What role can non-state providers play in scaling up healthcare delivery to meet the Millennium Development Goals? A policy briefing paper for the UK Department for International Development addresses this question using case studies in Bangladesh, India, Malawi, Nigeria, Pakistan and South Africa. Non-state providers (NSPs) of healthcare, whether philanthropic or commercial, exist outside the public sector. Research by the London School of Hygiene and Tropical Medicine found evidence that NSPs provide the majority of primary contacts with the health system in all six countries, except possibly South Africa. This is true for poor and rich alike. Poorer households are likely to spend a higher proportion of their income on private sector care than the rich, while the rich tend to access higher quality services. For successful and sustainable collaboration between governments and NSPs, the author recommends that donors should: encourage trust between state and non-state sectors; enable smaller providers, which may have greatest coverage of the poor, to come together to interact with governments and donors; and invest resources and expertise to develop human, transport and technical monitoring capacity; support policy formulation, management and research.
Public-Private Mix
Medical aid coverage is lowest among black South Africans, with only 7,4% of individuals covered, and highest in the white population, with a 66,5% coverage, Statistics SA said on Thursday. In the general population, 79,7% of those who were ill or injured consulted a health worker, according to the General Household Survey for 2007. The survey has been conducted annually since 2002. More individuals who used public-sector healthcare facilities were satisfied with the service they received in 2007 (87,6%) than in 2006 (84,2%) and in 2002 (81,6%). In the private sector, satisfaction levels increased slightly from 95,35% to 96,5% between 2002 and 2007.
Health minister Dr Manto Tshabalala-Msimang speaking at the Board of Healthcare Funders' annual conference stated that the private health sector has seen an uncontrolled cost spiral since the 1980s and that it has become increasingly unaffordable for South Africans to belong to medical schemes. She identified the most important cost drivers as private hospitals, specialists and administrative costs.
Global progress towards reducing undernutrition has been made through enlightened public policies, targeted development assistance, private sector actions and commitments from civil society. Yet every year, the deaths of more than 3.5 million children under the age of 5 can be attributed to undernutrition. This article argues that strong public-private sector partnerships can help to reduce undernutrition.
Public-private partnership organisations (PPPOs) — which focus on African neglected diseases — have failed to change the imperialist research paradigm or involve African researchers on an equal basis. Every major PPPO is headquartered in Europe or the United States: "Not one 'global' PPPO is led by a person who is a developing-country national, and not one resides within one of the developing countries severely affected by neglected infectious diseases." Senior staff and boards of directors show similar trends. And although disbursements to developing countries have been impressive, "Africans are only able to access resources that (predominantly) non-Africans decide are appropriate." In addition, African states have not created career structures for clinicians and scientists, so there is relatively little capacity to build PPPOs in Africa, a situation which must be changed by African states investing in health-related PPPOs.
The Free State Province in South Africa, with the provincial capital at Bloemfontein, is home to 2.8 million people. But only 13 per cent have private health insurance with most relying on government-operated facilities for their healthcare needs. There are two academic public hospitals in Bloemfontein: Pelonomi and Universitas. In 1997, the government was unable to raise the estimated R825 million needed towards the major renovation of Pelonomi hospital and a partial upgrade of Universitas Hospital. The solution emerged through a public-private partnership between the Philippine national government and the private sector. The PPP was structured for the hospital redevelopment project between three partners.
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, mobilising 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.
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 institutionalised. 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, the acceptance by the private players to take on some public responsibilities using their own resources etc. The challenges include the slow formalisation of the partnership, scepticism 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.
Using market mechanisms in the provision of health services and seeing health care as a private good are approaches that have featured prominently in health sector reforms across the world. The UNRISD research on global and local experiences of health care commercialization challenges this framework. It calls for reclaiming public policies that promote the purposes that health systems are set up to serve: population health and the provision of care for all according to need.
This report - presented at the African Civil Society Meeting of the Intergovernmental Working Group on Intellectual Property, Innovation and Health in Nairobi, Kenya, 28-29 August 2007 - found that there are over 30 registered local manufacturers in Kenya and at least two others under construction (foreign investments). It also analysed seven private-private partnership (PPP) projects (six in Kenya & one in Tanzania). The first PPP project passed its first inspection in August 2007 and the others are due for inspection by the end of the project. The main outcome of the report was that intellectual property rights do not stimulate research and development for medicines for diseases prevalent in developing countries simply because the market in poor countries is considered to be too small or too uncertain.