This paper, produced by Partnerships for Health Sector Reform/plus, discusses the effectiveness of contracting out primary care services as a tool for health reform. The paper provides a short history of contracting out, a discussion of its advantages and disadvantages, and a review of the available literature on the impact of contracting out. The authors note that there is a lack of evaluation research on the success of contracting-out, and a lack of conclusive evidence that contracting out improves overall health sector efficiency.
Public-Private Mix
Does contracting-out improve health services?
Does duty call? Contracts and GPs in South Africa
Some experts argue that private healthcare providers are preferred by service-users, or are more efficient or accessible than the public sector, and hence that government should contract out services to them. However, factors such as institutional capacity to write and manage contracts and market competition affect how contracts with private providers function. This has major implications for contracting in low and middle-income countries (LMICs). Research by the London School of Hygiene and Tropical Medicine explored the operation of a long-standing contract with private GPs in South Africa.
Does Ownership Matter? An Overview of Systematic Reviews of the Performance of Private For-Profit, Private Not-For-Profit and Public Healthcare Providers
Herrera CA, Rada G, Kuhn-Barrientos L, Barrios X: PLoS ONE 9(12), 1 December 2014
Ownership of healthcare providers has been considered as one factor that might influence their health and healthcare related performance. The authors provide an overview of what is known about the effects on economic, administrative and health related outcomes of different types of ownership of healthcare providers -namely public, private non-for-profit (PNFP) and private for-profit (PFP)- based on the findings of systematic reviews (SR). Of the 5918 references reviewed, fifteen SR were included, but six of them were rated as having major limitations, so they weren't incorporated in the analyses. According to the nine analysed SR, ownership does seem to have an effect on health and healthcare related outcomes. In the comparison of PFP and PNFP providers, significant differences in terms of mortality of patients and payments to facilities have been found, both being higher in PFP facilities. In terms of quality and economic indicators such as efficiency, there are no conclusive results. When comparing PNFP and public providers, as well as for PFP and public providers, no clear differences were found. PFP providers seem to have worst results than their PNFP counterparts, but there are still important evidence gaps in the literature that needs to be covered, including the comparison between public and both PFP and PNFP providers. More research is needed in low and middle income countries to understand the impact on and development of healthcare delivery systems.
Draft Charter on Private and Public Health Care in South Africa
Critical Health Perspectives
The Department of Health’s recently released Draft Charter of the Public and Private Health Sectors (CPPHS) aims to address the legacy of apartheid restraint on access to health care for all South Africans. It commits public and private sectors to create “a health care system that is coherent, cost-effective and quality driven … for the benefit of the entire population” and to work together “to improve the scope, accessibility and quality of care at all levels”. For these laudable goals we give our wholehearted support. The CPPHS specifies four “key areas” of transformation: access to health services, equity in health services, quality of health services, and Black Economic Empowerment (BEE). The first three – access to, equity in, and quality of health care services, are essential (though not enough) to meet the goal of health for all South Africans. The fourth area is problematic.
Further details: /newsletter/id/31148
Drug development for neglected diseases: a deficient market and a public-health policy failure
There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. This article from The Lancet analyses the outcomes of pharmaceutical research and development over the past 25 years, and reviews current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. It found that of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. The article concludes that private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.
DSA Annual Conference 11 November 2006: The private sector, poverty reduction and international development
Development Studies Association
The Development Studies Association (DSA) one-day conference titled The Private Sector, Poverty Reduction and International Development will take place on November 11th 2006 at the University of Reading. Health-related topics under one of three main conference themes "Business and Finance and Poverty Reduction" include "HIV and Aids: Technical and policy issues for the private sector" and "Government attitudes to the private sector as an engine of growth: policy issues and debate".
Effect of an expansion in private sector provision of contraceptive supplies on horizontal inequity in modern contraceptive use: evidence from Africa and Asia
Hotchkiss DR, Godha D and Do M: International Journal for Equity in Health 10(33), 19 August 2011
The study is based on multiple rounds of Demographic and Health Survey data from four selected countries (Nigeria, Uganda, Bangladesh, and Indonesia) in which there was an increase in the private sector supply of contraceptives. The methodology involves estimating concentration indices to assess the degree of inequality and inequity in contraceptive use by wealth groups across time. The results suggest that the expansion of the private commercial sector supply of contraceptives in the four study countries did not lead to increased inequity in the use of modern contraceptives. In Nigeria and Uganda, inequity actually decreased over time; while in Bangladesh and Indonesia, inequity fluctuated. The study results do not offer support to the hypothesis that the increased role of the private commercial sector in the supply of contraceptive supplies led to increased inequity in modern contraceptive use.
Engaging the private sector for tuberculosis control: much advocacy on a meagre evidence base
Mahendradhata Y, Lambert M-L, Boelaert M, Van der Stuyft P: Tropical Medicine & International Health 12(3): 315-316, March 2007
Advocacy on engaging the private sector in tuberculosis (TB) control is mounting. In the newly launched six-point Stop TB Strategy, WHO makes an urgent appeal to engage private care providers. Even more recently, this was supplanted by a guide on how to involve all care providers in TB control through different Public-Private Mix (PPM) approaches. At the same time the body of evidence on the effectiveness of such approaches, although growing, remains rather weak.
Europe’s contribution to anti-corruption efforts in Sub-Saharan Africa
Kaninda JT and Schepers S: European Policy Centre Policy Brief, March 2010
This article outlines the measures that European Union (EU) and African countries are planning through the economic partnership agreements to address public and private corruption, including non-compliance with promised off-sets in public contracts, in both African and EU governments and companies. Corruption is argued to distort fair competition, as companies gain competitive advantages and increase profitability and share value through illegal and unethical behaviour, while those companies that choose to be responsible find themselves at a disadvantage. Africa is argued to be no more corrupt than any other region, with alleged costs to African economies of US$148 bn per year, according to estimates by the Commission of the African Union. Corruption is argued to be responsible for losses of up to 50% of countries’ tax revenue, in many cases more than foreign debt.
Expensive private healthcare highlighted at inquiry
Mashego P: BDLive, February 2016
The high cost of private health care in South Africa was profiled in a February 2016 health market inquiry amid revelations that South Africans pay six times the international average for hospital stays. A World Health Organisation study on price levels for private hospitals found that 42% of the funds spent on private voluntary health insurance in South Africa were equivalent to 4% of the country’s gross domestic product. This is six times the average in the Organisation for Economic Cooperation and Development (OECD) countries, despite the expenditure in SA only covering 17% of the population. The report found that South Africans stayed in hospitals for an average of 3.9 days compared to 5.1 days in OECD countries and paid an estimated R20bn in out-of-pocket payments for healthcare. Speaking on the sidelines of the inquiry, Health Minister Aaron Motsoaledi said that healthcare prices were "exorbitant" and that needed to change.