Public-Private Mix

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?"

The Importance of Health and Safety at African Mine Sites
Bocoum B: World Bank, Live Wire 2017/70, doi:

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:

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.