One characteristic of discussions about strategies for the provision of services to poor people has been the persistence of ideological debates about the relative roles of public and private sectors. These debates are strongly influenced by the experiences of the advanced market economies and often do not reflect the reality of countries where most poor people live. This paper’s aim is to contribute to the development of common understandings of this reality and to the formulation of practical strategies for meeting the needs of the poor.
Public-Private Mix
Private provision in its institutional context: Lessons from health
Public health in the new era: improving health through collective action
The world is entering a new era in which, paradoxically, improvements in some health indicators and major reversals in other indicators are occurring simultaneously. Rapid changes in an already complex global health situation are taking place in a context in which the global public-health workforce is unprepared to confront these challenges. This lack of preparation is partly because the challenges are large and complex, the public-health workforce and infrastructure have been neglected, and training programmes are inadequate.
Health care commercialisation and inequality
Health care systems can embed and reinforce inequality within societies or, conversely, can be a platform for the public combatting of poverty and inequality. The objective of the paper is to argue that the process of health care commercialisation - a marked trend across the world since the 1970s for reasons that are explored - and the associated process of globalisation of both health care and health policy, changes the terms of these interactions. Commercialisation, sometimes discreditably sold as a policy for increasing equity, has generally acted to embed inequality in new forms.
Public-Private partnerships: Monitoring the effects on healthcare
Aids, malaria, tuberculosis and other infectious diseases have reached enormous proportions in many developing countries. Efforts to control and eradicate these diseases are extremely complex. Increasingly, global public-private initiatives are set up to address these issues. The question is whether global public-private initiatives are the most appropriate approach, and whether such partnerships can really serve the direct interests of the people. Public-private cooperation is a relatively new phenomenon, but it has already gained considerable ground.
Forced privatisation through Aid
This report from War on Want looks at how conditionalities and pressures from aid agencies and development banks force developing countries to adopt privatisation policies in public services. It focuses specifically on the sectors of water, electricity, and healthcare, in six countries: Colombia; El Salvador; Indonesia; Mozambique; South Africa; and Sri Lanka. It examines the impact of the requirements and policies of the International Monetary Fund (IMF), World Bank (WB), and other agencies including regional development banks, the European Commission (EC) and donor countries. It includes a specific examination of the various ways in which the UK’s Department for International Development (DFID) supports privatisation in these services.
The Impact of HIV/AIDS on the Health Sector
This report emanates from the results of a study that examined the impact of HIV/AIDS on the public and private health facilities in South Africa, and outlines the subsystems that are affected. Both public and private sector health facilities have reported an increase in the number of patients seeking clinical care for people living with HIV/AIDS, leading to increased admissions to medical and paediatric wards and increased workloads. This study addresses these issues and makes recommendations for managing the HIV/AIDS case load.
Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?
The private sector exerts a significant and critical influence on child health outcomes in developing countries. This article in the Bulletin of the World Health Organization reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector’s influence, extending its analysis to include nongovernmental organisations (NGOs), pharmacies, drug sellers, private suppliers, and food producers. The article analyses some of the most promising strategies for improving child health, and suggests a number of possible constraints to emulating these approaches more widely.
Policy options to improve the economic access of low-income households to state-provided health care
The purpose of this paper is to review a set of key policy options that aim to improve access to state-provided health care for poor households in low and middle income countries. It has been developed as part of a broader initiative that seeks to improve understanding of how to tackle the cost-related burdens influencing low income households’ access and use of health care.
Developing countries and the private sector: What chances for improving child health?
The private sector exerts a significant and critical influence on child health outcomes in developing countries. This article in the Bulletin of the World Health Organisation reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector's influence, extending its analysis to include nongovernmental organisations (NGOs), pharmacies, drug sellers, private suppliers, and food producers. The article analyses some of the most promising strategies for improving child health, and suggests a number of possible constraints to emulating these approaches more widely. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of the presence and potential of the private sector, including actors such as professional associations, producer organisations, community groups, and patients' organisations.
Impact of Public-Private Partnerships: addressing access to pharmaceuticals
The UK Department for International Development (DFID) funded the Initiative on Public Private Partnerships for Health (IPPPH) to conduct a pilot study in Uganda to assess the health and health systems impact of public private partnerships (PPPs) for improving access to pharmaceuticals in relation to leprosy, lymphatic filariasis, onchocerciasis, sleeping sickness, and HIV/AIDS. The specific remit was to examine issues of ownership, integration, coordination, implementation and impact, with a particular focus on the unique strengths and problems of these access PPPs as distinct from other comparable programmes where drugs are competitively procured.