This paper analyses private for-profit (PFP) providers currently offering services to the poor on a large scale, and assesses the future prospects of bottom of the pyramid models in health. The authors searched published and grey literature and databases to identify PFP companies that provided more than 40,000 outpatient visits per year, or who covered 15% or more of a particular type of service in their country. For each included provider, the authors searched for additional information on location, target market, business model and performance, including quality of care. Only 10 large scale PFP providers were identified. The majority of these were in South Asia and most provided specialised services such as eye care. The characteristics of the business models of these firms were found to be similar to non-profit providers studied by other analysts. They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments. There was a lack of reliable data concerning these providers. The authors observe that there is very limited evidence to support the notion that large scale bottom of the pyramid PFP models in health offer good prospects for extending services to the poor in the future, while successful PFP providers often require partnerships with government or support from public funding.
Public-Private Mix
This article, from the Bulletin of the World Health Organization, outlines the available evidence on which sections of society benefit from publicly provided care and which sections use private health care. The authors assess use of public and private health services, as well as the use of franchise networks which supplement government programmes in the delivery of public health services. Examples from health franchises in Africa and Asia are provided to demonstrate the potential for franchise systems to increase services available to the public.
According to this article, developing countries are put under increasing pressure to promote the private sector. It investigates how aid impacts on health in poor countries and the pressure donors put on developing countries to promote the private sector. Proponents of privatisation argue that, because the private sector is already significant, it will be key in scaling up, but this article indicates that privatisation says nothing about the right to health. Likewise, no evidence exists that conclusively demonstrates that the private sector is more efficient and can help reduce costs, and improvements in quality of care and accountability to patients have yet to be proven. A further evidence gap emerges when proponents claim that the private sector can help reach the poor. Public sector success stories, such as those of Bostwana, Cuba, Uganda and Eritrea still need to be studied further. Oxfam demands that external funders be honest, stop promoting unproven and risky private sector approaches, learn from countries that have achieved universal and equitable access, and prioritise rapidly expanding and strengthening free government healthcare.
This paper examines the experiences of private sector participation (PSP) in the water supply and sanitation (WSS) sector. The paper argues that publicly owned water utilities have not always been successful in both developed and developing economies. However, non-market failures in supplying water are much more severe in developing economies. On grounds of efficiency, public WSS services have remained wanting. Large proportions of the population remain with little or no access to public services, and the quality of services for those who receive them are often poor, characterised by frequent breakdowns and unreliable supply. The author argues that while private sector participation has made more progress in high-income and middle-income countries, it has failed considerably in low-income developing countries. Success in wealthier countries is attributed to investment by private capital. The report concludes by recommending that private sector participation in the WSS sector in developing countries should not be introduced without rigorous prior assessment of its feasibility. When prevailing conditions are not suitable for introducing PSP, reforming the public utility should be given due consideration as a viable alternative.
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.
The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. The authors review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are argued to be possible. Prohibiting the private sector is said by the authors to be unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope. This indicates the limitations of such interventions as a basis for universal health coverage, though they can address focused problems on a restricted scale.
More private investment and improvements in productivity will be needed if many developing countries are to reach the Millennium Development Goals. But how can developing countries mobilise more domestic investment and attract more foreign investment? How can the impact of this investment on poverty reduction be increased? The objective of this Policy Guidance is to help Development Assistance Committee (DAC) members use their Official Development Assistance (ODA) more effectively to mobilise private investment for development.
Occupational diseases are posing an ever increasing challenge to workers’ compensation systems. Out of the 2.34 million annual work-related deaths reported by the International Labour Organization (ILO) , the vast majority – approximately 2.02 million – are due to work-related diseases. As a consequence, occupational safety and health policy is shifting from an injury and accident centered approach to one that increasingly is occupational disease focused. To effectively address occupational diseases (ODs), many social security organizations responsible for insuring and compensating these risks are adopting a more proactive and preventive approach. Their leitmotif can best be described as ‘prevention is better than compensation’. Adopting such an approach also forms part of a broader understanding of the role that social security can play in promoting and shaping a national prevention culture.
Public-private collaborations are increasingly being utilized to universalize health care. In Malawi, the Ministry of Health contracts selected health facilities owned by the main faith-based provider, the Christian Health Association of Malawi (CHAM), to deliver care at no fee to the most vulnerable and underserved populations in the country through Service Level Agreements (SLAs). This study examined the features of SLAs and their effectiveness in expanding universal coverage. The study involved a policy analysis focusing on key stakeholders around SLAs as well as a case study approach to analyse how design and implementation of SLAs affect efficiency, equity and sustainability of services delivered by SLAs. It used qualitative and quantitative research methods in five CHAM health facilities, with national and district level decision makers and providers and clients associated with the health facilities. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others. There was strong consensus and shared interest between the government and CHAM regarding SLAs. The free services provided by SLAs had an impact on the impoverished locals that used the facilities. However, lack of supporting systems, inadequate infrastructure and shortage of health care providers affected SLA performance.
Despite the positive health effects of breast feeding, and adverse health effects of breastmilk substitutes, particularly in conditions of poverty, Nestlé is reported by Baby Milk Action to be continuing promotion of the use of formula. The authors report that Nestlé has backtracked on a past commitment not to advertise formula brands in ‘high risk’ developing countries. The authors report that the World Health Organisation's Guidelines for the safe preparation, storage and handling of powdered infant formula are not adequately included on labels of its products, that health workers in India are being included in sponsored events, and that it is pushing in Philippines, as part of an industry alliance, for a weakening of current law in this area. The World Health Assembly (WHA) has called for companies to bring their activities at every level into line with the International Code on Marketing of Breastmilk Substitutes and subsequent WHA Resolutions.