Public-Private Mix

Transnet launches new health train in South Africa
Styan JB:, 12 March 2012

Transnet has launched its second health train in South Africa, the Phelophepa II, costing R82m (US$10.8). The first Phelophepa train has served more than six million in rural communities over the past 18 years. The trains, crewed by medical specialists including a number of final year students, provide primary healthcare, dental, psychological and optical services. Transnet’s rail engineering division, TRE, was responsible for the development of the new train with the Swiss-based pharmaceutical group F Hoffman La Roche a major sponsor of both trains. The trains operate from January to September every year and cover vast areas of South Africa where primary healthcare facilities are under pressure.

Uganda: Companies scale-up Aids campaigns
Mukombozi R, The Monitor (Kampala), 21 March 2006

Through the theme: "Saving lives, Saving money," Ugandan businesses are being sponsored with modules designed to prevent the spread of HIV/Aids through training programmes and awareness campaigns on better access to ARVs. This presents a detailed argument for the care of employees with HIV/AIDS.

Ugandan generic ARV factory overprices its drugs
Plus News: 14 March 2013

AIDS activists in Uganda have drawn attention to overpricing of medicines at a local pharmaceutical plant, Quality Chemicals Industries Limited (QCIL). The plant was started in 2007 to improve treatment access by providing cheaper ARVs locally. The authors argue that between December 2009 and October 2010, the government's National Medical Stores (NMS) paid $17.8 million more than it should have to QCIL, with a 15% mark-up on imported drugs that had been intended only for locally produced drugs. QCIL is reported in the article to be selling imported drugs manufactured by Cipla at high prices even after it started producing its own drugs. The government inspector general and civil society activists have demanded the government investigate and recover the funds.

UN must stop health-related partnerships with the baby food and junk food industry
One Million Campaign, World’s Breastfeeding Movement: August 2011

The One Million Campaign’s petition to the President of the United Nations (UN) General Assembly urges the UN to re-consider proposed partnerships with the private sector for future work in prevention of non-communicable diseases (NCDs). The UN’s draft Political Declaration, developed in preparation for the High-level Summit on Non-communicable Diseases (NCDs) in September 2011, contained proposals to allow manufacturers of unhealthy foods - including infant foods and junk foods -to influence future global and national health strategies to control NCDs. The One Million Campaign asserts that strategies to prevent NCDs should emphasise support to women to continue breastfeeding up to two years, especially exclusive breastfeeding for the first six months and end promotion of all foods for infants, and children. Research indicates that this breastfeeding regimen significantly reduces the risk of NCDs. They argue that manufactures of unhealthy foods, breast milk formula and infant foods should not be allowed to participate in developing strategies or making decisions regarding healthy foods and prevention of NCDs, as there is a clear case of conflict of interest.

Undernutrition in Tanzania – is private sector growth the answer?
Steve Lewis, Eldis, May 2014

A recent RESULTS report on nutrition and education in Tanzania, “You can’t study if you’re hungry…” found that levels of undernutrition are worryingly high, at 42% of all children under five, and, surprisingly, that buoyant economic growth levels are having little impact on nutrition figures. In Tanzania, a lack of essential nutrients in the average child’s diet is one of the key determinants of undernutrition. So it is not necessarily a lack of food, but a lack of nutritious and varied food. Micronutrient deficiency is widespread in Tanzania and contributes to the high level of stunting. Yet, Tanzania’s Gross Domestic Product (GDP) Annual Growth Rate averaged 7% from 2002 until 2013, reaching an all-time high of 11% in 2007. But the sectors which have driven Tanzania’s economic growth are mainly those which are capital intensive and urban. So while the urban middle class are expanding there is little benefit in rural areas. The fastest growing economic sectors are communications, financial services, construction, and a new natural gas sector. In a meeting with Tanzanian MPs on the Parliamentary Group for nutrition the MPs who were especially concerned were from the area of the country described as the ‘agricultural growth corridor’. Precisely the rural areas of the country that have been targeted for private sector growth are those constituencies with highest rates of stunting. One MP said that the emphasis on export-led growth means that parents are now so busy that they do not have the time to focus on the adequate nutrition of their children.

