On paper, South Africa has some of the world's best HIV workplace programmes, but on the ground they just aren't adding up. Diamond mining giant De Beers has long boasted that 86% of employees at its six mines have been tested by its voluntary counselling and testing (VCT) programme. The company estimates that 10% of its workforce is HIV-positive, but markedly fewer access the antiretroviral (ARV) treatment programme. Workers' fears about confidentiality, a preference for traditional medicine and poor patient-doctor communication were all cited as challenges to raising treatment numbers, according to an ongoing study by De Beers. The research was presented by the company and the University of KwaZulu-Natal (UKZN) on 6 November at the Private Sector Conference on HIV and AIDS, hosted by the South African Business Coalition on HIV and AIDS (SABCOHA).
In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. This study described the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. The authors collected data from mothers with infants at baseline and endline using a structured questionnaire among private and public health facilities. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities. Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.
Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. This paper reviews this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. The paper documents how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. The paper concludes by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.
Millions of dollars given by major pharmaceutical companies to the World Health Organisation (WHO) raise questions of compliance with the organisation’s guidelines on interactions with commercial enterprises. Currently, WHO’s relations with commercial enterprises are guided by the “Guidelines on interaction with commercial enterprises to achieve health outcomes” . The 107th Session of the Executive Board in 2001 “noted” the Guidelines that cover cash donations, contributions in kind, seconded personnel, collaboration for product development, collaboration for meetings etc. Compliance with the Guidelines has essentially been left to the Secretariat. According to paragraph 11 of the Guidelines, “Commercial enterprises working with WHO will be expected to conform to WHO public health policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others”. It is notable that the draft Framework of Engagement with Non-State Actors (FENSA) currently being finalised by WHO Member States does not contain a provision that requires a commercial enterprise to conform to WHO’s polices, norms and standard. In the absence of such a clear provision FENSA could legitimise engagement with the private sector, which does not follow WHO’s policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others. WHO Member States at the resumed session of the Open Ended Intergovernmental Meeting (OEIGM) on FENSA is expected to look at the regulation of WHO’s engagement with the private sector. The experience with the implementation of the Guidelines on interaction with commercial enterprises to achieve health outcomes would be useful for the consideration of Member States. In 2014, WHO received USD 6,158,153 from GlaxoSmithKline (GSK). It received USD 5,785,000 and USD 8,266,284 in 2012 and 2013 respectively from GSK. GSK Biologics paid USD 17,000. Novartis AG donated USD 5,300,000 in 2014 and USD 4,500,000 in 2013. Hoffmann-La Roche donated USD 6,158,153 in 2014 and USD 4,806,492 in 2013. The purposes of those donations were not disclosed.
To investigate medicine retailer knowledge about anti-malarials and their dispensing practices, a survey was conducted of all retail drug outlets that sell anti-malarial medications and serve residents of the Webuye Health and Demographic Surveillance Site in the Bungoma East District of western Kenya. Results indicated that most (65%) of the medicine retailers surveyed were able to identify artemether-lumefantrine (AL) as first-line anti-malarial therapy for uncomplicated malaria recommended by the Kenyan Ministry of Health. Retailers who correctly identified this treatment were also more likely to recommend AL to adult and paediatric customers. Retailer training and education were found to be correlated with anti-malarial drug knowledge, which in turn was correlated with dispensing practices. While the Kenya Ministry of Health (MoH) guidelines were found to influence retailer drug stocking and dispensing behaviours, the authors argue that knowing the MoH recommended anti-malarial medication does not always ensure it is recommended or dispensed to customers. Retailer training and education are both areas that could be improved. Considering the influence that patient demand has on retailer behaviour, future interventions focusing on community education may positively influence appropriate dispensing of anti-malarials.
This paper, produced by Partnerships for Health Sector Reform/plus, discusses the effectiveness of contracting out primary care services as a tool for health reform. The paper provides a short history of contracting out, a discussion of its advantages and disadvantages, and a review of the available literature on the impact of contracting out. The authors note that there is a lack of evaluation research on the success of contracting-out, and a lack of conclusive evidence that contracting out improves overall health sector efficiency.
Some experts argue that private healthcare providers are preferred by service-users, or are more efficient or accessible than the public sector, and hence that government should contract out services to them. However, factors such as institutional capacity to write and manage contracts and market competition affect how contracts with private providers function. This has major implications for contracting in low and middle-income countries (LMICs). Research by the London School of Hygiene and Tropical Medicine explored the operation of a long-standing contract with private GPs in South Africa.
Ownership of healthcare providers has been considered as one factor that might influence their health and healthcare related performance. The authors provide an overview of what is known about the effects on economic, administrative and health related outcomes of different types of ownership of healthcare providers -namely public, private non-for-profit (PNFP) and private for-profit (PFP)- based on the findings of systematic reviews (SR). Of the 5918 references reviewed, fifteen SR were included, but six of them were rated as having major limitations, so they weren't incorporated in the analyses. According to the nine analysed SR, ownership does seem to have an effect on health and healthcare related outcomes. In the comparison of PFP and PNFP providers, significant differences in terms of mortality of patients and payments to facilities have been found, both being higher in PFP facilities. In terms of quality and economic indicators such as efficiency, there are no conclusive results. When comparing PNFP and public providers, as well as for PFP and public providers, no clear differences were found. PFP providers seem to have worst results than their PNFP counterparts, but there are still important evidence gaps in the literature that needs to be covered, including the comparison between public and both PFP and PNFP providers. More research is needed in low and middle income countries to understand the impact on and development of healthcare delivery systems.
The Department of Health’s recently released Draft Charter of the Public and Private Health Sectors (CPPHS) aims to address the legacy of apartheid restraint on access to health care for all South Africans. It commits public and private sectors to create “a health care system that is coherent, cost-effective and quality driven … for the benefit of the entire population” and to work together “to improve the scope, accessibility and quality of care at all levels”. For these laudable goals we give our wholehearted support. The CPPHS specifies four “key areas” of transformation: access to health services, equity in health services, quality of health services, and Black Economic Empowerment (BEE). The first three – access to, equity in, and quality of health care services, are essential (though not enough) to meet the goal of health for all South Africans. The fourth area is problematic.
There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. This article from The Lancet analyses the outcomes of pharmaceutical research and development over the past 25 years, and reviews current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. It found that of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. The article concludes that private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.