This paper provides a unique opportunity to understand the dynamics of non-state providers (NSP) engagement in different contexts. A standard template was developed and used to summarize the main findings from the country studies. The summaries were then organized according to emergent themes and a narrative built around these themes. Governments contracted NSPs for a variety of reasons – limited public sector capacity, inability of public sector services to reach certain populations or geographic areas, and the widespread presence of NSPs in the health sector. Underlying these reasons was a recognition that purchasing services from NSPs was necessary to increase coverage of health services. Yet, institutional NSPs faced many service delivery challenges. Like the public sector, institutional NSPs faced challenges in recruiting and retaining health workers, and ensuring service quality. Properly managing relationships between all actors involved was critical to contracting success and the role of NSPs as strategic partners in achieving national health goals. Further, the relationship between the central and lower administrative levels in contract management, as well as government stewardship capacity for monitoring contractual performance were vital for NSP performance. The authors suggest that for countries with a sizeable NSP sector, making full use of the available human and other resources by contracting NSPs and appropriately managing them, offers an important way for expanding coverage of publicly financed health services and moving towards universal health coverage.
Public-Private Mix
Multinational companies may be engaged in high-risk activity which is eroding the tax base and warrants a tax audit in their respective countries, say senior tax officials of South Africa, Mozambique, Ghana, Tanzania and Zambia. They met at the offices of the African Tax Administration Forum in South Africa on 23 June 2011. Logan Wort, executive secretary of the forum, said that tax authorities in Africa agreed that they would begin work on a multilateral agreement to exchange information on taxpayers, such as multinational companies, for tax purposes. Wort argues that multinationals should not enter into high-risk transactions, such as transfer pricing arrangements, which pose a risk to the tax base. Unfortunately, there is no legal instrument to take collective action against such companies, he said.
What checks should municipalities make before signing up to public private partnerships (PPPs) in solid waste management (SWM)? How can they judge the merits of technologies touted by international operators? Can private operators be persuaded to target the poor? How can the poor be involved in the collection of solid waste?
Scarce evidence exists on the features, determinants and implications of physicians’ dual practice, especially in resource-poor settings. This study considered dual practice patterns in three African cities, Cape Verde, Maputo and Guinea Bissau, and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physi-cians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and infer-ential statistics were employed to explore differences in physicians’ engagement in dual practice across the three loca-tions. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private prac-tice. The remaining 55% indicated that they engaged in some form of dual practice, 31% ‘outside’ public facilities, 8% ‘inside’ and 16% both ‘outside’ and ‘inside’. Local health system governance and the structure of the markets for phy-sician services were linked to the forms of dual practice found in each location, and to their prevalence. The authors analysis suggests that physicians’ decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and effi-ciency implications for service provision. The study shows the value of analysing health markets to understand physi-cians’ engagement in professional activities, and contributes to an evidence base for its regulation.
The owners of for-profit private hospitals have voted themselves to maintain high-cost-high profits health care system, in defiance of the modest call by the Minister to act in favour of health before profits. NEHAWU alleges that the refusal by private hospital companies to reduce the tariff increases, at least to the CPIX level, demonstrates once again why profit maximization in health care is incompatible with the needs of society as a whole. The organisatiion further observes in their report that much of the healthcare costs in the private health sector have nothing to do with provision of quality care, but spending on unnecessary and expensive equipment, hospital and office infrastructure and profits for their shareholders. NEHAWU does not believe however that the solution lies in another effort at regulation and calls for fundamental transformation of the sector, especially in the medical schemes and for-profit private hospital sector which command huge resources required for re-distribution in favour of the majority not the minority.
The Council for Medical Schemes and the Department of Health are planning new amendments to the Medical Schemes Act to beef up governance on medical scheme boards and stop unscrupulous trustees enriching themselves at members’ expense. In the past decade, 10 medical schemes have been placed under curatorship after trustees milked their reserves to line their own pockets and dish out contracts to friends and family. The most recent examples include Medshield and Sizwe. To date, not a single trustee from a scheme placed under curatorship had been convicted, and many of those identified by the council as behaving inappropriately were at liberty to circulate in the industry and join other schemes, said its head of compliance and investigations, Stephen Mmatli. Mmatli said member apathy, combined with weaknesses in the Medical Schemes Act, meant there was insufficient control over the skills and qualifications of the people elected as trustees and too few checks and balances. While many schemes have highly qualified trustees, some of whom take home modest remuneration (or none at all), the converse is also true: the Council’s latest annual report (in last month’s newsletter) shows trustees awarding themselves massive fees of up to R700,000 (US$81,000) a year.
In analysing the relationship between a “global public sphere” and social media on the African continent, the generalisations are argued to hide a far more interesting set of observations. Debates and discussions about what passes for a global public sphere often overlook and obscure dynamics of power. What is defined as the global public sphere by most observers and scholars is still very much limited to the industrial north and their public and private broadcasting systems, twitter handlers, and blogs. The term also refers, by default, it is argued, to debates and deliberation solely in English. This ignores the discussions in media in the Global South, especially social media.
Commercial production of Tanzania's first locally manufactured antiretroviral drugs (ARVs) will start later in 2012 and it is hoped the country will eventually provide medicines for half of all HIV-positive Tanzanians. A pharmaceutical plant has been built near the northern city of Arusha using a grant from the European Union of about US$6.6 million, as well as about $1.5 million in funding from the private sector. Co-operation with a generic licence-holder on a fixed-dose combination ARV is also being considered as this would shorten the registration period significantly. Under the World Trade Organisation's Trade-related Aspects of Intellectual Property Rights (TRIPS) agreement, low income countries like Tanzania are permitted to produce essential drugs without requiring the permission of patent holders until 2016. The plant's current capacity is designed to serve a minimum of 100,000 patients with a reserve to triple the output if required - its minimum output is 100 million tablets a year.
by Pia Schneider and Miriam Schneidman (August, 2000. Rwanda's prepayment schemes with large membership pools have become important interest groups. Besides improving members' access to quality care, in a post-genocide society, where the social fabric was seriously destroyed, the introduction of the mutual health schemes has the potential to rebuild trust and democratic processes.
The United States (US) Department of State, the George W. Bush Institute, the US President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G Komen for the Cure, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have launched Pink Ribbon Red Ribbon (PRRR), a partnership to leverage public and private investment in global health to combat cervical and breast cancer, the leading causes of cancer death in women in Sub-Saharan Africa and Latin America. The partnership aims to expand the availability of vital cervical cancer screening and treatment and breast care education, notably for women most at risk of getting cervical cancer in developing nations because they are HIV-positive. With initial indications of interest, PRRR expects to have commitments of up to US$75 million across five years, which will grow to include additional participants and services. The goals are to reduce deaths from cervical cancer by an estimated 25% among women screened and treated through the initiative, significantly increase access to breast and cervical cancer prevention, screening and treatment programmes, and create innovative models that can be scaled up and used globally. This public-private initiative includes initial commitments from founding corporate participants Merck, Becton Dickinson, QIAGEN, Caris Foundation, Bristol-Myers Squibb, GlaxoSmithKline and IBM.