Public-Private Mix

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.

Advertisement and knowledge of tobacco products among Ellisras rural children aged 11 to 18 years: Ellisras Longitudinal study
Monyeki KD, Kemper HCG, Amusa LO and Motshwane M: BMC Pediatrics 13(111), May 2013

Tobacco products use is the leading cause of chronic diseases morbidity and mortality. This study explores an exposure to tobacco advertisements factors and knowledge, an association with snuff/pipe usage and cigarette smoking among rural children aged between 11 to 18 years in Ellisras, South Africa. A total of 1,654 subjects (854 boys and 800 girls) completed the questionnaire. Results showed that a significant number of boys (11.7%) compared to girls (8.8%) received free cigarettes from the members of the community. Bill boards were successful in advertising tobacco products among the Ellisras rural boys (17% boys and 12.8% for girls). The authors found significant association between cigarette smoking and advertisements of tobacco products on the TV screens, videos or movies. Though tobacco products legislation exists in South Africa, the authors argue that efforts should be taken by the health professionals to emphasise the danger of using tobacco products even among the illiterate. Teachers and parents should refrain from advertising tobacco products at schools and at homes.


This report, produced by Population Action International, argues that condom promotion and provision is one of the most effective methods for preventing HIV/AIDS. They state that 8 billion would have been the minimum number of condoms to have made a difference to the spread of HIV in 2000, and that the 950 million provided by donors were therefore hugely inadequate. The report says that a number of different interventions are necessary for effective prevention programmes: the authors highlight the need for addressing poverty, gender inequity and promoting the 'ABCs' of abstinence, fidelity and condom use. However, they state that the mix of interventions must always include condoms. In calling for universal access to condoms, the report states that public/private partnerships will be necessary and that market segmentation, whereby those who can afford to pay more than the poorest, should be encouraged.

African app cuts medical costs with community "virtual pharmacy"
Reuters: Times Live, February 2017

A mobile app in Senegal helps families save money and reduce waste through a "virtual pharmacy" where users can exchange leftover medication for new prescriptions. JokkoSante is scaling up after a two-year pilot phase in one Senegalese town. It aims to reach 300,000 families in the West African nation by the end of the year. The app allows users to trade in unused, packaged medicine for points which can go toward the purchase of new medicine when they need it. All of the exchanges are done at health centres or pharmacies by licensed professionals. Users can send points to family members and friends, and donors can buy points for people in need. The project has been driven by telecoms companies. It reaches a certain demographic, such as women in their thirties, and if a matching user doesn't have enough points to pay for a prescription she will receive a text saying which company donated to complete her purchase.

African Governments Urged to move with Speed to Address Over-Dependence on Imported Medicines
United Nations Economic Commission for Africa: UNECA Addis Ababa, 2019

At the two-day Horn of Africa trade forum in Addis Ababa, organized by the ECA, the Government of Ethiopia, the African Union Commission (AUC), and the European Union, participants agreed that with the African Continental Trade Agreement (AfCFTA) in force, it was time for the continent to increase domestic production of pharmaceutical products and end over-dependence on imported medicines. The AfCFTA, they agreed, provides an opportunity for economies of scale necessary for African pharmaceutical production. The Economic Commission for Africa's (ECA) Director for Regional Integration and Trade, Stephen Karingi, in closing the forum said that domestic policies that can be used to support the industry, including through investment assurances, grants, fiscal incentives and local content requirements. Regional centers of excellence could be used to overcome constraints in human capacities and resources for research and development and testing. The forum also agreed on the need to strengthen regulatory frameworks to develop the pharmaceutical sector; to encourage domestic production with a regional focus; and to ensure efficient and safe logistic chains that can bring down the cost of medicines.

African Newsletter on Occupational Health and Safety Issue of Infectious Diseases
African Newsletter on Occupational Health and Safety 25 (1), 2015

This issue of the African Newsletter on Occupational Health and Safety examines infectious disease and occupational health. Marie-Paul Kelly explores governance and leadership, both at regional and global levels in preventing health emergencies. The issue explores guidance to workplaces and occupational health professionals in prevention of occupational infections and examines the workplace as an arena for raising awareness on infectious diseases. Further papers look at protecting front-line health care workers and enterprise workers from Ebola. Jeanneth Manganyi and Kerry Wilson author a paper on the importance of respirator fit testing and proper use of respirators. Further articles in the issue explore food-borne illnesses at workplaces, the effectiveness of personal protective equipment to prevent Ebola transmission and the use of blunt suture needles to halve the risk of needle stick injuries among surgeons.

