Public-Private Mix

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.

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: 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.