Although the Bill and Melinda Gates Foundation’s contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. This paper is an analysis of 1,094 global health grants awarded between January 1998 and December 2007, totalling US$895 billion, of which $582 billion (65%) was shared by only 20 organisations. In total, $362 billion (40% of all funding) was given to supranational organisations such as the World Health Organization, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria. Of the remaining amount, 82% went to recipients based in the United States. Just over a third ($327 billion) of funding was allocated to research and development (mainly for vaccines and microbicides) or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.
The author points out that no single non-governmental institution or individual wields more influence, and no one’s support is more powerful in global health, than the Gates Foundation and its namesake founders, Bill and Melinda Gates. The foundation has $39.6 billion in assets and spent $2.9 billion on developmental assistance for global health in 2015 alone ― more than every country in the world except the U.S. and the U.K. The author argues that WHO has frequently fallen short of its goal to protect and promote health of all people, leading some to propose returning to a more philanthropy-focused model. That means private charities such as the Gates Foundation might play an even larger role in protecting public health, which calls for scrutiny of the role that philanthropy has played in recent years. When the Gates Foundation takes aim at a disease, it can elicit billions of dollars from governments and reshape the world’s agenda for scientific research, to the cost of other diseases. WHO reliance on voluntary contributions from countries and private donors, including the Gates Foundation, for around 80 percent of its budget is argued to make the organisation vulnerable to outside pressure and funder 'pet programs', which skews global health priorities. The author documents trends post 2014 and argues that the world remains grossly underprepared for outbreaks of infectious disease, which are likely to become more frequent in the coming decades, according to a meta-analysis of post-Ebola studies published in January 2017. The author indicates that public and state funding remains critical for international health efforts and cannot be left to private players to fill the void.
This paper shows there is an urgent need to reassess the arguments used in favor of scaling-up private-sector provision in poor countries. The evidence shows that prioritising this approach is extremely unlikely to deliver health for poor people. The paper recommends that donors should rapidly increase funding for the expansion of free universal public health-care provision in low-income countries, including through the International Health Partnership. Developing countries must resist donor pressure to implement unproven and unworkable market reforms to public health systems and an expansion of private-sector health-service delivery. Civil society must also act together to hold governments to account by engaging in policy development, monitoring health spending and service delivery, and exposing corruption.
While the South African government and private healthcare funders urged one another to make internal changes to enable faster progress towards a more equitable healthcare system, some concrete evidence of vitally needed partnership did emerge from the Board of Healthcare funders' conference held in August 2014. Government’s new Essential Drugs Committee will include representatives of the private healthcare funding industry to obtain consensus on just which essential medicines should be available to patients.
A blueprint on how the National Department of Health (NDoH) can partner
with the private healthcare funding sector in conducting economic evaluations of products to save both sectors time and money (and avoid
longstanding unnecessary duplication) has been drawn by NDoH. National Health Minister Dr Aaron Motsoaledi also pleaded with delegates to ‘embrace change’, warning that they would be hardest hit by the‘exploding’ epidemic of non-communicable diseases if they failed to introduce health promotion and disease prevention measures.
According to this article, South African government spending on health care comprises less than half of total health expenditure even though the public system serves more than 80% of the population (i.e. around 40 million South Africans) without private health insurance. Around 70% of all doctors and most specialists only work in the private sector, the remaining 30% serve the public sector. Sixteen per cent of the population use private doctors and hospitals which are covered by their health insurance, often with a monthly contribution from their employers. It is this stark public–private divide that the South African Government hopes its proposed National Health Insurance (NHI) scheme will deal with by providing universal access to health care based on need rather than ability to pay. Despite some reservations about whether government can afford to pay for the proposed national health insurance scheme, an integrated pool of funds has been offered as one way to ensure that all the public sector’s available human resources are used more effectively and efficiently.
At this stage, very little is known about the details of the South African government’s national health insurance (NHI) proposals, as all discussions are being held behind closed doors. However, key elements of the proposals are reported to include implementing a dedicated payroll tax for healthcare and establishing an administrative infrastructure to oversee these funds. The author, who is the head of strategy and risk management at Discovery Health (a private health services provider in South Africa) makes four proposals: transparent and vigorous public debate, based on hard evidence, is needed; healthcare reform, including NHI, must uplift the standards of public healthcare and improve the quality and accessibility of decent healthcare for all South Africans; healthcare reform must be rooted in South Africa’s economic realities; and South Africa’s private healthcare system should be seen as part of the solution, not part of the problem.
Earlier this year, the US Government, through President Bush’s Emergency Plan for AIDS Relief, announced an unprecedented public-private partnership to promote scientific and technical discussions on solutions for pediatric HIV treatment, formulations and access. These partnerships seek to capitalise on the current strengths and resources of both innovator and generic pharmaceutical companies, the US Government, as well as multilateral organisations to facilitate the process.
This book assesses the achievements and limitations of a new set of non-state or multi-stakeholder institutions that are concerned with improving the social and environmental record of business, and holding corporations to account. It does so from a perspective that aims to address two limitations that often characterise this field of inquiry. First, fragmentation: articles or books typically focus on one or a handful of cases. Second, the development dimension: what does such regulation imply for developing countries in terms of well-being, empowerment and sustainability? This volume examines more than 20 initiatives or institutions associated with different regulatory and development approaches, including the business-friendly corporate social responsibility (CSR) agenda, 'corporate accountability' and 'fair trade' or social economy. Several chapters deal specifically with the mining sector in Africa.
This investigation by ActionAid used published ﬁnancial information, interviews with government ofﬁcials and research to follow up on corporate tax avoidance across Africa and India. They estimate that as much as £20 million per year may have been lost in the form of corporate taxes or a fifth of the corporate tax bill that could have paid for education, health and infrastructure. The authors argue for strengthened tax law and revenue administration capacity to deal with taxing multinational companies; improved transparency around corporate reporting; for countries to not give away their right to tax royalties, management fees and other foreign payments at source; and to examine and, where necessary, reform the way they tax multinationals.
The private sector exerts a significant and critical influence on child health outcomes in developing countries. This article in the Bulletin of the World Health Organization reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector’s influence, extending its analysis to include nongovernmental organisations (NGOs), pharmacies, drug sellers, private suppliers, and food producers. The article analyses some of the most promising strategies for improving child health, and suggests a number of possible constraints to emulating these approaches more widely.