Public-Private Mix

A Trojan horse of the private sectors interests at the World Health Organisation
People’s Health Movement; Medicus Mundi International: 26 January 2016

A January 2016 statement of the People's Health Movement (PHM) and Medicus Mundi International (MMI) identified that the Framework of Engagement with Non-State Actors (FENSA) currently under discussion at the World Health Organisation (WHO) fails to provide a robust framework against undue influence of the corporate sector and its philanthropies. In the statement the PHM and MMI argue that FENSA is symbolic of a more fundamental issue of the compromise to WHO’s independence due to its under-funding and tightly earmarked voluntary contributions making it vulnerable to such influence. They argue for an end to the dual freeze on the WHO Programme Budget and on assessed contributions which severely limits WHO’s functioning. "Until and unless this is addressed, WHO stands at risk of private sector capture and further loss of its integrity, independence, and credibility", the statement warned.

Common Declaration for Responsible Partnerships
International Forum on Public-Private Partnerships for Sustainable Development, December 2015

In the context of the 2015 Paris Climate Conference, COP 21, an International Forum on Public-Private Partnerships (PPPs) for Sustainable Development has been held in Annemasse. Within this framework and in view of the Sustainable Development Goals defined by the UN, the Cité de la Solidarité Internationale organised on October 30 2015 a collective intelligence workshop gathering representatives from the civil society as well as public and private stakeholders. The assembly called for PPPs that guarantee access for all to common goods and the respect of Human Rights to foster an economy of human dimension. They recommended to: Include the civil society in the entire process of public-private partnerships, upstream to downstream, by identifying the genuine needs, promoting the general interest as the final goal and avoiding conflict of interest and controlling the services of which they are the main beneficiaries. They argued that it is necessary to create a legal framework and appropriate tools to strengthen civil society legitimacy, to guarantee co-construction of equal win partnerships with general interest as a common objective to avoid an unbalanced or competitive approach and to consider alternative approaches and initiatives of collaboration (such as social and solidarity-based economy) as an evolution towards more balanced and inclusive partnerships favouring a participatory democracy.

Do financial contributions from ‘pharma’ violate WHO Guidelines?
Gopakumar K: Third World Network (TWN) Info Service on Health Issues Dec 15(01), December 2015

Millions of dollars given by major pharmaceutical companies to the World Health Organisation (WHO) raise questions of compliance with the organisation’s guidelines on interactions with commercial enterprises. Currently, WHO’s relations with commercial enterprises are guided by the “Guidelines on interaction with commercial enterprises to achieve health outcomes” . The 107th Session of the Executive Board in 2001 “noted” the Guidelines that cover cash donations, contributions in kind, seconded personnel, collaboration for product development, collaboration for meetings etc. Compliance with the Guidelines has essentially been left to the Secretariat. According to paragraph 11 of the Guidelines, “Commercial enterprises working with WHO will be expected to conform to WHO public health policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others”. It is notable that the draft Framework of Engagement with Non-State Actors (FENSA) currently being finalised by WHO Member States does not contain a provision that requires a commercial enterprise to conform to WHO’s polices, norms and standard. In the absence of such a clear provision FENSA could legitimise engagement with the private sector, which does not follow WHO’s policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others. WHO Member States at the resumed session of the Open Ended Intergovernmental Meeting (OEIGM) on FENSA is expected to look at the regulation of WHO’s engagement with the private sector. The experience with the implementation of the Guidelines on interaction with commercial enterprises to achieve health outcomes would be useful for the consideration of Member States. In 2014, WHO received USD 6,158,153 from GlaxoSmithKline (GSK). It received USD 5,785,000 and USD 8,266,284 in 2012 and 2013 respectively from GSK. GSK Biologics paid USD 17,000. Novartis AG donated USD 5,300,000 in 2014 and USD 4,500,000 in 2013. Hoffmann-La Roche donated USD 6,158,153 in 2014 and USD 4,806,492 in 2013. The purposes of those donations were not disclosed.

Conceptualising the impacts of dual practice on the retention of public sector specialists - evidence from South Africa
Ashmore J; Gilson L: Human Resources for Health 13(3), 2015,

‘Dual practice’, or multiple job holding, generally involves public sector-based health workers taking additional work in the private sector. This form of the practice is purported to help retain public health care workers in low and middle-income countries’ public sectors through additional wage incentives. There has been little conceptual or empirical development of the relationship between dual practice and retention. This article helps begin to fill this gap, drawing on empirical evidence from a qualitative study focusing on South African specialists. Fifty-one repeat, in-depth interviews were carried out with 28 doctors (predominantly specialists) with more than one job, in one public and one private urban hospital. Findings suggest dual practice can impact both positively and negatively on specialists’ intention to stay in the public sector. This is through multiple conceptual channels including those previously identified in the literature such as dual practice acting as a ‘stepping stone’ to private practice by reducing migration costs. Dual practice can also lead specialists to re-evaluate how they compare public and private jobs, and to overworking which can expedite decisions on whether to stay in the public sector or leave. Numerous respondents undertook dual practice without official permission. The idea that dual practice helps retain public specialists in South Africa may be overstated. Yet banning the practice may be ineffective, given many undertake it without permission in any case. Regulation should be better enforced to ensure dual practice is not abused. The conceptual framework developed in this article could form a basis for further qualitative and quantitative inquiry.