Universal Health Coverage, Primary Health Care and the role of the Private Sector
Ozano K; Simkhada P; Porcellato L; Khatri R: Health Systems Global, 2019

This report provides an overview of the discussions around Primary Health Care (PHC) and the private sector, which took place during the 5th Global Symposium on Health Systems Research 2018: Advancing health systems for all in the SDG era. Universal Health Coverage (UHC) and how health systems are working to deliver this global goal by 2030 was a major theme of the conference. Discussions were captured through session data capture and semi-structured interviews. 26 conference rapporteurs captured data in 93 sessions; and 21 interviews were conducted with policy makers, implementers and practitioners from the public and private sector. The discussions referred to initiatives to better engage, train and support small private providers such as community pharmacists to broaden their role and regulate their prescribing to develop safer PHC services. Urgent policy level exploration was called for on public-private links to achieve comprehensive PHC and UHC and clear mechanisms and legal frameworks for strategic purchasing and regulation that consider the power of purchasing medicines and supplies across countries within geographic regions.

Untangling the web of anti-retroviral price reductions
Campaign for Essential Medicines: Médecins Sans Frontières, 17 July 2011

In this report, Médecins Sans Frontières (MSF) notes that middle-income countries with large numbers of people living with HIV, such as South Africa, will no longer benefit from preferential pricing when buying antiretroviral drugs from large pharmaceutical companies. According to the report, pharmaceutical firm ViiV Healthcare - owned by Pfizer and GlaxoSmithKline - no longer offers reduced prices to middle-income countries, even when their programmes are fully funded by the Global Fund to fight HIV, Tuberculosis and Malaria. Merck has also ceased to offer discounted prices to all lower middle- and upper middle-income countries, proposing instead to negotiate discounts on a case-by-case basis. Previously, Merck offered middle-income countries discounts that were still up to ten times the price of generic versions. MSF warns that drug company discount programmes are not a long-term solution, and urges governments to start using Trade-related Aspects of Intellectual Property Rights (TRIPS) measures to override patents.

Use of family planning and child health services in the private sector: an equity analysis of 12 DHS surveys
Chakraborty N; Sprockett A: International Journal for Equity in Health 17(50) 1-12, 2018

This paper seeks to explore improved access to healthcare while minimizing financial hardships or inequitable service delivery. The authors analyzed Demographic and Health Survey data from Bangladesh, Cambodia, DRC, Dominican Republic, Ghana, Haiti, Kenya, Liberia, Mali, Nigeria, Senegal and Zambia. They conducted weighted descriptive analyses on current users of modern family planning and the youngest household child under age 5 to understand and compare country-specific care seeking patterns in use of public or private facilities based on urban/rural residence and wealth quintile. The modern contraceptive prevalence rate ranged from 8.1% to 52.6% across countries, generally rising with increasing wealth within countries. For relatively wealthy women in all countries except Ghana, Liberia, Mali, Senegal and Zambia, the private sector was the dominant source. Source of family planning and type of method sought across facilities types differed widely across countries. Across all countries women were more likely to use the public sector for permanent and long-acting reversible contraceptive methods. Wealthier women demonstrated greater use of the private sector for family planning services than poorer women. Overall prevalence rates for diarrhoea and fever/ARI were similar, and generally not associated with wealth. Over 40% of children with cough or fever did not seek treatment in DRC, Haiti, Mali, and Senegal. Of all children who sought care for diarrhoea, more than half visited the public sector and just over 30% visited the private sector; with differences more pronounced in the lower wealth quintiles. Use of the private sector varies widely by reason for visit, country and wealth status. Given these differences, the authors suggest that country-specific examination of the role of the private sector furthers an understanding of its utility in expanding access to services across wealth quintiles and providing equitable care.

Use of over-the-counter malaria medicines in children and adults in three districts in Kenya: implications for private medicine retailer interventions
Abuya TO , Mutemi W, Karisa B, Ochola SA, Fegan G, Marsh V: Malaria Journal 6:57, 10 May 2007

Global malaria control strategies highlight the need to increase early uptake of effective antimalarials for childhood fevers in endemic settings, based on a presumptive diagnosis of malaria in this age group. Many control programmes identify private medicine sellers as important targets to promote effective early treatment, based on reported widespread inadequate childhood fever treatment practices involving the retail sector. Data on adult use of over-the-counter (OTC) medicines is limited. This study aimed to assess childhood and adult patterns of OTC medicine use to inform national medicine retailer programmes in Kenya and other similar settings.

User Fees and the impact on female children in rural zambia

The World Bank and International Monetary Fund favour healthcare user fees. User fees offer revenue and may decrease inappropriate care. However, user fees may deter needed care, especially in vulnerable populations. A cross-sectional analysis of healthcare utilization in a large Zambian hospital was conducted for children 3-6 years of age during a one-month observation period. Trends suggest female children may be less likely to present for care when user fees are imposed. This paper concludes that user fees appear to decrease differentially utilization of inpatient care for female children in rural Zambia.