Public-Private Mix

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.

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.

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 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.