Public-Private Mix

The public-private health sector mix in South Africa
Health Economics Unit (HEU), University of Cape Town: HEU Health Care Financing Information Sheet, 2009

This sheet provides information on financing in the public and private health sectors in South Africa. It notes that medical schemes cover 16% of the population, on whom about R11,300 is spent per person (this includes both medical scheme spending and out-of-pocket payments), while the public sector covers most of the rest of the population, particularly the 68% who do not use any private care – government spends about R1,900 per person on this group. Sixteen percent of the population use the private sector on an out-of-pocket basis for primary care but are almost entirely dependent on the public sector for hospital care; for this group nearly R2,500 is spent per person. Medical scheme spending has been increasing, while public sector health spending has been largely stagnant until recently. Most health professionals (except enrolled nurses) work in the private health sector.

The public-private mix and reproductive health in Africa
Women’s Health Project, University of the Witwatersrand: Moorman J

Health sector reforms usually involve changes in the organisation and management of health care systems, including a re-examination of the roles of the public and private sectors in the delivery of health care. From a gender perspective there is silence about the unpaid provision of health services in which women in the household and community are the main providers. This silence pervades most of the literature on privatisation.

The role of public funds in reducing child mortality

What chance do poor countries have of reducing child mortality by two thirds between 1990 and 2015? What contribution can public spending make to meeting this Millennium Development Goal (MDG)? Research by the Overseas Development Institute suggests the need for a greater pro-poor focus in public health expenditure. Over the last 40 years child mortality has halved in low-income countries. However, it is increasing in sub-Saharan Africa and there are also large differences between the health status of poor and non-poor children within countries. What can governments do to improve child survival?

The role of the private sector in the context of aid effectiveness
Davies P: Organisation for Economic Co-operation and Development, 2 February 2011

The purpose of this report is to identify and summarise lessons learned, opportunities and challenges in relation to the role of the private sector in the context of aid effectiveness. The authors conducted 47 qualitative interviews with different stakeholders, including external funders, private sector representatives (for-profit and private foundations), partner countries, civil society organisations and independent experts. Some respondents emphasised that the profit-driven incentives of the private sector seldom converge with development objectives, which poses challenges for the aid effectiveness agenda. In contrast, others noted that business incentives can converge with those of donors and partner countries, and private sector companies can contribute to development in three main ways, namely by integrating their core business operations and value chains, by making social investments and undertaking philanthropic ventures, and by promoting public advocacy, policy dialogue and institution strengthening. External funders in particular emphasised that for-profit private sector contributions to the development process are more sustainable if they are embedded in the core business strategy of a company. The authors propose new types of inclusive business models, with increased commitments to include people living in poverty as part of core business strategy, and where the private sector contributes best to aid objectives by running responsible businesses but also plays diverse roles and engages directly in aid processes.

The Role of the Private Sector within the South African Health System
HST, 2007

The 2007 edition of the South African Health Review focuses on broad areas with respect to the role of the private health sector i.e. oversight, pooling of resources and purchasing of health care, delivery of health care services and health and related indicators.


Presented to the commission on health hosted by civil society at WSSD by BUPENDRA MAKAN of The Equity Project.
Development is inextricably linked to social justice & equity. Health is a basic human right.
“It should never be that the anger of the poor, should be the finger of accusation pointed at all of us because we failed to respond to the cries of the people for food, for shelter, for the dignity of the individual” former President of South Africa, Nelson Mandela to US Congress in 1990. Poverty in a world of plenty is the greatest barrier to health as shown in the huge inequities in health status.

Further details: /newsletter/id/29331
The utilisation of public-private partnerships: Fiscal responsibility and options to develop intervention strategies for HIV and AIDS in South Africa
Schoeman L: University of Pretoria, April 2007

This study aimed to put forward value-creating strategies and develop a best practice model that strengthened government capacity to provide efficient, effective, economical and equitable health care and thereby impact on plans for HIV and AIDS prevention and treatment roll-out.

The viability of local pharmaceutical production in Tanzania
Losse K, Schneider E: Deutsche Gessellschaft fur Technische Zusammenarbeit , 2007

This study analyses the economic potential of pharmaceutical production of Anti Retroviral Drugs (ARVs) in Tanzania. This includes an analysis of the pharmaceutical sector in the country and the potential to export ARVs to the region. The study shows that production of pharmaceutical products in Tanzania is on the rise and can become viable in the long term. Even though the overall drug market is rather small, public health related drugs have a significant, largely donor based, market.

The vital role of the private sector in reproductive health
O'Hanlon B: PSP-One, April 2009

While universal access to reproductive health care – including family planning, maternal health care, and prevention of HIV/AIDS and other sexually transmitted infections – is critical to achieve the United Nation's Millennium Development Goals, it is far from becoming a reality. Governments are often major providers of reproductive health services, but inadequate funding greatly limits the availability and quality of the services. The private sector can help expand access to and quality of reproductive health services through its resources, expertise, and infrastructure. This brief provides an overview of the private sector, highlights the critical role it plays in delivering health services and products in developing countries, and explains how governments and donor agencies can engage this sector to achieve reproductive health goals.

The way forward: prioritising district health care services in developing countries

The growing movement in favour of the privatisation of public services and the reliance on market forces in many developing countries suggests that the critical role of the district health system needs to be restated. Research by the Institute of Development Studies, UK, indicates that district health services are the best means of delivering primary health care and basic hospital care and should be made a priority for public funding. The most important task is to develop a special programme of rehabilitation for a demoralised workforce, including improved management of staff mix and distribution, incentives for good performance, support and training as well as better pay.