African Union Technical Committee meeting on Local Production on Pharmaceuticals Johannesburg, South Africa
Dr Manto Tshabalala-Msimang, MP Minister of Health of South Africa and Chairperson of the Bureau of the Third Session of the African Union Conference of Ministers of Health, 18 February 2008

As the World celebrates 30 years of the Alma Ata Declaration that launched the Primary Health as the Pillar of Quality services, there is greater need for all of us to improve access to affordable medicines. Even in rich countries, access to affordable medicines cannot be guaranteed. Of course, the problems are much greater in many developing countries, with insufficient or no manufacturing capacities in the pharmaceutical sector. In Africa we are too reliant on other countries to provide essential medicines for us. This is not strategic and correct, as we cannot guarantee availability of appropriate technologies that truly respond to our current and emerging needs.

After the handover: Exploring MSF’s role in the provision of health care to migrant farm workers in Musina, South Africa
de Gruchy T; Kapilashrami A: Global Public Health, doi:, 2019

Non-state actors, including humanitarian agencies, play a prominent role in providing health care in low- and middle-income countries. Between 2007 and 2009, Musina, a South African municipality bordering Zimbabwe, became the site of several interventions by non-state organisations as an unprecedented number of Zimbabweans crossed the border, putting strain on already burdened local systems. After the initial need for humanitarian relief dissipated, organisations started to implement projects that were more developmental in nature. For example, Médecins sans Frontières developed a mobile clinic programme to improve health care access for migrant farm workers, a programme that was subsequently integrated into the Department of Health. Since the handover of the programme, it has faced multiple challenges. Using qualitative methodology and a case study approach, this paper traces the development of the programme, exploring the changing relationship between MSF and the state during this time. This research raises questions about the implications of short-term ‘innovative’ interventions targeting the access that migrants have to care, within a context in which policy and programmatic responses to health are not 'migration aware'. The authors highlight the ways in which the energies and resources of local health department employees were redirected by MSF's involvement in the area.

Agreements and disagreements with Oxfam
Montagu D, Feachem R, Feachem NS, Koehlmoos TP, Kinlaw H, Smith R: 17 April 2009

The point made by Oxfam’s chief executive concerning failed states and the proliferation of private security firms is indicative of the ideological predisposition that impedes an open debate regarding healthcare delivery in developing countries. The view that healthcare is a fundamental responsibility of the State and must be largely provided by agencies of the State is not generally accepted outside of the UK, and is increasingly being challenged within the UK. British organisations tend to be skeptical of the private sector, but elsewhere the important role of the private sector in health systems, in countries both with and without well functioning state health programmes, is widely acknowledged. Public versus private provision is not a binary choice facing governments, donors, patients, and global policy makers – there is enough space for both to co-exist.

Alternatives to privatisation of health services: Perspective from Africa
Dambisya Y: University of Limpopo and EQUINET in the Municipal Services Project: 2010

The Municipal Services Project and Focus on the Global South held a one-day workshop on building alternatives to the privatisation of basic services on 31 March 2010 in New Delhi, India. This presentation on health in Africa was given at the workshop. The presenter discussed some alternatives to privatisation, such as community-based health insurance and mutual health organisations. Functional national health insurance schemes are already in operation in Ghana and Nigeria, while South Africa is busy putting together its own scheme and a similar scheme is in its initial stages in Uganda. Community-based alternatives to the privatisation of health services were considered but measures are needed to promote equity through cross-subsidisation provisions for democratic participation and improved quality of health services. However, the presenter pointed out that administrative efficiency and the cost effectiveness of collecting the premiums in community-based approaches were often problematic and sustainability was also a challenge, and faced dwindling membership due to low income. Benefits, including improved accountability through greater member involvement, were more likely if these approaches were integrated with national health systems, as shown in Rwanda, Tanzania and Ghana.