Public-Private Mix

Amanzi Ngawethu (The Water is Ours)
Coalition Against Water Privatisation, Centre for Applied Legal Studies, Anti-Privatisation Forum, Friction Films, Phiri Concerned Residents and Unitarian Universalist Service Committee: 2010

In September 2009, the Constitutional Court of South Africa heard the final appeal in a case brought by five Soweto residents challenging prepaid water meters and insufficient free basic water. The Bill of Rights of the South African Constitution guarantees right of access to sufficient water. However, poor communities in Johannesburg's townships do not have sufficient water and do not receive the same water service as the richer suburbs. Amanzi Ngawethu (The Water is Ours) is a short documentary representing the six-year legal battle against water privatisation. It brings together protest songs, photos and video from people and organisations involved in the struggle and working in solidarity.

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda
Okal J, Kanya L, Obare F, Njuki R, Abuya T, Bange T, Warren C, Askew I and Bellows B: Health Research Policy and Systems 11(38): 18 October 2013

This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages. Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program.

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher programme in Uganda
Okal J, Kanya L, Obare F, Njuki R, Abuya T et al: Health Research Policy and Systems 11(38), 18 October 2013

This paper describes a reproductive health voucher programme that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the programme to include public sector facilities. Researchers conducted interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher programme in south-western Uganda. Barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the programme by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in south-western Uganda is constrained by both facility and individual level factors that can be addressed by inclusion of the public facilities in the programme. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher programme with other services is likely to address some of the barriers. Accrediting public facilities has the potential to increase voucher programme coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening links between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilisation of resources to support the sustainability of the programmes. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher programme.

An assessment of private General Practitioners contracting for public health services delivery in O.R. Tambo District, South Africa
Hongoro C; Funani I; Chitha W; Godlimpi L: Journal of Public Health in Africa 6(2) doi: http://dx.doi.org/10.4081/jphia.2015.525

Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contract related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The authors suggest that the idea of a one-size-fits-all contract was probably inappropriate.

Anti-counterfeiting initiative aimed at protecting African medical industries
New W: Intellectual Property Watch, 8 August 2008

West African people should establish a medical anti-counterfeiting task force to promote local herbal medicines by protecting indigenous knowledge and genetic property. This is according to the communiqué from a workshop held in Accra, Ghana from 21-23 July 2008. A survey conducted by WHO between January 1999 and October 2000 found 60% of counterfeiting incidents occurred in developing countries and 40% in industrialised nations. To protect the local medical industries, the task force will prepare a mechanism for reporting counterfeit issues, including its harmful effect on local economy and health and launch awareness creation programmes as well as advising governments and local companies on ways to increase the use of security features on their products including medicines, cosmetics and medical devices. According to President Kufuor, this protection of intellectual property rights for local medical industries will sustain socioeconomic development that depends on investment and the growth of local industries, entrepreneurs and innovators who are willing to invest the capital needed to create brands and copyrights and to deploy money into research and development necessary to produce products which are accorded IP rights.

Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho
Hellowell M: BMJ Global Health 4(2), doi: http://dx.doi.org/10.1136/bmjgh-2018-001217, 2019

Many governments in sub-Saharan Africa are seeking to establish public–private partnerships (PPPs) to finance and operate new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, much less is known about their operation in low-income and middle-income countries. This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health. Governments may use budget-related incentives to promote the use of PPPs which may threaten financial sustainability in the long term. The authors suggest that future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.

Are We In It for the Long Haul?

Many AIDS activists have been enraged by the export abroad of conservative American morality on sex, drugs and prostitution through HIV/AIDS programs funded by the U.S. government. Particularly galling is that it replaces accepted, evidence-based public health policies with ideology. But if there is one thing this U.S. government hates more than fags, junkies, hookers, condoms and clean needles, it's socialized medicine. Quietly, the President's Emergency Plan for AIDS Relief (PEPFAR) and other bilateral initiatives are exporting the HMO-ization of AIDS in Africa and elsewhere on the planet, in which a network of private institutions are being built up to provide antiretroviral therapy (ART) to the millions who need it.

Article: Insurance Benefit Preferences of the Low-income Uninsured


Marion Danis, MD, Andrea K. Biddle, PhD, Susan Dorr Goold, MD. Journal of General Internal Medicine
Volume 17 Issue 2 Page 125 - February 2002. A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints.

Further details: /newsletter/id/29182
BEYOND PUBLIC AND PRIVATE? UNORGANISED MARKETS IN HEALTH CARE DELIVERY

This paper, Prepared and Presented at the 'Making Services Work for Poor People' World Development Report (WDR) 2003/04 Workshop, puts forward three arguments. First our understanding of the health sector is handicapped by trying to fit it into language and concepts which do not adequately capture its changing realities and the political economies within which health sectors are embedded. Second, this has disposed to putting forward decontextualised, and thus largely normative solutions, such as “regulation,” to the problem of improving service delivery in poorly performing environments. Third, approaches need to move beyond the dualism of public versus private and work creatively with messy and sometimes contradictory realities. It concludes with a discussion of how this analysis can be applied to a major international intervention set up to benefit the poor – the Global Fund for HIV/AIDS, TB and Malaria.

Big tobacco and the food and beverage industry are NOT civil society
Gonsalves G: Health-e News, 27 September 2011

The Global Business Coalition for Health (GBCHealth), which took part in the United Nations Conference on Non-Communicable Diseases (NCDs) held in New York in September 2011, has argued that companies must have a place at the tables where their future is discussed. GBCHealth, which represents companies that manufacture unhealthy (junk) foods and tobacco products, believes that their expertise is essential to developing public health policy. But activists disagree, arguing instead that industries producing unhealthy products should not be viewed as trusted partners and should not have a seat at the table during public health negotiations. In this open letter, AIDS activist Gregg Gonsalves responds to GBCHealth’s article justifying their right to be part of the negotiations. Though GBCHealth has had a long history of working on HIV and AIDS, he argues that big business cannot be considered representative of civil society, which is largely composed of marginalised groups, civil society organisations and other interested parties whose fight for civil, social and economic rights are not part of big business, whose primary goals are profit oriented. He calls on big business to stop trying to halt generic production of anti-retrovirals and drugs for NCDs (such as Novartis' continuing attempts to alter Indian patent law), to stop selling and promoting cigarettes and to stop advertising and marketing of high-sugar and high-fat foods across the globe.

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