Public-Private Mix

The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence
Liu X, Hotchkiss DR, Bose S: Health Policy Plan 23: 1-13, 2008

The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting-out, which could be either positive or negative. Although the study results leave open the question of how contracting-out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success.

The Equity implications of health sector user fees in Tanzania

Research for Poverty Alleviation (REPOA) commissioned ETC Crystal to examine the equity implications of health sector user fees in Tanzania, with particular reference to proposed and actual charges at dispensary and health centre level. This year, Tanzania will review its Poverty Reduction Strategy. With the findings of the user fee study, REPOA aims at making a valuable contribution to the review process and provide country-specific insight into one of the most debated issues in health financing.

The Extraordinary Science of Addictive Junk Food
Moss M: New York Times, 20 February 2013

Why are soft drinks and junk foods so popular? The author of this article discusses processes of product optimisation, and the balance of salt, sugar and fat content of a product aimed at in products to ensure that consumers crave and continue to buy a product. Complex formulas are reported that pique the taste buds enough to be alluring but that do not have a distinct, overriding single flavour that tells the brain to stop eating. With the current global epidemic of obesity and rising levels of non-communicable diseases, the author advocates legislation rather than self-regulation on these issues.

The Gates Foundation and Coca-Cola: At odds or legitimate bedfellows?
Shumate M: Non-Profit Quarterly, 31 January 2013

In this article, the author argues that there is a conflict of interest regarding public and nonprofit leaders who sit on the corporate boards of major commercial softdrink companies and their role on non profit foundations. The author reports in the paper that 7% of the Gates Foundation’s corporate stock endowment (more than 15 million shares) is in the form of shares of Coca-Cola, and questions whether Gates should be invested so heavily in sweetened soft-drinks given its health focus.

The globalization of public health:
the first 100 years of international health diplomacy

David P. Fidler. Bulletin of the World Health Organization Volume 79, Number 9, September 2001
Global threats to public health in the 19th century sparked the development of international health diplomacy. Many international regimes on public health issues were created between the mid 19th and mid-20th centuries. The present article analyses the global risks in this field and the international legal responses to them between 1851 and 1951, and explores the lessons from the first century of international health diplomacy of relevance to contemporary efforts to deal with the globalization of public health.

The health systems funding platform and World Bank legacy: the gap between rhetoric and reality
Brown SS, Sen K and Decoster K: Globalization and Health 9(9), 6 March 2013

In this paper, the authors argue that global health partnerships created to encourage funding efficiencies need to be approached with some caution, especially when claims for innovation and responsiveness to development needs are based on untested assumptions around the potential of some partners to adapt their application, funding and evaluation procedures within these new structures. The authors examine this in the case of the Health Systems Funding Platform, which despite being set up some three years earlier, has stalled at the point of implementation of its key elements of collaboration. While much of the attention has been centred on the suspension of the Global Fund’s Round 11, and what this might mean for health systems strengthening and the Platform more broadly, they argue that inadequate scrutiny has been made of the World Bank’s contribution to this partnership, which might have been reasonably anticipated based on an historical analysis of development perspectives. Given the tensions being created by the apparent vulnerability of the health systems strengthening agenda, and the increasing rhetoric around the need for greater harmonisation in development assistance, an examination of the positioning of the World Bank in this context is vital, the authors conclude.

The IFC’s Health in Africa initiative is failing to reach the poor
Mohga Kamal-Yanni: Global Health Check, Sep 10th, 2014

Health In Africa is a $1 billion investment project launched by the IFC in 2008, which aimed to ‘catalyze sustained improvements in access to quality health-related goods and services in Africa [and] financial protection against the impoverishing effects of illness’, through harnessing the potential of the private health sector. Specifically, it sought to improve access to capital for private health companies, and to help governments incorporate the private sector into their overall health care system. Health In Africa would do this through three mechanisms: an equity vehicle, a debt facility, and technical assistance. Perhaps of most importance, the initiative would make extra efforts to ‘improve the availability of health care to Africa’s poor and rural population’. The author reports that Oxfam’s assessment of the sporadic investment information available finds that far from delivering health care for the poorest, Health In Africa has favoured high-end urban hospitals, many of which explicitly target a country’s wealthy and expatriate populations. The initiative’s biggest investment to date has been in South Africa’s second largest private hospital group Life Healthcare. This $93 million endowment no doubt supported the company in its subsequent expansion, but there is no evidence it has used this investment to expand access to health care for the 85% of South Africans without health insurance. Oxfam has called on the IFC to cease all Health In Africa investments until a robust, transparent and accountable framework is put in place to ensure that the initiative is pro-poor, and geared towards meeting unmet need. In addition, it calls on the World Bank Group to conduct a full review of the IFC’s operations and impact to date in the health sector in low- and middle-income countries, to investigate how they are aligned with, and are accountable to, the overarching goals of the World Bank Group: to end extreme poverty and promote shared prosperity.

The Impact of HIV/AIDS on the Health Sector

This report emanates from the results of a study that examined the impact of HIV/AIDS on the public and private health facilities in South Africa, and outlines the subsystems that are affected. Both public and private sector health facilities have reported an increase in the number of patients seeking clinical care for people living with HIV/AIDS, leading to increased admissions to medical and paediatric wards and increased workloads. This study addresses these issues and makes recommendations for managing the HIV/AIDS case load.

The impact of privatisation on public services

This article produced by Social Watch analyses the impact of privatisation of health, education and basic infrastructure. It follows the United Nations Commission on Human Rights (UNCHR) report that urges WTO member nations to consider the human rights implications of liberalising trade in services, especially health, education and water. Social Watch is an international NGO watchdog network monitoring poverty eradication and gender equality.

The Impact of Privatization on developing countries
John Nellis and Nancy Birdsall, eds.

"The privatization of state-owned enterprises has been among the most controversial of market reforms. This new edited volume brings together a comprehensive set of country studies on the effects of privatization on people-and answers the overarching question: who are the winners and losers of the wave of privatizations that swept across the developing world in the 1980s and 1990s? The studies are sophisticated and careful, and address the big questions: Are the poorest households paying more for water, power, and other basic services? Did those who lost jobs suffer permanent declines in income? Were state assets sold at prices that were too low, and who benefited from the resulting windfalls? Was the process, in laypersons' terms, fair?"