The Department of Health’s recently released Draft Charter of the Public and Private Health Sectors (CPPHS) aims to address the legacy of apartheid restraint on access to health care for all South Africans. It commits public and private sectors to create “a health care system that is coherent, cost-effective and quality driven … for the benefit of the entire population” and to work together “to improve the scope, accessibility and quality of care at all levels”. For these laudable goals we give our wholehearted support. The CPPHS specifies four “key areas” of transformation: access to health services, equity in health services, quality of health services, and Black Economic Empowerment (BEE). The first three – access to, equity in, and quality of health care services, are essential (though not enough) to meet the goal of health for all South Africans. The fourth area is problematic.
Public-Private Mix
"The privatization of state-owned enterprises has been among the most controversial of market reforms. This new edited volume brings together a comprehensive set of country studies on the effects of privatization on people-and answers the overarching question: who are the winners and losers of the wave of privatizations that swept across the developing world in the 1980s and 1990s? The studies are sophisticated and careful, and address the big questions: Are the poorest households paying more for water, power, and other basic services? Did those who lost jobs suffer permanent declines in income? Were state assets sold at prices that were too low, and who benefited from the resulting windfalls? Was the process, in laypersons' terms, fair?"
The United Nations-sponsored Financing for Development conference in Monterrey in 2002 concluded that greater cooperation between public and private actors will be required to overcome the inadequacies of development finance and achieve internationally agreed development goals. As a follow-up to this conference, the World Economic Forum's Global Institute for Partnership and Governance in cooperation with the UN Department of Economic and Social Affairs (UNDESA) and the Swiss Agency for Development and Cooperation (SDC) convened a series of nine separate practitioner-driven, multistakeholder roundtable discussions during the period 2004-05. These two day expert roundtables, supplemented by individual meetings and other research, sought to identify where the greatest opportunities and obstacles lay.
User fees are once again a topic of hot policy debate in Africa. They were introduced relatively recently in many countries, but the current call is for their removal, particularly at primary care level. As analysts who have consistently argued against user fees, we broadly support this call. However, we recognise that this action cannot be introduced overnight and, if weakly implemented, may exacerbate the problems facing African health systems.
To achieve the health-related Millennium Development Goals, the delivery of health services will need to improve. Contracting with non-state entities, including non-governmental organisations (NGOs), has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here, in this Lancet article. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. (requires registration)
The paper first discusses the concept of PuPs and proposes a two-dimensional typology for categorising the various forms of partnership so described. The range of types of PuPs is then discussed with reference to specific sectors (water and healthcare), international associations, and six case studies. The final section draws general conclusions and makes recommendations for future research into the subject.
This issues paper, published by the DFID Health Systems Resource Centre (HSRC), was one of several feeding into Department for International Development (DFID) policy discussions in mid-2004. It examines evidence on the impacts of user fees for primary health care, evaluates the cost implications of abolishing user fees, and considers what line donors should take on the issue. The paper argues that the case for abolishing user fees is strong: they raise little money, rarely meet their stated efficiency and equity goals.
This paper, from the DFID Health Resource Centre (HRC) aims to provide a common understanding of what Global Health Partnerships (GHPs) are, how they might be classified and how they operate. The document reviews definitions of GHPs, outlines a classification system used in the Resource Centre’s broader GHP project, describes the key findings, and provides a detailed list of GHPs with their missions, aims and/or objectives. It also details a global GHP mapping exercise, which examined prevalence or cases of specific diseases of interest to target GHPs, poverty, and political and health systems characteristics.
"This paper reviews the current status of the global pharmaceutical industry and its research and development focus in the context of the health care needs of the developing world. It will consider the attempts to improve access to critical drugs and vaccines, and increase the research effort directed at key public health priorities in the developing world. In particular, it will consider prospects for public-private collaboration. The challenges and opportunities in such public-private partnerships will be discussed briefly along with a look at factors that may be key to success. Much of the focus is on HIV/AIDS where the debate on the optimal balance between intellectual property rights (IPR) and human rights to life and health has been very public and emotive."
Debates about the roles of public and private healthcare sectors reflect the experiences of advanced market economies. But in many developing countries, the boundaries between public and private sectors are blurred. Strategies towards private providers must address the context of local relationships between the state, market and civil society. A paper from the UK Department for International Development's Health Systems Resource Centre aims to help the development of a common understanding of the reality of countries where most poor people live and of practical strategies for meeting their needs.