SOUTH AFRICA TO INVESTIGATE PRIVATE HEALTH MARKET
Roelf W: Reuters, 7 May 2013
South African competition authorities will launch an investigation into the private healthcare industry, where early evidence showed high prices and market distortions, according to Economic Development Minister Ebrahim Patel. Various stakeholders have raised concerns about pricing, costs and the state of competition and innovation in private healthcare. Patel said competition authorities had ruled previously that the practice of setting up common tariffs for medical procedures was uncompetitive. Instead he pointed to a growing trend of increasing healthcare costs and a massive asymmetry of power health markets. Patel said preliminary evidence showed that some that in some cases competition was "prevented, distorted or restricted." Private health providers in Africa's largest economy include Life Healthcare, Mediclinic International and Netcare Ltd, all of whom have benefitted from the growth of the middle classes. The Competition Commission, which can impose administrative fines, is expected to launch the "market inquiry" before September 2013.
HOPE FOR FINANCING AFRICA'S DEVELOPMENT THROUGH PRIVATE EQUITY
UNECA: 9 May 2013
A high-level roundtable on Building Private Equity and Private Capital Markets in Africa met on 8 May 2013 to explore the promise and obstacles facing private capital investments in Africa. The report of this meeting highlights a discussion on the growth of private equity markets in Africa given rapid urbanisation and a growing middle-class, but questions whether the growth of Africa’s private equity will be based on a model that benefits local people.
SOUTH AFRICA’S NHI SEEKS GPS
Health-e News: 18 March 2013
South Africa’s National Department of Health (DoH) has embarked on an initiative to improve and expand access to healthcare services through the contracting of private General Medical Practitioners (GPs) to render sessional service in Primary Healthcare facilities. This initiative is in support of the National Health Insurance (NHl) pilot that aims to improve access to high quality public sector health care services. The initial phase of GP contracting for sessional services will take place in the 10 NHI pilot districts across the country. The DoH embarked on a consultation process started by the Minister of Health in his visits and road shows to the various districts; this was then followed by a letter from the Director-General of Health to GPs to test their levels of interest to participate in this project. Government has advertised for candidates and will soon begin the selection process.
A LITERATURE REVIEW: THE ROLE OF THE PRIVATE SECTOR IN THE PRODUCTION OF NURSES IN INDIA, KENYA, SOUTH AFRICA AND THAILAND
Reynolds J, Wisaijohn T, Pudpong N, Watthayu N, Dalliston A, Suphanchaimat R Et Al: Human Resources For Health 11(14), 12 April 2013
This scoping systematic review was undertaken to assess the evidence for the role of private sector involvement in the production of nurses in India, Kenya, South Africa, and Thailand. The authors performed an electronic database search and also captured grey literature from the websites of relevant human resources organisations and networks. The review revealed that despite very different ratios of nurses to population ratios and differing degrees of international migration, there was a nursing shortage in all four countries, which were struggling to meet growing demand. All four countries saw the private sector play an increasing role in nurse production. Policy responses varied from modifying regulation and accreditation schemes in Thailand, to easing regulation to speed up nurse production and recruitment in India. There were concerns about the quality of nurses being produced in private institutions. The authors recommend that strategies must be devised to ensure that private nursing graduates serve public health needs of their populations. They call for policy coherence between producing nurses for export and ensuring sufficient supply to meet domestic needs, in particular in under-served areas. Further research is needed to assess the contributions made by the private sector to nurse production and to examine the variance in quality of nurses produced.
PRIVATE MEDICAL AID MEMBERSHIP: WHAT IS THE IMPACT ON HEALTH CARE USE AND OUT-OF-POCKET PAYMENTS IN SOUTH AFRICA?
Health Economics Unit, University Of Cape Town: Policy Brief, January 2013
This policy brief examines the extent to which private medical scheme membership shields South African members from out-of-pocket payments. This is important for the design of the National Health Insurance system in the country. The Health Economics Unit (HEU) found that medical scheme members have significantly more private health care visits and pay substantial out-of-pocket payments to use health services, in addition to their contributions to the medical schemes. Consequently, there is a need to move away from fee-for-service payments, which often leads to over-servicing, cost escalation, and assessment and regulation of less effective medications and interventions. There is also a need to limit, as much as possible, out-of-pocket payments that adversely affect scheme members and also address the rising contribution rates. A form of insurance that ensures adequate use of health services is needed. Ideally, this should be a form that ensures universal access to health care, for example, the proposed National Health Insurance, the policy brief concludes.
