Public-Private Mix

The cupboard is full: Public finance for public services in the global South
Lipschutz RD and Romano ST: Municipal Services Project, Briefing Note No 2, 2012

Governments around the world argue that there is no money for badly needed public services. But the author of this briefing note disagrees, pointing to evidence that large pools of public monies exist for investment in public infrastructure, with public pension funds and sovereign wealth funds being two examples. Currently, these funds are being directed toward large-scale, capital-intensive, high-return projects aimed primarily at well-off urban residents and the private sector. Lessons from the financial crisis show that such funds could actually realise greater long-term returns from investment in public service provision, the authors argue, while avoiding the politically controversial and contradictory practice of using public sector funds to support privatisation. They make the case for using public pension funds and sovereign wealth funds for socially responsible investments in the global South, in support of essential public services.

The difficult relationship between faith-based healthcare organisations and the public sector in sub-Saharan Africa
Boulenger D and Criel B: Studies in Health Services Organisation and Policy 29, ITG Press, 2012

In this book, the authors present the principal findings of a study conducted between September 2007 and March 2009 on contractual arrangements between faith-based hospitals and public health authorities in four sub-Saharan African countries: Cameroon, Tanzania, Chad and Uganda. In Tanzania, Christian faith-based organisations were found to be well represented, particularly the Catholic Church. The study focused on the Nyakahanga District Designated Hospital (NDDH), a rural Lutheran hospital located in the north-west of the country. Researchers found that monitoring of the contractual relationship between church and state is not properly done and supervision remains erratic, with frequent stock-outs and lack of capital investment, leading to a negative perception of the relationship by both parties. In Uganda, the faith-based health sector owns about 30% of the country’s health facilities. Field research for the study focused on two faith-based hospitals in Uganda that were involved in contracting agreements with PEPFAR recipients. Restrictive and demanding agreements between PEPFAR recipients and hospitals were identified as problematic, but this was mitigated by the reliability of PEPFAR funding. The authors observe that where the relationship between public and faith-based sectors is not satisfactory, faith-based organisations may opt for more predictable agreements that they can rely on with external organisations like PEPFAR.

the Drugs for Neglected Diseases Initiative: A global initiative to develop drugs for those in need

Recent international efforts to revive pharmaceutical R&D for neglected diseases have focused mainly on malaria, tuberculosis and HIV/AIDS. These have relied heavily on market-based incentive mechanisms, including public-private partnerships. The DND-WG's analysis clearly shows that this strategy will have limited impact for what we describe as the "most neglected diseases". One strategy to address this fatal imbalance that is currently being pursued is the creation of a needs-driven global drug development network - the Drugs for Neglected Diseases Initiative (DNDi). The DNDi is a not-for-profit research and development organisation that will manage global R&D networks with the goal of producing new, effective, affordable and field-relevant drugs for neglected diseases. The Drugs for Neglected diseases Initiative is the brainchild from Médecins Sans Frontières' Drugs for Neglected Diseases Working Group. The DNDi aims to take the development of drugs for neglected diseases out of the marketplace and encourage the public sector to assume greater responsibility.

The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomised, controlled trial
Kangwana BP, Kedenge SV, Noor AM, Alegana VA, Nyandigisi AJ, Pandit J et al: Malaria Journal 12(81), 1 March 2013

To improve the quality of care received for presumptive malaria from the highly accessed private retail sector in western Kenya, subsidised pre-packaged artemether-lumefantrine (AL) was provided to private retailers, together with a one-day training course for retail staff on malaria diagnosis and treatment, job aids and community engagement activities. This study assessed the intervention through provider and mystery-shopper cross-sectional surveys, which were conducted at baseline and eight months post-intervention to assess provider practices. On average, 564 retail outlets were interviewed per year. At follow-up, 43% of respondents reported that at least one staff member had attended the training in the intervention arm. The intervention significantly increased the percentage of providers knowing the first line treatment for uncomplicated malaria by 24.2%; the percentage of outlets stocking AL by 31.7%; and the percentage of providers prescribing AL for presumptive malaria by 23.6%. Generally, outlets that received training and job aids performed better than those receiving one or none of these intervention components.

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.