New Media in Africa and the Global Public Sphere
Jacobs S: African Futures, Essays, 21 February 2013

In analysing the relationship between a “global public sphere” and social media on the African continent, the generalisations are argued to hide a far more interesting set of observations. Debates and discussions about what passes for a global public sphere often overlook and obscure dynamics of power. What is defined as the global public sphere by most observers and scholars is still very much limited to the industrial north and their public and private broadcasting systems, twitter handlers, and blogs. The term also refers, by default, it is argued, to debates and deliberation solely in English. This ignores the discussions in media in the Global South, especially social media.

Achieving universal health coverage in East and Southern Africa: what role for for-profit providers?
Doherty J: Paper presented at the Panel session T03P13: Private sector and universal health coverage - examining evidence and deconstructing rhetoric International Conference on Public Policy, 1-4 July 2015, Milan, Italy

This paper considers evidence on the effectiveness, equity and sustainability of for-profit private provision, and the effectiveness of government’s stewardship of the sector, in East and Southern Africa. It draws conclusions about policy and regulatory requirements to encourage for-profit providers to make a more useful contribution towards achieving universal health coverage in the region. The author observes a recent increase in the size of a formerly relatively small for-profit private sector in some countries in the region, but also the emergence of 'boutique’ hospitals (targeted at the high-income local market, expats and foreign NGO workers, as well as medical tourism) in otherwise underdeveloped settings. As warned by the international literature that critiques the commercialisation of health care, such developments could worsen inequity and destabilise national health systems if inadequately regulated.

Differences in essential newborn care at birth between private and public health facilities in eastern Uganda
Waiswa P; Akuze J; Peterson S; Kerber K; Tetui M; Forsberg BC; Hanson C: Global Health Action 8(10), March 2015, doi: 10.3402/gha.v8.24251

In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. This study described the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. The authors collected data from mothers with infants at baseline and endline using a structured questionnaire among private and public health facilities. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities. Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.

The Access to Medicine Index and Accountability of Pharmaceutical Companies
de Felice D; Edwards D: Health and Human Rights Journal, September 2015

The UN post-2015 development agenda includes 17 Sustainable Development Goals (SDGs) and a “revitalized” Global Partnership to ensure their implementation. Formal inclusion of the private sector (in addition to governments, civil society, the UN system and other actors) is one of the defining features of this Global Partnership. Plenty of studies have shown how corporate actions can have significant impacts, positive and negative, for vulnerable people and for marginalised communities. However the author argues that it also raises an important question. How will the private sector be held accountable for its contribution to the Global Partnership? The latest draft of the 2030 Agenda for Sustainable Development provides that a High Level Political Forum (HLPF) under the auspices of the General Assembly and the Economic and Social Council will have the central role in overseeing follow-up and review at the global level. Interestingly, the HLPF will be tasked to carry out regular reviews that will include relevant stakeholders, including the private sector. The author argues that measuring businesses is as fundamental as measuring governments and that rigorous benchmarking of pharmaceutical companies will be crucial.

CSOs voice concerns over corporate takeover of WHO
Raja K: Third World Resurgence, 298/299, 35-37, 2015

At the World Health Assembly in May, civil society organisations criticised the rich countries for refusing an increase in their assessed contributions to WHO and opposing actions by the agency which would be contrary to the interests of their corporations. THE Framework for Engagement with Non-State Actors (FENSA), initiated to safeguard the independence, integrity and credibility of the World Health Organisation (WHO), now seems to bear the threat of facilitating and legitimising corporate capture of the organisation, civil society groups have charged. 'Many proposals by rich countries in draft FENSA text [are] promoting corporate capture of WHO in the name of promotion of engagements without discussion on any comprehensive mechanism to avoid conflict of interest. These proposals, if accepted, would institutionalise the undue corporate influence on WHO,' said Lida Lhotska of the International Baby Food Action Network (IBFAN) in a press release. Over the last 20 years, the proportion of WHO's budget which is met through mandatory assessed contributions has fallen from 75% to 20%. This is a consequence of continuing new functions being added to the organisation and a continuing freeze on assessed contributions. The remaining 80% is met by voluntary donations, including from the rich countries, the World Bank and the Bill & Melinda Gates Foundation.

Nurses who moonlight strain the health system
Rispel L: Business Day Live (BDLive), July 2015

Between 2009 and 2010, the author reports that the South African government spent about R1.49bn hiring nurses for the public health sector from nursing agencies. In that period, the provincial spending on agency nurses ranged from a low of just under R36.4m in Mpumalanga to a high of R356.4m in the Eastern Cape. In that financial year, this article reports that more than 5,300 registered nurses could have been employed by provincial governments instead of agency nurses, according to the published research. The government’s spending on agency nursing is argued to be a result of nursing vacancies, poorly managed staff absenteeism, sub-optimal planning for patient loads and not involving nurses in decisions on their shifts or how best to cover hospital wards. Nursing agencies provide a vehicle for nurses to moonlight, as they could be employed concurrently in a public or private sector hospital as well as the agency. These agencies are not obliged to ask nurses whether they have concurrent employment. The author argues that the nursing agency spending is, however, an indication of the bigger crisis in South African nursing.