This study estimated efficiency among primary health facilities (health centres), examined the potential fiscal space from improved efficiency and investigated the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities were estimated using the Nopo matching decomposition procedure. The average efficiency score across all health centres included in the sample was estimated to be 0.51, about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, the authors found that, on average, facilities could save about US$7634 if efficiency was improved. The authors also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. They argue for primary health facility managers to improve productivity via effective and efficient resource use, through training of health workers and improving the facility environment alongside effective monitoring and evaluation exercises.
Public-Private Mix
The quality of primary health care (PHC) delivered to people in developing countries is often poor and coverage is not yet universal. This is despite a focus on the public delivery of comprehensive PHC over the past 20 years. People frequently consult private providers including qualified medical professionals and unqualified health practitioners. A better use of private care providers, therefore, might be a potential solution, including contracting them to provide services on behalf of the public sector. Research from the London School of Hygiene and Tropical Medicine, the University of Witwatersrand and the University of Cape Town examines the performance of various models of PHC provision in South Africa.
The quality of primary health care (PHC) delivered to people in developing countries is often poor and coverage is not yet universal. This is despite a focus on the public delivery of comprehensive PHC over the past 20 years. People frequently consult private providers including qualified medical professionals and unqualified health practitioners. A better use of private care providers, therefore, might be a potential solution, including contracting them to provide services on behalf of the public sector. Research from the London School of Hygiene and Tropical Medicine, the University of Witwatersrand and the University of Cape Town examines the performance of various models of PHC provision in South Africa.
The Congress of South African Trade Unions' (Cosatu's) strike action against privatisation has placed a large question mark over the effectiveness of South Africa's efforts to privatise parastatals - or at least communicate to the broader community the need to restructure.
This policy brief aims to understand whether or how session work in hospitals could be expanded to help achieve universal health coverage. About 14% of private sector specialists work part-time in public hospitals, through what is known as ‘session work’. Private specialists undertake session work for a number of mainly non-financial reasons, such as to ‘give back’ to the public sector and to teach in academic hospitals. There are a number of private specialists who seem interested in working in the public sector in future, but the pay is very low for session work. The author argues that higher session wages may induce specialists to leave full-time public work to undertake private and session work. Thus it may be important to only give new session worker posts to those who have already left the public sector.
India's government could become the country's only purchaser of patented drugs and medical devices, under new proposals currently being discussed by ministers. While other nations operate central medicines buying for their public health care systems, this would be the first instance of a government also becoming the sole supplier for private health care providers, and could set a precedent for African countries.
This paper examines India's partnership with Africa in four sectors – medical tourism, tele-health, frugal innovations, and the pharmaceutical industry. It examines the nature of Indian private sector investments in African healthcare. It analyses their effectiveness in dealing with the issues around equity of access, the establishment of comprehensive 'prevention- based' health systems, and the creation of mutual benefit. The author reports that there is significant Indian commercial presence in Africa's health systems but the engagement needs a broader conception of the 'private sector' to include traditional healers and social entrepreneurs engaged in innovation for healthcare. Given their common health challenges, the authors argue that India and African countries must work towards crafting innovative low-cost healthcare models, and invest in the production and research of pharmaceutical products, especially for neglected diseases.
This study reviewed peer-reviewed and grey literature on examples of innovation in pruvate sector health care. From 46 studies, 10 case studies were selected spanning different countries and health service delivery models. The cases included social marketing, cross-subsidy, high-volume, low cost models. They tended to have a narrow clinical focus, facilitating standardised care models but allowing experimentation with delivery models. Information on the social impact of these innivations was variable, with more data on availability and affordability and less on quality of care. More rigorous evaluations are needed to investigate the impact and quality of private health service innovations and to determine the effectiveness of the strategies used.
This study examined peer-reviewed and grey literature on examples of innovation in private sector health care. From 46 studies, 10 case studies were selected spanning different countries and health service delivery models. The cases included social marketing, cross-subsidy, high-volume, low cost models. They tended to have a narrow clinical focus, facilitating standardised care models but allowing experimentation with delivery models. Information on the social impact of these innovations was variable, with more data on availability and affordability and less on quality of care. The study calls for more rigorous evaluations to investigate the impact and quality of private health service innovations and to determine the effectiveness of the strategies used.
This case study describes how a public-private partnership initiated to develop a new anti-malarial combination has evolved over time to address issues posed by its effective deployment in the field. In 2002, the Drugs for Neglected Diseases Initiative (DNDi) created the FACT project to develop two fixed-dose combinations, artesunate-amodiaquine and artesunate-mefloquine, to meet the WHO anti-malarial treatment recommendations and international regulatory agencies approval standards. In co-operation with private drug manufacturers, the partners developed the product and embarked on additional partnerships to ensure the adoption of this new medicine by malaria-endemic countries. The speed at which the drug was adopted in the field is argued to show the power of partnerships that combine different sets of strengths and skills, and that evolve to include additional actors.