At the inception of Uganda's second 5-year Health Sector Strategic Plan (HSSP II), this paper traces the history of the public - private partnership for health (PPPH) in Uganda, giving its justification and mandate. It also gives its current state of the art, outlining the successes scored, the challenges still faced in its implementation and current efforts being made to make it comprehensively institutionalized. The successes include the bilateral acceptance of the principle and need for partnership by both the public and private partners, the overt gestures by the public partner through direct funding of the private providers, the ceding of some responsibilities to private players and the acceptance by the private players to take on some public responsibilities using their own resources. The challenges include the slow formalization of the partnership, skepticism about autonomy, the stagnation of government funding, the poor understanding of the partnership at sub-national levels and poor sharing of information, among others. These challenges are now further compounded by the recent introduction of new policy reforms like fiscal decentralisation to the same local officials who do not fully appreciate the partnership and are therefore not likely to support it. The paper concludes with some useful suggestions on how these challenges may be tackled.
Public-Private Mix
The Health Sector Strategic Plan (HSSP) aims to ensure access to basic health care by the Ugandan population through the delivery of the National Minimum Health Care Package (NMHCP). This requires availability of well-trained health professionals. This study demonstrates that the Private-Not-For-Profit (PNFP) Health Training Institutions - the majority in Uganda - have remained grossly under-funded, which poses a threat to achievement of the HSSP. They are faced with decreasing income from fees, dwindling donor support and over-dependence on government grants which are both uncertain and erratic. Consequently, vital activities for students' training such as field trips, teaching and reading materials are left unsatisfied as a copying mechanism, but not without negative implications for quality. It is recommended that government increases and guarantees its support to these Health Training Institutions as a way of maintaining quality of health worker training. At the same time, the training institutions need to diversify their funding options to include designing short tailor-made courses, mobilizing alumni contributions, research and consultancies, self-help projects like farming, canteens and stationeries as well as fund-raising activities as a way of bridging their funding gap. This should be coupled with more efficiency mechanisms and prudent management to avoid wastage of the already scarce financial resources.
In responding to the goal of rapidly increasing access to antiretroviral treatment (ART), the government of Botswana undertook a major review of its health systems options to increase access to human resources, one of the major bottlenecks preventing people from receiving treatment. In mid-2004, a team of government and World Health Organization (WHO) staff reviewed the situation and identified a number of public sector scale up options. The team also reviewed the capacity of private practitioners to participate in the provision of ART. Subsequently, the government created a mechanism to include private practitioners in rolling out ART. At the end of 2006, more than 4500 patients had been transferred to the private sector for routine follow up. It is estimated that the cooperation reduced the immediate need for recruiting up to 40 medically qualified staff into the public sector over the coming years, depending on the development of the national standard for the number and duration of patient visits to a doctor per year.
The Government of Lesotho, with assistance from the World Bank Group and other development partners, is undertaking a long-term health sector reform program. Replacing the collapsing and only national referral hospital is a major challenge facing the country. To maximize the use of the limited available resources, the Government decided to adopt a PPP model to finance and manage a new replacement hospital. The intention is that partners from the private sector will build, equip and subsequently operate the new hospital before it is eventually turned over to the Government. This initiative, the first of its kind in IDA Sub-Saharan Africa in the public health sector, will have a profound impact on Lesotho’s health sector and its reform program.
Private hospitals are currently not participating in any processes which require the disclosure of the cost to themselves of providing health care services. For this reason, BHF and its members believe that it is necessary and appropriate to call for greater transparency in the area of hospital costs and the setting of hospital fees and prices of medical materials used by hospitals.
In a recent meeting with private health care providers and insurers, Health Mininster Dr Tshabalala-Msimang criticised private providers for placing a large burden on health consumers, with out-of-pocket expenditures pushing patients further and further into poverty. She emphasised that a national health system cares for all and urged private providers to work with government to secure a decent national health system.
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 Global Fund to fight AIDS, Tuberculosis and Malaria was founded on the principle of public-private partnership. It was created with the belief that without the combined efforts of government, civil society and the private sector, the world could not hope to halt the spread of the world's infectious disease. This speech examines some of the contributions made by the private sector in this regard.
The World Health Organization made a unique proposition: what if big donors pooled resources to take out private insurance to pay for vaccines in the case of a bird flu pandemic? WHO Director-General Dr Margaret Chan said WHO had been given more preparation time than it could have hoped for ahead of an influenza pandemic. WHO is using that time to study various financing options to allow low income countries to access vaccines and prevent a pandemic catastrophe that could kill millions of people.
Advocacy on engaging the private sector in tuberculosis (TB) control is mounting. In the newly launched six-point Stop TB Strategy, WHO makes an urgent appeal to engage private care providers. Even more recently, this was supplanted by a guide on how to involve all care providers in TB control through different Public-Private Mix (PPM) approaches. At the same time the body of evidence on the effectiveness of such approaches, although growing, remains rather weak.