Public-Private Mix

The Importance of Health and Safety at African Mine Sites
Bocoum B: World Bank, Live Wire 2017/70, doi: http://hdl.handle.net/10986/25997

This brief observes that equity and shared prosperity calls for a closer look at the working and living conditions of millions of mine workers in Africa, where tuberculosis (TB) imposes a high burden on mining economies and constitutes a regional public health crisis. Health hazards are reported to be perpetuated by poor enforcement of mining legislation, limited application of best international practices, weak institutions, and inadequate equipment and skills. In uncontrolled mining operations and communities of the type common in Africa, several factors are argued to combine to form a perfect storm for TB infection and transmission. They argue that the practice of allowing mining companies to self-report on health issues should be eliminated and that legislation on the health aspects of mining operations in Africa must be developed in line with international standards and best practices. The continent’s regional development communities should act urgently to establish public-private partnerships capable of ensuring that mining in fact benefits the region’s people in their path toward sustainable development. The goal should be the adoption of preventive measures to avoid further damage to the region’s health and skilled human capital.

The importance of strategic management in the implementation of private medicine retailer programmes: Case studies from three districts in Kenya
Abuya T, Amin A, Molyneux S, Akhwale W, Marsh V and Gilson L: BMC Health Services Research 10(Suppl 1), 2010

In Kenya’s Home Management of Malaria Strategy, the government seeks to improve prompt and effective anti-malarial drug availability through the informal sector, with a potential channel being the private medicine retailers (PMRs). This paper examines the implementation processes of three PMR programmes in Kenya, in the Kwale, Kisii Central and Bungoma districts. The research methods included 24 focus group discussions with clients and PMRs, 19 in-depth interviews with implementing actors, document review and a diary of events. The researchers found that the Kisii programme was successfully implemented, thanks to good relationships between district health managers and the ‘resource team’, and supported by a memorandum of understanding. It had flexible budgetary and decision making processes which were responsive to local contexts, and took account of local socio-economic activities. In contrast, the Kwale programme, which had implementation challenges, was characterised by a complex funding process, with lengthy timelines tied to the government financial management system. Although there was a flexible funding system in Bungoma, a perceived lack of transparency in fund management, inadequate management of inter-organisational relationships, and inability to adapt and respond to changing circumstances led to implementation difficulties. The researchers conclude that an active strategy to manage relationships between implementing actors through effective communication mechanisms is essential for the PMR approach to work, in conjunction with a strong and transparent management system.

The initial pharmaceutical development of an artesunate/amodiaquine oral formulation for the treatment of malaria: a public-private partnership
Lacaze C, Kauss T, Kiechel J, Caminiti A, Fawaz F, Terrassin L at al: Malaria Journal 10(142), May 2011

This paper reports on the initial phases of the pharmaceutical development of an artesunate-amodiaquine (ASAQ) bilayer co-formulation tablet, undertaken following pre-formulation studies by a network of scientists and industrials from institutions of both industrialised and low income countries. University researchers, private companies specialised in pharmaceutical development and clinical batch manufacturing, as well as the World Health Organisation and Medecins Sans Frontieres collaborated on the project within a larger public-private partnership (the FACT project). The main pharmaceutical goal was to combine in a solid oral form two incompatible active principles while preventing artesunate degradation under tropical conditions. Collaborations between research and industrial groups greatly accelerated the process of development of the bi-layered ASAQ tablet. No intellectual property right was claimed. Lack of public funding was the main obstacle hampering the development process.

The medical device development landscape in South Africa: Institutions, sectors and collaboration
De Jager K; Chimhundu C; Saidi T; Douglas TS: South African Journal of Science 13(5/6), 2017

A characterisation of the medical device development landscape in South Africa would be beneficial for future policy developments that encourage locally developed devices to address local healthcare needs. The landscape was explored through a bibliometric analysis (2000–2013) of relevant scientific papers using co-authorship as an indicator of collaboration. Collaborating institutions found were divided into four sectors: academia (A); healthcare (H); industry (I); and science and support (S). A collaboration network was drawn to show the links between the institutions and analysed using network analysis metrics. The academic sector collaborated the most extensively both within and between sectors; local collaborations were more prevalent than international collaborations. Translational collaborations (AHI, HIS or AHIS) are considered to be pivotal in fostering medical device innovation that is both relevant and likely to be commercialised. Few such collaborations were found, suggesting room for increased collaboration of these types in South Africa. These results could inform the development of strategies and policies to promote certain types of medical device development. Further studies could identify drivers and barriers to successful medical device development in South Africa.

