Public-Private Mix

Africa and the corrosive international tax system
Mukumba C; Etter-Phoya R: Tax Justice Network, 2021

Illicit financial flows are argued by the authors to punch holes in the public purse across the African continent. Over the past five decades Africa is reported to have lost in excess of US$ 1 trillion in illicit financial flows, dwarfing the continent's receipts of overseas development assistance during this period and the foreign direct investment into Africa. Based on research of national laws, policies and practice, each of the 70 countries included in the Corporate Tax Haven Index are given a score. African countries are found to contribute less to tax abuse than European Union and OECD member states and their dependencies, but have less robust transparency and anti-avoidance measures. The authors call for policy improvements in African countries to curb and protect against corporate tax abuse, and advocate for a UN Tax Convention.

Regulation of medicines advertisement in Zimbabwe: an assessment of the impact of pharmaceutical promotion on the prescribing behaviour of healthcare professionals
Semu T C; Ngara B and Mudzviti T: BMC Health Services Research 21(1337), 1-7, 2021

The authors present results of a cross sectional study the levels of knowledge, attitude and perception towards regulation of pharmaceutical promotion among 330 healthcare practitioners in Zimbabwe, using face-to-face interviews and a web-based online survey. The study found that healthcare practitioners in Zimbabwe have a favourable relative importance index score of knowledge (95%), attitudes (67%), and perceptions (90%). This outcome and a positive perception of the regulation of pharmaceuticals related to health care workers’ profession, gender, education level, the nature of the working institution and the number of prescriptions involved per week.

Challenges in health service delivery under public-private partnership in Tanzania: stakeholders’ views from Dar es Salaam region
Nuhu S; Mpambije CJ; Ngussa K: BMC Health Services Research 20, 765, 1-12, 2020

Public-private partnership in the health sector was introduced to improve the delivery of health services in Tanzania, but the expected outcomes have not been fully realised. This study investigated challenges encountered in implementing public-private partnership (PPP) institutional arrangements in health service delivery in Kinondoni Municipality, Dar es Salaam, Tanzania through interviews and document review. Findings revealed that although PPPs are hailed for supplementing the government’s efforts in the provision of health services, institutional arrangements for the smooth provision of these services are lacking. The challenges include inadequate resources, ineffective monitoring and evaluation, insufficient consultations between partners, inadequate legal and policy frameworks and ineffective implementation practices. The authors suggest that these areas need to be addressed in pursuing PPPs.

An assessment of the knowledge, practices and resources during the delivery of malaria health care services among private health care practitioners: a cross section study in the Mid-Western Region of Uganda
Wanzira H; Tumwine D; Bukoma P; et al: BMC Health Services Research 21(788), 1-12, 2021

This study documented the knowledge, practices and resources during the delivery of malaria care services, among private health practitioners in the Mid- Western region of Uganda, an area of moderate malaria transmission. The authors determined the proportion of health workers that adequately provided malaria case management according to national standards in interviews with 135-health facilities staff. The study revealed sub-optimal malaria case management knowledge and practices at private health facilities with only 14 % of health care workers demonstrating correct malaria case management cascade practices. To strengthen the quality of malaria case management, they recommend guidelines and tools, training; continuous mentorship and supervision; provision of adequate stock of essential medicines; and communication and data management at private health facilities.

The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems
Williams O; Chun Yung K; Grépin K: Global Public Health 16(8-9), 2021

For decades, governments and development partners promoted neoliberal policies in the health sector in many low and middle income countries, largely motivated by the belief that public services were too weak to meet population needs. Private health markets as a governance and policy solution to the delivery of health services enabled forms of market failure to persist in these countries. These were exposed during the COVID-19 pandemic, as analysed by the authors using data from an assembled database of COVID-19 related news items sourced from the Global Database of Events, Language, and Tone. They identify how pre-existing market failure and failures of redistribution have led to the rise of three urgent crises: a financial and liquidity crisis among private providers, a crisis of service provision and pricing, and an attendant crisis in state-provider relations. They note that COVID-19 has exposed important failures of the public-private models of health systems.

