The private sector exerts a significant and critical influence on child health outcomes in developing countries. This article in the Bulletin of the World Health Organisation reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector's influence, extending its analysis to include nongovernmental organisations (NGOs), pharmacies, drug sellers, private suppliers, and food producers. The article analyses some of the most promising strategies for improving child health, and suggests a number of possible constraints to emulating these approaches more widely. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of the presence and potential of the private sector, including actors such as professional associations, producer organisations, community groups, and patients' organisations.
Public-Private Mix
The UK Department for International Development (DFID) funded the Initiative on Public Private Partnerships for Health (IPPPH) to conduct a pilot study in Uganda to assess the health and health systems impact of public private partnerships (PPPs) for improving access to pharmaceuticals in relation to leprosy, lymphatic filariasis, onchocerciasis, sleeping sickness, and HIV/AIDS. The specific remit was to examine issues of ownership, integration, coordination, implementation and impact, with a particular focus on the unique strengths and problems of these access PPPs as distinct from other comparable programmes where drugs are competitively procured.
What chance do poor countries have of reducing child mortality by two thirds between 1990 and 2015? What contribution can public spending make to meeting this Millennium Development Goal (MDG)? Research by the Overseas Development Institute suggests the need for a greater pro-poor focus in public health expenditure. The author argues that the state’s role is to provide public goods, to regulate healthcare and health insurance, and to offer a safety net for the poor. Good health itself and many preventative and curative interventions have broader benefits for society. This justifies state funding of health.
Developing countries are now being asked to follow developed countries in the privatisation of goods and services previously provided by the state. It is argued that these countries will gain from the creation of efficient markets which offer their best chance to establish competitiveness, leading to economic growth. But critics claim that privatisation damages the quality of public services and undermines public accountability. Conventional forms of regulation address these two issues; but is it also possible to regulate for development that reduces poverty?
What chance do poor countries have of reducing child mortality by two thirds between 1990 and 2015? What contribution can public spending make to meeting this Millennium Development Goal (MDG)? Research by the Overseas Development Institute suggests the need for a greater pro-poor focus in public health expenditure. Over the last 40 years child mortality has halved in low-income countries. However, it is increasing in sub-Saharan Africa and there are also large differences between the health status of poor and non-poor children within countries. What can governments do to improve child survival?
This paper asks how to make a much needed system of user fees for government health services compatible with the goal of preserving equitable access to services. It demonstrates that different countries have tried different approaches and that those which have carefully designed and implemented waiver systems have had much greater success in terms of benefits incidence than countries that have improvised such systems.
Privatisation is being pushed by international governance institutions, the governments that control them, and the corporations that lobby both groups, even though the dangers that privatisation entails can seriously - and permanently - harm the livelihoods of the world's poorest people. The position of "privatise first and ask questions later" and the naïve confidence in the processes and outcomes of market reform have imposed hardship on precisely the groups those organisations are entrusted to protect. It is time to shift the burden of proof from those who question risky solutions to those who propose them, says this article.
In response to shortages in public budgets for government health services, many developing countries around the world have adopted formal or informal systems of user fees for health care. In most countries user fee proceeds seldom represent more than 15 percent of total costs in hospitals and health centres, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial or full waivers to the poor often results in inequity in access to medical care. The dilemma, then, is how to make a much-needed system of user fees compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence than countries that have improvised such systems (Ghana, Kenya, Zimbabwe).
The use of private health care providers in low- and middle-income countries is widespread and is the subject of considerable debate. This article, produced by the Bulletin of the World Health Organisation, reviews a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardised primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In addition, implications for public health policy of the emergence of this new model of private provider are discussed.
In the past decade a growing number of health franchising schemes have emerged in developing countries. Often reaching tens of thousands of poor households, these private schemes currently provide logistical, managerial, and sometimes financial support to small-scale providers (franchisees) of preventive care, such as family planning and maternal and child health services. While franchising has attracted growing interest among governments and donors as a possible way to achieve health objectives, there is some debate about the ability of the model to reach the poorest people and the ability of franchisers to sustain themselves financially.