On the eve of the landmark inquiry into the private healthcare industry in South Africa, the Netcare group is challenging the Competition Commission's use of professional services firm KPMG as its technical service provider for the investigation. The commission originally suggested the market inquiry into the private healthcare industry after concerns were expressed that certain factors in the sector prevent, distort or restrict competition. Health Minister Aaron Motsoaledi has been particularly vocal in expressing his disquiet about the matter. The market inquiry provision in the Competition Act became effective last year and paved the way for the introduction of an inquiry into private healthcare. The provision will allow the commission to initiate an inquiry if it has reason to believe that any feature of a market distorts or restricts competition. Unlike the 2006 inquiry into banking costs, which required the banks’ voluntary co-operation, the commission now has wide-ranging powers to summon people to testify or to provide documents. It will be able to call for any information it may deem relevant and may initiate a complaint against a firm based on what it gathers during the inquiry. The final terms of reference for the competition authorities’ private healthcare inquiry were published at the end of last year. They included looking at possible cost drivers such as pharmaceutical manufacturers, medical equipment and the inter-relationship between the public and private healthcare systems.
Public-Private Mix
The focus in Tanzania has mainly been on communicable diseases, in particular HIV/AIDS, TB and Malaria. Childhood illnesses, including diarrhoea and upper respiratory tract infections, have also received a great deal of attention. More recently, efforts have been directed towards neglected tropical diseases. However, the burden of communicable diseases is still high, so the increase in non-communicable diseases (NCD) creates a double burden to both individuals and the health system in general.The prevention of NCDs at the workplace is argued by the authors to require a multisectoral approach. The occupational health law (Occupational Health and Safety Act of 2003) in Tanzania stipulates that each employee undergo
a medical examination at enrolment. This could be expanded to include periodic examinations. Employers should push insurance companies to cover such examinations. Other options that could be useful are noted as the HIV committees already in place at workplaces. These structures could be used to also co-ordinate NCD prevention activities at workplaces.Another option could be to promote physical activity at the workplace through sports competitions, designated sports days or sports bonanzas. More advocacy is needed to raise the profile of the burden of NCDs and to bring them to the attention of policy-makers.
The United States Agency for International Development (USAID)/Tanzania
commissioned the SHOPS project and the IFC-World Bank Health in Africa
Initiative to conduct a private sector assessment of mainland Tanzania,
in response to a request from the Public-Private Partnership Technical
Working Group (PPP-TWG) in Tanzania. The assessment is intended
to assist the Ministry of Health and Social Welfare to develop a
prioritized agenda for more effectively engaging the private health sector
and building public-private partnerships focused on the country’s
key health challenges: HIV/AIDS, reproductive and child health, malaria,
and tuberculosis. It notes that although the private health sector in Tanzania is smaller than in some east African countries, it is sizable, diverse, and actively engaged throughout the health system
This report reviews the progress made in the health sector in Africa over the last 50 years, in terms of health outcomes, and particularly in the
utilization of, and access to, healthcare services. The current challenges faced by the health sector are assessed, and the discussion lays the groundwork for projections regarding the future of healthcare in Africa over the next 50 years. The authors outline that the private sector has been playing an increasingly important role in health financing in Africa, and that in some countries, such as Angola and Mali, all private expenditure is direct payments from households. Lack of continuity in policy, lack of resources, poor management of available resources, and poor policy implementation are identified as major impediments to improving the health systems. The private sector is playing a major role in the delivery of health services to citizens, yet dialogue and the sharing of information between the private and public sector is rare. They indicate that in addition to scaling up public spending, there needs to be a drive to ensure better value for money throughout the health system. They also suggest that The health sector will become a labor-intensive industry that can provide an estimated 2–3 million skilled jobs for young Africans and contribute to economic growth on the continent. As the pharmaceutical, medical technologies, and ICT segments develop, there will be more opportunities in research and development, manufacturing, sales and distribution. Within this industry, other opportunities will be driven by the hospital, health insurance, and medical education segments.
Occupational diseases are posing an ever increasing challenge to workers’ compensation systems. Out of the 2.34 million annual work-related deaths reported by the International Labour Organization (ILO) , the vast majority – approximately 2.02 million – are due to work-related diseases. As a consequence, occupational safety and health policy is shifting from an injury and accident centered approach to one that increasingly is occupational disease focused. To effectively address occupational diseases (ODs), many social security organizations responsible for insuring and compensating these risks are adopting a more proactive and preventive approach. Their leitmotif can best be described as ‘prevention is better than compensation’. Adopting such an approach also forms part of a broader understanding of the role that social security can play in promoting and shaping a national prevention culture.
