Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. This paper reviews this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. The paper documents how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. The paper concludes by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.
Public-Private Mix
The policy of hospital autonomy is contingent on the idea that market forces can discipline hospitals and so improve their performance. This article contests that idea from two perspectives. There is scarce evidence to assess the validity of the market forces model or of either conflicting model. The operation of health sector reform is multi-faceted, time lagged and beset by inter-relationships between multiple variables. Research funding is usually small scale and haphazard. This paper seeks to draw together evidence across four countries (the UK, Zambia, Indonesia and Colombia) where evidence of hospital performance in the wake of reform is relatively robust, in an attempt to identify patterns of response to reform.
As a medical doctor, working in the field of maternal and neonatal health, Dr. Imtiaz Jehan sees public-private partnerships and the challenges related to access to health from a Southern perspective. She shares with us how she believes progress can be made for the public and the private sectors to working together.
Rich countries must deliver more money directly to poor nations to avert a growing health and sanitation crisis spreading across the southern hemisphere, according to Oxfam. The global charity said investment in health care, water, sanitation and education must be delivered by governments rather than the private sector. The report condemned the World Bank for forcing privatisation or inappropriate private sector projects on developing countries, and criticised Western governments for signing up to the so-called Washington agenda.
Classrooms with teachers, clinics with nurses, running taps and working toilets: these basic public services are key to ending global poverty, according to a new report from Oxfam and WaterAid. And, the agencies say, only governments are in a position to deliver them on the scale needed to transform the lives of millions living in poverty. The report, “In the Public Interest”, calls on developing country governments to devote a greater proportion of their budgets to building these vital services for their citizens - and for rich countries to support their plans with increased, long-term aid commitment.
What conditions lead to efficient PPP's? Should we reject PPP's all together? Should governments do more in terms of Research and Development (R&D)? There are no straightforward answers but the speakers at this symposium offered convincing and interesting solutions.
Whether via international bodies or by means of bilateral agreements, nationally or in PPPs, the public sector would continue to play the key role in terms of setting strategy and providing funds for access to health. With a view to ensuring that a larger percentage of public funds actually reach their intended beneficiaries, Dr Gwatkin of the World Bank urged NGOs to undertake monitoring of government and donor programmes in individual countries, stressing that together, "civil society and the public sector comprise a powerful force for change". He also mentioned that he would like to see efforts by international bodies, such as the World Health Organization (WHO) (www.who.int), to make their health and funding statistics more user-friendly as a means of improving grassroots use of them to increase global access to health.
The Development Studies Association (DSA) one-day conference titled The Private Sector, Poverty Reduction and International Development will take place on November 11th 2006 at the University of Reading. Health-related topics under one of three main conference themes "Business and Finance and Poverty Reduction" include "HIV and Aids: Technical and policy issues for the private sector" and "Government attitudes to the private sector as an engine of growth: policy issues and debate".
This audit report examines the Department for International Development (DFID)'s approach, policies and financing mechanisms in support of private sector development (PSD). Some of the issues covered in the report include understanding private development, enabling investment climates, financing private sector development: public private partnerships, and how the private sector is contributing to development and how donors can support this work.
Earlier this year, the US Government, through President Bush’s Emergency Plan for AIDS Relief, announced an unprecedented public-private partnership to promote scientific and technical discussions on solutions for pediatric HIV treatment, formulations and access. These partnerships seek to capitalise on the current strengths and resources of both innovator and generic pharmaceutical companies, the US Government, as well as multilateral organisations to facilitate the process.