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)
Public-Private Mix
Contracting for health service delivery in developing countries
The Lancet, Volume 366, Number 9486, 20 August 2005
Public- public partnerships in health and essential services
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.
The case for abolition of user fees for primary health services
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.
Mapping global health partnerships: what they are, what they do and where they operate
Department for International Development Health Systems Resource Centre (DFID HSRC), 2004
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.
Medicines and vaccines for the world's poorest: Is there any prospect for public-private cooperation?
Globalization and Health 2005
"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."
Social contracts and private health sector performance
Health Systems Resource Centre 2004
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.
Abolishing user fees for child health
This Save the Children brief shows that abolishing user fees and covering the relatively small cost of abolition would immediately save nearly a quarter of a million children under five. It argues that user fees for basic healthcare, paid in the poorest countries around the world, are in reality "killer bills". Children and their families either don’t go to the health clinic when they are sick or when they do, and have to pay, they are forced further into poverty and sometimes have to go without food. Some families remove children from school in order to pay for health care.
User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity
International Journal for Equity in Health 2005
"...user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible."
Are We In It for the Long Haul?
Many AIDS activists have been enraged by the export abroad of conservative American morality on sex, drugs and prostitution through HIV/AIDS programs funded by the U.S. government. Particularly galling is that it replaces accepted, evidence-based public health policies with ideology. But if there is one thing this U.S. government hates more than fags, junkies, hookers, condoms and clean needles, it's socialized medicine. Quietly, the President's Emergency Plan for AIDS Relief (PEPFAR) and other bilateral initiatives are exporting the HMO-ization of AIDS in Africa and elsewhere on the planet, in which a network of private institutions are being built up to provide antiretroviral therapy (ART) to the millions who need it.
Private sector, human resources and health franchising in Africa
This article, from the Bulletin of the World Health Organization, outlines the available evidence on which sections of society benefit from publicly provided care and which sections use private health care. The authors assess use of public and private health services, as well as the use of franchise networks which supplement government programmes in the delivery of public health services. Examples from health franchises in Africa and Asia are provided to demonstrate the potential for franchise systems to increase services available to the public.