This paper seeks to explore improved access to healthcare while minimizing financial hardships or inequitable service delivery. The authors analyzed Demographic and Health Survey data from Bangladesh, Cambodia, DRC, Dominican Republic, Ghana, Haiti, Kenya, Liberia, Mali, Nigeria, Senegal and Zambia. They conducted weighted descriptive analyses on current users of modern family planning and the youngest household child under age 5 to understand and compare country-specific care seeking patterns in use of public or private facilities based on urban/rural residence and wealth quintile. The modern contraceptive prevalence rate ranged from 8.1% to 52.6% across countries, generally rising with increasing wealth within countries. For relatively wealthy women in all countries except Ghana, Liberia, Mali, Senegal and Zambia, the private sector was the dominant source. Source of family planning and type of method sought across facilities types differed widely across countries. Across all countries women were more likely to use the public sector for permanent and long-acting reversible contraceptive methods. Wealthier women demonstrated greater use of the private sector for family planning services than poorer women. Overall prevalence rates for diarrhoea and fever/ARI were similar, and generally not associated with wealth. Over 40% of children with cough or fever did not seek treatment in DRC, Haiti, Mali, and Senegal. Of all children who sought care for diarrhoea, more than half visited the public sector and just over 30% visited the private sector; with differences more pronounced in the lower wealth quintiles. Use of the private sector varies widely by reason for visit, country and wealth status. Given these differences, the authors suggest that country-specific examination of the role of the private sector furthers an understanding of its utility in expanding access to services across wealth quintiles and providing equitable care.
Public-Private Mix
A current wave of pharmaceutical industry investment in sub-Saharan Africa is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. The authors present evidence from interviews in 2013–15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. The authors identify key policies that can ensure that local health systems benefit from the investments. They argue for a ‘local health’ policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health–industry linkages and strengthening of both sectors. This local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with ‘global health’ frameworks but poses a challenge to some of its underlying assumptions.
Kenya’s post election violence has led to the founding of RescueBnB – a community with the mission to map the locations of those in need of shelter and connect them with volunteer hosts. With a core team of volunteers, a web developer set up the pro bono website, and Kenyans have spread the word on social media. Within 48 hours of this, they had assembled more than 100 volunteers across the country and had arranged multiple home stays with vetted hosts. To date, RescueBnB has supported 800 people across Kenya, and team members say that’s just the start. RescueBnB has since begun crowdfunding to provide care packages as well as to cover medical expenses. Its partnerships with community organizations and religious groups helped it reach more individuals, and companies stepped in to assist. A supermarket chain welcomed shoppers to drop off donations, and a boda boda (motorbike) delivery company volunteered to get the donations into the hands of people who needed them.
Low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialisation strategies. The authors present evidence from interviews in 2013–15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. Key policies are identified that can ensure that local health systems benefit from the investments. The authors argue for a ‘local health’ policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health–industry linkages and strengthening of both sectors. This local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with ‘global health’ frameworks but poses a challenge to some of its underlying assumptions.
The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, the evidence base for diet-related interventions based on fiscal policies are described and the key questions that need to be asked by both health and economic policy-makers are considered. From the health sector’s perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. The authors highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions.
Each year, hundreds of billions of dollars are spent on research and development (R&D) into new or improved health products and processes, ranging from medicines to vaccines to diagnostics. But the way these funds are distributed and spent is often poorly aligned with global public health needs. in 2017, the World Health Organization launched an initiative to gather information and provide an accurate picture of where and how R&D monies are being spent. The Global Observatory on Health R&D has identified striking gaps and inequalities in investment both between countries and between health issues, with frequent disconnects between burden of disease and level of research activity. High income countries have an average of 40 times more health researchers than low income countries. Serious imbalances in funding flows mean countries with comparable levels of poverty and health needs receive strikingly different levels of Official development assistance (ODA) for medical research and basic health sectors (health ODA). As little as 1% of all funding for health R&D is allocated to diseases such as malaria and tuberculosis, despite these diseases accounting for more than 12.5% of the global burden of disease. Investing in R&D to discover and develop medicines and vaccines is argued to be key to improving access to medicines and quality health care for people across the world and to achieving universal health coverage.
The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. The authors examined the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. To measure private sector participation, we computed the percentage of live births that took place in a private (for-profit or non-profit/mission) health facility and the percentage of children with ARI symptoms who were treated at a private health facility. Private sector participation was positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations, including after controlling for confounders including per capita income and maternal education. However, higher private sector participation may be affected by other variables that also affect access and equity. In addition to an increased level of overall service utilization, countries with a relatively large share of private sector participation tend to also have significantly higher levels of maternal education and also higher levels of GDP per capita, so the relationships may be confounded by differences in socioeconomic development (particularly maternal education, a well-established key determinant of health service utilization and child health outcomes). The authors controlled for maternal education and per capita income but report that other confounders such as better functioning transportation infrastructure may also influence both private sector participation and access. They further notes that the appropriate role of the private sector might depend on the capacity of governments to provide effective stewardship and regulation, the health care financing environment, and the organization of the public health sector.
This study explored the perceptions and experiences of seeking treatment and advice from pharmacists and drugstore workers in Dar es Salaam, Tanzania, by men who have sex with men (MSM) with regards to their sexual health and STI-related problems. Fifteen in-depth interviews were conducted with MSM with experience of seeking assistance relating to their sexual health at pharmacies and drugstores in Dar es Salaam in 2016. Four themes related to different aspects of MSM’s perceptions and experiences of pharmacy care emerged from the analysis: Balancing threats against need for treatment reflected informants’ struggles concerning risks and benefits of seeking assistance at pharmacies and drugstores; Identifying strategies to access required services described ways of approaching a pharmacist when experiencing a sexual health problem; Seeing pharmacists as a first choice of care focused on informants’ reasons for preferring contact with pharmacies/drugstores rather than formal healthcare services; and lacking reliable services at pharmacies indicated what challenges existed related to pharmacy care. MSM perceived the barriers for accessing assistance for STI and sexual health problems at pharmacies and drugstores as low, thereby facilitating their access to potential treatment. However, the results further revealed that MSM at times received inadequate drugs and consequently inadequate treatment.
Despite the significant adverse social and economic costs of mental illness, psychiatric and related services receive a low level of priority within the health care system. A public–private mental health leadership initiative, emanating from a patient access to care programme, was developed to build leadership capacity within the South African public mental health sector. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants’ daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included with personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. Participants acquired both skills and the confidence to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum for specialist training.
A multi stakeholder panel on “Governing Non-Communicable Diseases - Addressing the Commercial Determinants of Health” was held as a side-event during the 70th session of the World Health Assembly. It explored the commercial determinants of health, their links to the political determinants of health and how to navigate the narrow space to create both health and wealth, not just the latter at the expense of the first. The panel identified that government has a central role in taking the lead in policy formulation and in creating a political space for this. Rocco Renaldi from the International Food and Beverage Alliance highlighted the need for governments to create a regulated space and to encourage systemic change within the private sector which will allow them to adjust their strategies to meet the challenge. of chronic conditions. NCD Alliance Executive Director Katie Dain raised in contrast that the private sector has no role in policy development as this remains the responsibility of governments. The event made a case for enhanced engagement between different sectors of government to build systems of accountability, monitoring and implementation to manage the private sector in health.