The Novartis Drop the Case Campaign
Medicins Sans Frontieres: 1 February 2012

In 2006 the drug company Novartis took the Indian government to court over its patent law, in a move that threatened access to affordable medicines produced in India for millions of people across the developing world. The company wanted to get the law changed so that they could more easily extend the patents on their products, and stop generic companies producing the same medicines at a fraction of the price. MSF’s Drop the Case campaign, launched in response to this move, gathered nearly half a million signatures calling on the company to drop its case. But six years later, the legal battle continues. India’s Supreme Court is now due to give the final judgement on the case this year. In August 2007, the Madras High Court in August 2007 ruled against Novartis. Undeterred, the company has continued to appeal against each legal reversal, with the result that India’s final court – the Supreme Court - is now due to hear the case. To add your voice to the discussion, visit: http://www.msfaccess.org/STOPnovartis/

The pharmaceutical industry in Sub-Saharan Africa: A guide for promoting pharmaceutical production in Africa (UNIDO)
White S; Banda G; Chaudhuri S; Chen L; et al.: United Nations Industrial Development Organisation (UNIDO), 2019

The authors report that there is consensus that local pharmaceutical production in sub-Saharan Africa in close proximity to where medicines are needed can reduce dependence and improve health outcomes for the population. Many African governments, regional economic communities and the African Union have recognized the need for active support to the development of the sector if these benefits are to be realized. However, concrete action on the ground is reported to have remained hesitant and piecemeal to date. This document contains advice for government policy makers, the private sector especially pharmaceutical manufacturers in sub-Saharan African countries, development partners and finance institutions on how to promote pharmaceutical production. The guide focuses on the key areas of competitiveness, market access, technology and access to finance. It further proposes a path of how governments could embark on and steer a policy development process as well as giving guidance on policy interventions. The document especially emphasizes the interconnectedness of key intervention areas and recommends that promotional measures from key areas should be combined to increase impact.

The Private Sector and Development in Africa – Challenges and Opportunities
Janneh A: UN Under Secretary General, November 2006

According to the UN Under-Secretary General, the private sector in Africa, although still in its infancy and not as organised as in other parts of the world, is expanding at a very fast rate, is contributing to growth and poverty reduction and that the state, by expanding economic space, has been central to this development. However, there is much that remains to be done both by the state and the private sector to realise the full possibilities of the sector’s contribution to African development.

The private sector does have a role to play in health service delivery
Over M: 13 March 2009

Oxfam’s latest publication characterises as illogical and unethical the view that governments could serve their people by facilitating and regulating a private sector contribution to health care delivery. The author’s research in South Asia shows that, at least for antiretroviral therapy (ART), there is a role for public as well as private provision in developing countries. In countries like India, the private health care sector is industrious, entrepreneurial and accounts for most health care delivery. However, its quality is extremely varied. This variability of quality is less of a problem when health care addresses non-infectious health problems, like broken arms or diabetes. For these problems, lower quality care may be better than no care at all. So even if the government were able to successfully ban all the lower quality health care providers, it may only end up making health care less accessible to the poorest.

The privatisation of global health
Basu S: 28 July 2009

The author describes events in Lesotho and South Africa where public-private health partnerships have not produced the desired results and notes that these incidents are not isolated, but part of a wave of new privatisation initiatives that uses donor dollars for public health by shuttling them into private contractors in poor countries. Advocates of private-public partnerships are noted to cite selective data from specific privatisation schemes, ignoring the costs of contracting and the broader impact of their initiatives on communities. The author questions the idea that foreign health policy analysts know better than local providers and patients, and points to the irony of poorer performance in public health relative to resources in the United States, the country with the greatest number of health policy analysts per capita.

The privatisation of global health
Basu S: 28 July 2009

The author describes events in Lesotho and South Africa where public-private health partnerships have not produced the desired results and notes that these incidents are not isolated, but part of a wave of new privatisation initiatives that uses donor dollars for public health by shuttling them into private contractors in poor countries. Advocates of private-public partnerships are noted to cite selective data from specific privatisation schemes, ignoring the costs of contracting and the broader impact of their initiatives on communities. The author questions the idea that foreign health policy analysts know better than local providers and patients, and points to the irony of poorer performance in public health relative to resources in the United States, the country with the greatest number of health policy analysts per capita.

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