This paper describes a reproductive health voucher programme that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the programme to include public sector facilities. Researchers conducted interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher programme in south-western Uganda. Barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the programme by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in south-western Uganda is constrained by both facility and individual level factors that can be addressed by inclusion of the public facilities in the programme. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher programme with other services is likely to address some of the barriers. Accrediting public facilities has the potential to increase voucher programme coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening links between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilisation of resources to support the sustainability of the programmes. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher programme.
Public-private collaborations are increasingly being utilized to universalize health care. In Malawi, the Ministry of Health contracts selected health facilities owned by the main faith-based provider, the Christian Health Association of Malawi (CHAM), to deliver care at no fee to the most vulnerable and underserved populations in the country through Service Level Agreements (SLAs). This study examined the features of SLAs and their effectiveness in expanding universal coverage. The study involved a policy analysis focusing on key stakeholders around SLAs as well as a case study approach to analyse how design and implementation of SLAs affect efficiency, equity and sustainability of services delivered by SLAs. It used qualitative and quantitative research methods in five CHAM health facilities, with national and district level decision makers and providers and clients associated with the health facilities. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others. There was strong consensus and shared interest between the government and CHAM regarding SLAs. The free services provided by SLAs had an impact on the impoverished locals that used the facilities. However, lack of supporting systems, inadequate infrastructure and shortage of health care providers affected SLA performance.
Tobacco products use is the leading cause of chronic diseases morbidity and mortality. This study explores an exposure to tobacco advertisements factors and knowledge, an association with snuff/pipe usage and cigarette smoking among rural children aged between 11 to 18 years in Ellisras, South Africa. A total of 1,654 subjects (854 boys and 800 girls) completed the questionnaire. Results showed that a significant number of boys (11.7%) compared to girls (8.8%) received free cigarettes from the members of the community. Bill boards were successful in advertising tobacco products among the Ellisras rural boys (17% boys and 12.8% for girls). The authors found significant association between cigarette smoking and advertisements of tobacco products on the TV screens, videos or movies. Though tobacco products legislation exists in South Africa, the authors argue that efforts should be taken by the health professionals to emphasise the danger of using tobacco products even among the illiterate. Teachers and parents should refrain from advertising tobacco products at schools and at homes.
The public health approach to regulatory intervention is normally very inclusive, bringing all stakeholders to the table to present their perspectives, to argue about the impacts of the interventions on their organisations, and to find compromises that work for the greater good of all those involved. However, the author of this paper argues against including the tobacco industry as a stakeholder in public health decisions, based on the reputation of the industry in obfuscating the truth about the harm of tobacco use, dividing the public health community over harm reduction approaches, and befuddling critically important regulatory processes. The profits from selling cigarettes and alternative tobacco products are simply too great for the tobacco industry to be a genuine stakeholder in public health, the author notes. Thus, the public health community needs to do what it does best: to rally popular support for strong, science-based approaches to prevention of tobacco use, to expose the truths about the harms of tobacco use to current users, and to support government agencies in carrying out their legislatively mandated duties to protect public health. The author highlights the irreconcilable conflict between the public health community and the global tobacco industry.
This pilot study on the quality of anti-malarial tablets for sale in retail outlets during the major fishing season was conducted in a malarious fishing village located along the coast of Tema in southern Ghana. Researchers randomly sampled blisterpacks of anti-malarial tablets and assessed them according to the International Pharmacopoeia and Global Pharma Health Fund Minilab protocols. When testing for genuine artesunate per tablet, 10% of one manufacturer’s tablets and 50% of the other’s passed the titrimetric test. While 100% of the first manufacturer’s tablets passed for genuine amodiaquine, 17% of a similar package by the second manufacturer failed spectrophotometric testing. The inadequate amounts of artesunate and amodiaquine detected in the tablets suggest that both pharmaceutical companies may not be following recommended drug formulation procedures, or the active pharmaceutical ingredients might have been degraded by improper storage conditions. The authors conclude that the drugs being sold at Kpone-on-Sea, Ghana may likely be classified as substandard drugs and are not suitable for malaria treatment.