Latest Equinet Updates

The private health sector in South Africa is substantial. This paper explores the private sector involvement in funding and providing health services in South Africa and the implications for equity and access to health care. Serious challenges face the private health care sector in South Africa, not least of all the very rapid increases in expenditure and, hence, contribution rates in medical schemes. A range of factors underlie these trends; but in recent years, schemes’ spending increases have been driven largely by private for-profit hospitals and specialists, with the number of private hospital beds increasing rapidly and considerable consolidation of beds within three large private hospital groups. The 2007 policy conference of the ruling African National Congress (ANC) resolved to introduce a National Health Insurance (NHI). If successfully implemented, the substantial reforms envisaged will promote health system equity, affordability and sustainability within South Africa. However, there are growing concerns that the introduction of these reforms will contribute to increased activities by South African private for-profit health care companies in other African countries. Private health care firms in South Africa not only have an interest in expanding into other African countries, they will also have access to substantial investment resources. In particular, the World Bank’s International Finance Corporation (IFC) is actively seeking to invest in the private health sector in African countries. The experience of the private health sector in South Africa should be taken into account by policy-makers in other African countries when considering what role they envisage for the private health sector within their country context.

Medical aid societies (MAS) in Zimbabwe cover a tenth of the population, and about 80% of income to private health care providers in Zimbabwe comes from MAS. They contribute more than 20% of the country’s total health expenditure. This paper outlines the flows of private capital that lie behind the growth of the profit medical aid and insurance health care sector in Zimbabwe. It was implemented within the Regional Network for Equity in Health in East and Southern Africa (EQUINET) by Training and Research Support Centre and SEATINI, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. The report proposes measures for improving the functioning of and equity in the sector and to address the current exposure of beneficiaries. Strengthening the regulatory environment will help to address legal ambiguities on investment of the industry’s ‘surplus’ funds, to ensure the multiple relevant laws from finance and health are known and applied by MAS/ insurance providers, and to fairly and firmly enforce the law. The sector should ensure timely scheme reporting as required by law and maintenance of a database with basic information on schemes, as well as registration of all schemes, avoiding increasing segmentation of the sector into small fragmented risk pools from individual schemes and encouraging (for example through enforcement of regulation on registration and liquidity requirements), mergers into larger and more viable risk pools. Regulatory and scheme policy measures should be introduced that require and implement cross-subsidies necessary for equity and ensuring benefits packages cover personal care and personal prevention services. Other measures include taking up the shortfalls in coverage of medicines on existing plans, checking the degree of vertical integration in each scheme and unbundling any monopolies across the sector that are limiting patient choice (e.g. paying only for selected linked services), and improving the outreach of consumer information on schemes, benefits packages and consumer rights to members and organisations servicing members (e.g. the labour movement and employer organisations).

The countries in eastern and southern Africa and the East African Community are at various stages of enacting laws to address counterfeiting. Substandard and fasified medicines are a problem for public health if they lack the active ingredients that make them effective, or if they are harmful. Yet making quality, safety and efficacy an intellectuual property issue, and defining counterfeiting so widely as to include generic medicines have even greater potential public harm, as they may make these essential medicines available as branded versions, at significantly higher cost. This policy brief draws policy makers attention to the need to ensure that counterfeit laws do not include generic medicines and that falsified medicines are dealt with under public health and not ntellectual propoperty law. It discusses the key issues in these laws and draft laws and how they are likely to affect public health and access to essential medicines in the region.

Briefing leaflet on EQUINET. Le Réseau Régional sur l’Equité en matière de santé en Afrique orientale et australe (EQUINET) est un réseau de professionnels, membres de la société civile, décideurs, employés gouvernementaux et autres personnalités de la région qui se sont réunis pour mettre en oeuvre une politique en matière d’équité, ce afi n de promouvoir et défi nir des valeurs communes en matière d’équité et de justice sociale au niveau de la santé.