PLoS Medicine 8(4), 12 April 2011

In recent years, tax-exempt private foundations and for-profit corporations have increasingly engaged in relationships that can influence global health. Using a case study of five of the largest private global health foundations, the authors of this study identified the scope of relationships between tax-exempt foundations and for-profit corporations. They found that many public health foundations have associations with private food and pharmaceutical corporations. In some instances, these corporations directly benefit from foundation grants, and foundations in turn are invested in the corporations to which they award these grants. Personnel move between food and drug industries and public health foundations. Foundation board members and decision-makers also sit on the boards of some for-profit corporations benefitting from their grants. While private foundations adopt standard disclosure protocols for employees to mitigate potential conflicts of interests, these do not always apply to the overall endowment investments of the foundations or to board membership appointments. Transparency or grant-making recusal of employees alone may not be preventing potential conflicts of interests between global health programmes and their financing, the authors conclude.

Global Health Workforce Alliance offers support to Task Force on the Private Sector
Global Health Workforce Alliance: 2009

The private health sector in the developing world is poorly understood, best practices are not documented, promising initiatives are not scaled for broader application, and there is mistrust between the public and private sectors. Yet all acknowledge a comprehensive approach to the critical health worker shortage must involve the private sector. The private health sector in resource-poor settings relies on an enabling environment of civil society, financial and operational resources. How that interrelationship between society and the private sector operates and potentiates greater scaling of innovative responses to the HRH crisis is not understood. Scaling and implementation of innovative private sector responses will require greater understanding of this relationship. The Alliance has agreed to support the development of a Task Force on private sector involvement in human resources for health to ensure that identified innovative private sector models will gain broader attention and implementation and scaling up of these models into other locales can be facilitated. The overarching goal is to accelerate the scaling and cross-border movement of initiatives in the private health sector, which can increase the supply of new workers, improve the efficiency and effectiveness of existing health workers and reduce the attrition of health workers out of the field of practice or movement out of region.

Global health-related public-private partnerships and the United Nations

This brief examines the policy implications of increased activity between the UN and the corporate sector, specifically focusing on the increased collaboration between the corporate sector and the World Health Organization (WHO), UNICEF and UNFPA. The brief also explores the major global health-related public-private partnerships (GHPPPs) which operate primarily outside the UN, such as the Global Alliance for Vaccination and Immunisation (GAVI). The brief concludes that, although guidelines and procedures to address public-private interactions (PPIs) have been developed within UN agencies, they are inadequate to ensure UN integrity.

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