Public Private Partnerships (PPPs) and Women’s Human Rights: Feminist Analysis from the Global South
Development Alternatives with Women for a New Era (DAWN): DAWN, 2021

Corporations across the globe are capturing more and more of the public sphere, encroaching on all aspects of people’s lives. This publication compiles analyses of different country experiences on public-private partnerships that in themselves have become a powerful tool to achieve what the authors observe is starting to look like the privatisation of life itself. Feminist researchers from the Global South have spent a year researching this theme in their home countries, including in Kenya and Zimbabwe. Together they present an analysis and critique of the state of PPPs today, and the consequences for women’s lives, communities’ wellbeing, and public health and social services.

Sales and pricing decisions for HIV self-test kits among local drug shops in Tanzania: a prospective cohort study
Chiu C; Hunter L; McCoy S; et al: BMC Health Services Research 21(434), 1-11, 2021

From August to December 2019, the authors provided free HIV self-test kits, a new product, to 26 pharmacy shops in Shinyanga, Tanzania to sell to the local community. Sales volume, price, customer age and sex were measured using shop records, together with willingness-to-pay to restock test kits. Purchase prices ranged from 1000 to 6000 Tsh. Within shops, prices were 11.3% higher for 25 to 34 and 12.7% higher for 45+ year olds relative to 15 to19 year olds and 13.5% lower for men on average. Although prices varied between shops, prices varied little within shops over time, and did not converge over the study period or cluster geospatially. Shopkeepers charged buyers different prices depending on buyers’ age and sex and there was low demand among shopkeepers to restock at the end of the study. The authors propose that careful consideration is needed to align the motivations of retailers with public health priorities while meeting their private for-profit needs.

Market strategies used by processed food manufacturers to increase and consolidate their power: a systematic review and document analysis
Wood B; Williams O; Nagarajan V; Sacks G: Globalization and Health 17 (17), 2021

The authors reviewed the market strategies deployed by processed food manufacturers to increase and consolidate their power from a systematic review of public health, business, legal and media content databases and of grey literature. The market strategies identified related to six interconnected objectives: i) reducing competition with equivalent sized rivals and maintaining dominance over smaller rivals; ii) raising barriers to market entry by new competitors; iii) countering the threat of market disruptors and driving dietary displacement in favour of their products; iv) increasing firm buyer power over suppliers; v) increasing firm seller power over retailers and distributors; and vi) leveraging informational power asymmetries in relations with consumers. The authors note that analysing such market strategies promoting unhealthy foods helps to identify countervailing public policies, such as those related to merger control, unfair trading practices, and public procurement, as part of efforts to improve population diets.

All Risk and No Reward: How the Government and Mine Companies Fail to Protect the Right to Health of Miners and Ex-Miners in Botswana
Botswana Labour Migrants Association, Centre for Economic and Social Rights, Northwestern Pritzker School of Law Centre for International Human Rights, Botswana, 2020

All Risk and No Reward presents the findings of a two-year investigation into the right to health of miners and ex-miners in Botswana. It describes in vivid detail a series of critical issues for their health and the health of their communities. The report also considers the Government and mine companies' financial responsibilities to equitably generate, allocate and spend sufficient funds for health. The report is based on extensive desk research, and interviews and focus groups discussions with more than 50 miners, ex-miners, family and community members, doctors and nurses, and government and industry officials in Botswana.

An overview of the commercial determinants of health
Mialon M: Globalization and Health 16(74), doi: https://doi.org/10.1186/s12992-020-00607-x, 2020

This desk review provides an overview of the commercial determinants of health. The commercial determinants of health are reported to cover three areas. First, they relate to unhealthy commodities that are contributing to ill-health. Secondly, they include business, market and political practices that are harmful to health and used to sell these commodities and secure a favourable policy environment. Finally, they include the global drivers of ill-health, such as market-driven economies and globalisation, that have facilitated the use of such harmful practices. The discussion on the commercial determinants of health is argued to offer an opportunity to shift the dominant paradigm in public health, so ill-health, damages to the environment, and health and social inequalities, might be better understood through a commercial determinant lens.

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