THE EFFECT OF AN ANTI-MALARIAL SUBSIDY PROGRAMME ON THE QUALITY OF SERVICE PROVISION OF ARTEMISININ-BASED COMBINATION THERAPY IN KENYA: A CLUSTER-RANDOMISED, CONTROLLED TRIAL
Kangwana BP, Kedenge SV, Noor AM, Alegana VA, Nyandigisi AJ, Pandit J Et Al: Malaria Journal 12(81), 1 March 2013
To improve the quality of care received for presumptive malaria from the highly accessed private retail sector in western Kenya, subsidised pre-packaged artemether-lumefantrine (AL) was provided to private retailers, together with a one-day training course for retail staff on malaria diagnosis and treatment, job aids and community engagement activities. This study assessed the intervention through provider and mystery-shopper cross-sectional surveys, which were conducted at baseline and eight months post-intervention to assess provider practices. On average, 564 retail outlets were interviewed per year. At follow-up, 43% of respondents reported that at least one staff member had attended the training in the intervention arm. The intervention significantly increased the percentage of providers knowing the first line treatment for uncomplicated malaria by 24.2%; the percentage of outlets stocking AL by 31.7%; and the percentage of providers prescribing AL for presumptive malaria by 23.6%. Generally, outlets that received training and job aids performed better than those receiving one or none of these intervention components.
UGANDAN GENERIC ARV FACTORY OVERPRICES ITS DRUGS
Plus News: 14 March 2013
AIDS activists in Uganda have drawn attention to overpricing of medicines at a local pharmaceutical plant, Quality Chemicals Industries Limited (QCIL). The plant was started in 2007 to improve treatment access by providing cheaper ARVs locally. The authors argue that between December 2009 and October 2010, the government's National Medical Stores (NMS) paid $17.8 million more than it should have to QCIL, with a 15% mark-up on imported drugs that had been intended only for locally produced drugs. QCIL is reported in the article to be selling imported drugs manufactured by Cipla at high prices even after it started producing its own drugs. The government inspector general and civil society activists have demanded the government investigate and recover the funds.
THE HEALTH SYSTEMS FUNDING PLATFORM AND WORLD BANK LEGACY: THE GAP BETWEEN RHETORIC AND REALITY
Brown SS, Sen K And Decoster K: Globalization And Health 9(9), 6 March 2013
In this paper, the authors argue that global health partnerships created to encourage funding efficiencies need to be approached with some caution, especially when claims for innovation and responsiveness to development needs are based on untested assumptions around the potential of some partners to adapt their application, funding and evaluation procedures within these new structures. The authors examine this in the case of the Health Systems Funding Platform, which despite being set up some three years earlier, has stalled at the point of implementation of its key elements of collaboration. While much of the attention has been centred on the suspension of the Global Fund’s Round 11, and what this might mean for health systems strengthening and the Platform more broadly, they argue that inadequate scrutiny has been made of the World Bank’s contribution to this partnership, which might have been reasonably anticipated based on an historical analysis of development perspectives. Given the tensions being created by the apparent vulnerability of the health systems strengthening agenda, and the increasing rhetoric around the need for greater harmonisation in development assistance, an examination of the positioning of the World Bank in this context is vital, the authors conclude.
PATENT POOL ANNOUNCES COLLABORATION ON PAEDIATRIC HIV GENERICS
New W: Intellectual Property Watch, 4 March 2013
The Medicines Patent Pool (MPP) has announced a ground-breaking collaboration with a private sector joint venture that will facilitate greater availability of critical generic medicines for children with HIV. The deal allows the royalty-free licensing of a key HIV medicine, abacavir, in 118 countries where 98.7% of children with HIV live, as well as future commitments for licensing of pipeline drugs. The Memorandum of Understanding goes further than previous deals struck by the Pool, which came under some criticism for possibly not being ambitious enough in getting commitments from partner companies. The agreement is expected to include future drugs developed by the industry venture. The MPP has a priority list of antiretrovirals (ARVs) to fight HIV and AIDS, based on the most needed and those that are patented (and therefore not readily available at affordable prices). The company with which the MPP struck the deal, ViiV, has a number of desirable ARVs in the pipeline, and has committed to allow the MPP to licence them for paediatric use for the same geographic territory, once the drugs receive approval.
GLOBAL HEALTH PHILANTHROPY AND INSTITUTIONAL RELATIONSHIPS: HOW SHOULD CONFLICTS OF INTEREST BE ADDRESSED?
Stuckler D, Basu S And McKee M: PLoS Medicine 8(4), 12 April 2011
In recent years, tax-exempt private foundations and for-profit corporations have increasingly engaged in relationships that can influence global health. Using a case study of five of the largest private global health foundations, the authors of this study identified the scope of relationships between tax-exempt foundations and for-profit corporations. They found that many public health foundations have associations with private food and pharmaceutical corporations. In some instances, these corporations directly benefit from foundation grants, and foundations in turn are invested in the corporations to which they award these grants. Personnel move between food and drug industries and public health foundations. Foundation board members and decision-makers also sit on the boards of some for-profit corporations benefitting from their grants. While private foundations adopt standard disclosure protocols for employees to mitigate potential conflicts of interests, these do not always apply to the overall endowment investments of the foundations or to board membership appointments. Transparency or grant-making recusal of employees alone may not be preventing potential conflicts of interests between global health programmes and their financing, the authors conclude.