Public-Private Mix

This paper explodes Rand Water’s rhetoric about itself as a promoter of “public” services.The paper discusses the context of changes in public sector management and in the water sector. Rand Water (RW), the biggest public water utility in Africa entering the market on the continent engage in other activities that are beyond its core function of providing bulk potable water to local government in the industrial heartland of South Africa. This report examines the expansion of RW into non-core activities in the period 1994-2006, the rationales offered by RW for that expansion, and deliberates on this expansion in the context of similar activities by other public sector operations both in South Africa and in other countries.

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.

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.

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.