A campaign to vaccinate people at risk of developing Ebola in the latest outbreak in the Democratic Republic of the Congo began in May 2018. The government of the DRC has formally asked to use an experimental vaccine being developed by Merck. The WHO has a stockpile of 4,300 doses of the vaccine in Geneva and the company has 300,000 doses of the vaccine stockpiled in the United States. Merck has given its permission for the vaccine to be used in this outbreak. As the vaccine — provisionally called V920 — is not yet licensed, the government deployed it under a compassionate use protocol. At this stage, it can only be used in the context of a clinical trial, plans for which are already in the works. The WHO director-general noted that DRC has lots of experiencing combating Ebola, since the first known outbreak in 1976 happened there. The 2018 outbreak marks the ninth known time Ebola has broken out in the DRC.
Public-Private Mix
The author of this paper examined the functioning of the informal transport markets in facilitating access to maternal health care in Eastern Uganda, to demonstrate the role that higher institutions of learning can play in designing projects that can increase the utilisation of maternal health services. Data were collected through qualitative and quantitative methods that included focus group interviews and a review of project documents and facility-level data. There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilising mothers to attend services, the authors found. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations. The findings indicate that locally existing resources such as motorcycle riders can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilisation of maternal health services. However, care must be taken to mobilise the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.
This study examines the delivery of health services by faith-based organizations (FBOs) as a possible alternative to privatization in Uganda, where they have been servicing communities since the mid-19th century. Their facilities focus on primary care and operate in rural, under-serviced areas where they provide access to care without discrimination on the basis of religion or ethnic group, charging affordable user fees while also treating those who cannot pay. The sector presently contributes to more than a quarter of all health services in the country, including the training of health professionals. Based on literature reviews and more than 30 key informant interviews, this research finds that FBOs promote solidarity through multi-stakeholder engagement and through cross-subsidization using mechanisms such as community health financing schemes that protect patients from catastrophic health expenditure. It analyzes how this ‘private not-for-profit’ sector fosters the development of a strong quasi-public ethos in service delivery, especially at the primary level of the Ugandan health system, posing a challenge to western liberal ideas about how the state and religion interface.
Public-private partnerships (PPP) could be effective in scaling up services. The study estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB) treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient. Where PPPs are tailored to target groups and supported by the public sector, scaling up of effective services could occur at much lower cost than solely relying on public sector models.
This report highlights how changes in the legal and regulatory environment can facilitate expanded access to family planning and reproductive health services through Africa’s private health sector. Using laws and regulations from three Africa countries - Ethiopia, Kenya and Nigeria - this report presents a road map on how to review the most important laws governing the private sector, as well as key issues to assess.
The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, the evidence base for diet-related interventions based on fiscal policies are described and the key questions that need to be asked by both health and economic policy-makers are considered. From the health sector’s perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. The authors highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions.
Data from every part of the world show that those that are least well off have shorter life expectancies and heavier burdens of disease than those that are relatively wealthy. Subsequently, public–private partnerships (PPPs) have gained growing popularity as mechanisms for increasing access to essential drugs. This series of papers examines the characteristics of PPPs that aim to improve the health of the world’s poorest people. The authors contribute to the debate about the future role of PPPs and provide pointers to key areas for urgent attention to sustain and increase the momentum to reach the goals towards which PPPs are striving. Issues highlighted include the roles of different actors in partnerships involving public sector and philanthropic donors, the private sector, nongovernmental organizations, communities and researchers in developed and developing countries.
This report from War on Want looks at how conditionalities and pressures from aid agencies and development banks force developing countries to adopt privatisation policies in public services. It focuses specifically on the sectors of water, electricity, and healthcare, in six countries: Colombia; El Salvador; Indonesia; Mozambique; South Africa; and Sri Lanka. It examines the impact of the requirements and policies of the International Monetary Fund (IMF), World Bank (WB), and other agencies including regional development banks, the European Commission (EC) and donor countries. It includes a specific examination of the various ways in which the UK’s Department for International Development (DFID) supports privatisation in these services.
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.
Equity is a frequently stated justification for government involvement in the health care market. This is often taken to mean directly providing all segments of the population with a wide range of government-operated health services at no cost: free universal care. Yet a look at the record suggests that this goal all too often remains elusive, especially in poor countries; that governments in fact serve only some of the population; and that the people served are disproportionately concentrated among the better-off. When this happens, government health services, far from promoting equity, work against it. The purpose of this chapter is to illustrate that there are many ways for governments to pursue the goal of ensuring that the poor receive adequate, affordable services through alternative approaches to resource allocation and purchasing. The first section summarizes the information known about the distribution of benefits from government health services across social groups in order to document the regressive pattern that now frequently exists and the need for significant changes in approach if the poor are to benefit. The second and third sections illustrate the kinds of changes that might be considered.