Public-Private Mix

The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal
Naidoo P, Jinabhai CC and Taylor M: African Journal of Primary Health Care and Family Medicine 2(1), 2010

This paper aimed to gauge the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Most of the doctors were male GPs aged 30–50 years who had been in practice for more than ten years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. The paper concluded that many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, which could potentially remove some of the current burden on the public health sector.

The world's health sector is expanding. Can it heal our economies?
Tulenko K: World Economic Forum, May 2016

The author writes that the health sector is predicted to be the largest source of job creation for the next decade globally. Its growth is being driven by increasing numbers of older people and by the expansion of the global middle class. As these two groups grow, the higher levels of healthcare they demand will cause seismic shifts in the amount of money being spent in the health sector, driving employment. Even without these trends, the world would need millions more health workers. Despite increased training, it is not meeting population demand. The world no longer dominated by infectious diseases requiring episodic treatment, and is instead becoming dominated by non-communicable, chronic diseases such as heart disease, diabetes, cancer, and mental-health conditions, which require continuous treatment. Unlike traditional employment sectors such as agriculture and manufacturing, which shed jobs as technology advances, healthcare tends to add jobs with increasing technology. The author argues that the health sector will be an economic engine that not only creates new jobs and business but, by making workers in other sectors healthier and more productive, will enable those sectors to grow faster creating tens of millions of new jobs.

There is no alternative to strengthening the public role in the health system
Hanson K, Gilson L, Goodman C and Mills A: PLoS Medicine, November 2008

Is private health care the answer for the world's poor? This article’s starting point is that there are no strong grounds for assuming the superiority of either public or private health care. Theory dictates that it is not whether a health facility is publicly or privately owned that determines health provider performance. Instead, what influences performance is the nature of incentives that providers face and the quality of management and oversight. Theory does, however, suggest that the profit-making incentive dominant in much of the private sector is likely to be problematic for health care. Is there then scope for private providers to be paid through public financing? Past experiences all point to the significant transactions costs of such arrangements and the need for strong and capable contracting units within health ministries.

Thinking forward: The quicksand of appeasing the food industry
Brownell KD: PLoS Medicine 9(7): 3 July 2012

In addressing the problem of global obesity, our greatest failure may be collaboration with and appeasement of the food industry, argues the author of this article. She warns against current initial steps in this direction in the form of so-called ‘public–private partnerships' with health organisations, ‘healthy eating’ campaigns and corporate social responsibility initiatives. These occur at the same time as the private sector food and beverage sectors fight against meaningful change such as limits on marketing food to children, taxes on products such as sugared beverages, and regulation of nutritional labelling. The food industry distorts science, creates front groups to do its bidding, compromises scientists, professional organisations and community groups with contributions, and blocks needed public health policies in the service of shareholder, the author notes. This is normal ‘business as usual’. While respectful dialogue with industry is desirable, she argues that there must be recognition that this will bring small victories only and that to take the obesity problem seriously will require courage, leaders who will not back down in the face of harsh industry tactics, and regulation with purpose.

To corporatise or not to corporatise (and if so, how?)
McDonald D: Utilities Policy, 2016, doi: http://dx.doi.org/ 10.1016/j.jup.2016.01.002

Governments around the world are increasingly turning to the use of stand-alone, state-owned utilities to deliver core services such as water and electricity. This article reviews the history of such ‘corporatisation’ and argues that its recent resurgence has been heavily influenced by neoliberal theory and practice, raising important questions about whether it should be adopted as a public service model. Not all corporatisations promote commercialisation, however. The article also discusses stand-alone utilities that have managed to stave off market pressures and develop in more equity-oriented directions. The scope for non-commercialised corporatisation is narrow, but given the expansion of this organisational model, the author argues that it is important that we understand both its limitations and potentials, particularly in low-income countries where service gaps are large and equity is a major challenge.

Toilet capitalism: A Zimbabwean basket case
Sharife K: Pambazuka News, 22 February 2012

This author argues that Zimbabwe is ripe for private waste sanitation companies (“toilet capitalists”). In 2008, cholera swept through the country due to aging and absent water and waste sanitation systems. The author argues that private systems cannot replace public investment and that what happens in the political terrain will be critical for determining whether revenue will flow in the direction of the public good.

Towards A Dynamic Concept of Health - CPRN Report

Sholom Glouberman, Director of Canadian Policy Research Networks, May 2001
One characteristic stands out above all in the history of our developing understanding of health, - its complexity. "We now realize that health is shaped by numerous, perhaps countless, forces from many different spheres of influence, ranging from the molecular to the socioeconomic," says Sholom Glouberman, Director of CPRN's Health Network. Glouberman is the author of Towards a New Perspective on Health Policy, the final report of a three-year research project at CPRN. The report ties together a number of separate studies and the results of discussions involving some 3,500 people at more than 90 events held over the course of developing the research conclusions. Judith Maxwell, President of CPRN, says Glouberman's study points to the importance of placing the reform of the health care system in this broader context. "All of us want to feel secure in the knowledge that health care will be there for us should we need it." says Maxwell. "What Sholom's study underlines is that further investment in the health care system should consider how to regain public confidence in it. It is this interactive sense of security that has a significant impact on health along with other factors such as biological condition, social relationships, economic status, work experience and culture."

Towards a more sustainable globalisation:
the role of the public health community

DOUGLAS W BETTCHER and HEATHER WIPFLI - J Epidemiol Community Health 2001;55:617-8
In her article Fran Baum is correct in pointing out that the political complexities of our globalised world must be taken into account by public health professionals. Global health futures are directly or indirectly associated with the transnational economic, social, and technological changes taking place in the world. Issues such as poverty, equity, and justice must be firmly rooted in any discussions aimed at improving global public health. However, globalisation is a "janus faced" creature: the double face of globalisation, one promising and the other threatening, is a fact of life as humanity is being catapulted into a more interdependent future.

Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system
Grieve A; Olivier J: International Journal for Equity in Health 17(97)1-20, 2018

This paper presents a mapping of faith-based health assets in Ghana using both qualitative and quantitative evidence to provide a visual representation of changes in the spatial footprint of the faith-based non-profit (FBNP) health sector. The geospatial maps show that FBNPs were originally located in rural remote areas of the country but that this service footprint has evolved over time, in line with changing social, political and economic contexts. The sector has had a long-standing role in the provision of health services and remains a valuable asset within national health systems in Ghana and sub-Saharan Africa more broadly. The authors observe that collaboration between the public sector and such non-state providers, drawing on the comparative strengths and resources of FBNPs and focusing on whole system strengthening, is essential for the achievement of universal health coverage.

Trade Unions and reform of public utilities: International perspective
Lobina E, Hall D: Public Services International Research Unit, 2006

Privatisation has been promoted throughout the world for the last 20 years. The advantages are supposed to be increased efficiency, lower prices, greater investment, and greater dynamism than public ownership. It has been seen as a central policy element in transforming former communist states into market economies. It has been promoted wordwide by international institutions including the IMF, the World Bank and the OECD, and by multinational companies. The EU is in principle neutral on privatisation, but in practice encourages PPPs. Privatisation has been made especially attractive because of economic policies aimed at reducing the borrowing of governments at national and municipal level. This dociment discusses futher the impact of reform on industry, workers in health and trade unions.

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