The authors write from the 68th World Health Assembly, where a drafting group of Member States are discussing the Framework of Engagement With Non-State Actors (FENSA). This process aims to determine the rules of engagement between WHO and non-State actors (NSAs), a moniker encompassing academia, nongovernmental organizations, philanthropic foundations, and the private sector. Many from civil society view this process as a way of safeguarding WHO's independence from private interests. The authors outline the fault lines in the proposals of contentious issues. During the open-ended process, India supported including language in paragraph 44 that named specific industries WHO should exercise caution in engaging with, such as the food, beverage, alcohol, and infant formula industries. India further proposed, "WHO's engagement will be strictly limited to assisting such industries to comply with WHO's norms and standards or guideline or policy." On behalf of the African group, Zimbabwe asserted that the "framework should explicitly list the types of industries that WHO will deal cautiously with and the reasons for the cautious engagement," also naming alcohol, food, and beverage. Greece argued, "strict rules should govern its [WHO] engagement with the pharmaceutical industries." Finland recommended a "high level of restriction" for engagement with industries that have "clear interests in health policies," referencing non-communicable disease control. Yet these calls were rejected by Canada, Denmark, Norway, and the United States. U.S. sought to eliminate the line concerning "other industries affecting human health" altogether. Other issues up for debate have been secondments from the private sector, as well as restrictions and/or ceilings on financial contributions from non state actors. The authors urged member states to ensure that FENSA creates a strong enough "fence" to safeguard public health.
Public-Private Mix
A Kenyan pharmaceutical company, Universal Corporation, is reported to have been certified by the World Health Organisation (WHO) to start producing antiretroviral (ARV) drugs. The company alleges that the cost of its medicines will be at least 30% cheaper than those the government is currently buying from foreign manufacturers in countries like India, largely as it will avoid high importation costs. The authors note that whether or not the government will buy medicines locally depends on their pricing. Activists have called on WHO to certify more local manufacturers to produce high-quality generic drugs. Government officials have welcomed the development as a step in providing universal coverage to all HIV-positive Kenyans.
On 6 December 2011, the East African Community Regional Pharmaceutical Manufacturing Plan of Action was launched in Arusha, Tanzania. The Plan of Action will guide the region towards evolving an efficient and effective pharmaceutical manufacturing industry that can supply national, regional and international markets with quality efficacious medicines. A number of recommendations were made at the end of the meeting. Participants agreed that, following discussion on the baseline survey, the draft report and the relevant questionnaire will be sent to national associations and regulatory authorities for corrections and further input, and then to national pharmaceutical manufacturers associations for input. They called on EAC Partner States to mobilise the necessary resources to ensure successful implementation of the Plan of Action. It was resolved that the EAC Secretariat will be responsible for putting in place clear coordination and management structures for the implementation, monitoring and evaluation of the plan.
Public-private partnerships are increasingly popular initiatives in international health. The Global Alliance for Vaccines and Immunisation (GAVI) was launched in January 2000 with a donation of US$ 750 million from the Bill and Melinda Gates Foundation. An assessment of its work by researchers at the London School of Hygiene and Tropical Medicine reveals important lessons for similar initiatives, including the new Global Fund to Fight AIDS, Tuberculosis and Malaria.
The market for primary health care in South Africa represents a growing opportunity for private providers targeting lower income employed workers, who often prefer not to use the public sector. A new model of service provision is emerging in the form of private companies providing fixed price primary care services in urban areas. Whilst the range of services delivered was quite limited compared to the public sector, apparently effective delivery, clearly better patient experiences, and a similar cost to the public sector, all suggest that the public sector can learn about some aspects of service delivery from these companies.
This paper examines the experuence of the the new Queen Mamohato Memorial Hospital, a US$120 million privately financed hospital in Lesotho's capital Maseru, the first in Africa to be built through a “Public Private Investment Partnership” (PPIP). According to the World Bank, the new hospital is supposed to operate as the national referral hospital as well as the district hospital for the greater Maseru area. It was built and is run by a consortium headed up by South African private medical giant Netcare, and replaced the Queen Elizabeth II Public Hospital. In return, the Lesotho government will pay a US$32.6m index-linked annual ‘unitary charge’ to Netcare for the hospital and services, representing a 100% increase in costs from the 2007/08 budget and despite the fact that the government had already invested $62 million in the project. The new hospital is expected to treat all patients who present, up to a maximum of 20,000 in-patient admissions and 310,000 outpatient attendances annually, against an estimated need of 64,000 patients annually. The annual charge for the hospital is a third of Lesotho’s recurrent health budget. The author suggests that this can distort national health spending, especially for the expansion of primary health care for Lesotho’s majority rural population. The unfavourable terms of the contract are traced back to an imbalance in expertise among those negotiating the contract terms. The authors questioned why the International Finance Corporation, who acted as consultants on the project, failed to support the Lesotho negotiators to prevent these unfavourable terms.
The Government of Lesotho, with assistance from the World Bank Group and other development partners, is undertaking a long-term health sector reform program. Replacing the collapsing and only national referral hospital is a major challenge facing the country. To maximize the use of the limited available resources, the Government decided to adopt a PPP model to finance and manage a new replacement hospital. The intention is that partners from the private sector will build, equip and subsequently operate the new hospital before it is eventually turned over to the Government. This initiative, the first of its kind in IDA Sub-Saharan Africa in the public health sector, will have a profound impact on Lesotho’s health sector and its reform program.
Adequate and appropriate vehicles are essential for health service delivery. These are required for transport and transfer of patients from community to health facilities and between levels of health care delivery of essential equipment, medicines and other supplies to point of service delivery transport of health workers for supervisory visits, to attend meetings and training sessions and for administrative purposes. A transport management system that is efficiently and cost effectively run is essential to ensure availability of vehicles for health service delivery when required.
This paper describes an academic partnership to support the public-sector health care system, with a major focus on scaling up HIV care in western Kenya to build a system able to take responsibility for the health of an entire population. The population health care delivery model involved comprehensive, integrated, community-centred, and financially sustainable services, with a path to universal health coverage. The authors share information on the partnership with strategic planning and change management experts from the private sector to use a ‘Learning Map®’ to collaboratively develop and share a vision of population health, and achieve strategic alignment with key stakeholders at all levels of the public-sector health system in western Kenya. The authors describe how the model has leveraged the power of partnerships to move beyond the traditional disease-specific silos in global health to a model focused on health systems strengthening and population health.
In many countries people use a wide variety of market-based providers of health-related goods and services ranging from highly organised and regulated hospitals and specialist doctors to informal health workers and drug sellers operating outside the legal framework. The boundary between public and private sectors is often very porous, with people either paying government health workers informally or consulting them outside their official hours. Unregulated markets, in particular, raise problems in terms of safety, efficacy and cost. Understanding health markets and improving system performance is central to accelerating action to scale-up coverage and use of health services and deliver improved outcomes against the health-related MDGs and universal access commitments.