Public-Private Mix

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.

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.

the ROLE OF THE STATE IN HEALTH

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

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