In many African countries, hundreds of health-related non-government organisations (NGOs) are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage. In the 1990s, NGOs multiplied across post-war Mozambique: the country’s structural adjustment program constrained public and foreign aid expenditures on the public health system, while donors favoured private contractors and NGOs. In the 2000s, funding for HIV/AIDS and other vertical aid from many donors increased dramatically. In 2004, the United States introduced PEPFAR in Mozambique at nearly 500 million USD per year, roughly equivalent to the entire budget of the Ministry of Health. PEPFAR funding has helped thousands access antiretroviral treatment, but over 90% of resources flow “off-budget” to NGO “implementing partners,” with little left for the public health system. After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795. Achieving UHC will require rejection of austerity constraints on public sector health systems, and re-channelling of aid to public systems building rather than to NGOs.
Public-Private Mix
According to this article, February 2012 is a key month for the future of the life-saving Indian generic industry, because fights on all three fronts (EU-India FTA, TPPA, and Novartis v. India) are occurring simultaneously - all with the same objective of using intellectual property rules that will significantly reduce the ability of Indian suppliers to produce and export low cost generic medicines. The European Union (EU) has put great pressure on India to conclude a trade agreement that includes TRIPS-plus IP protections, particularly in terms of investor-versus-state claims, general IP enforcement measures, and data exclusivity. In sum, the EU wants to enshrine IP-right holders and other investors rights to bring private arbitration claims directly against India when their investment-return expectations are upset by government regulations or other actions. February is also a key month in the ongoing TPPA negotiations, with side meeting on IPRs scheduled in Hollywood as a precursor to major negotiation in early May in Melbourne. The United States (US) attack on India-style protections against patent monopoly evergreening is quite explicit in its leaked TPPA demands. Contrary to the direct rule of Sec. 3(d) of the India Amended Patents Act (2005), the US is trying to mandate that patent be granted on minor changes in the form, new uses, and dosages, formulations, and combinations of known chemical entities. It also seeks mandatory patent term extensions, disallows the kind of pre-grant oppositions used so effectively by activists in India, and insists on data exclusivity and patent-registration linkage. Moreover, the US seeks to limit price control mechanisms like those currently used in India and seeks enforcement rights even more onerous than those pursued by the EU.
Between 2009 and 2010, the author reports that the South African government spent about R1.49bn hiring nurses for the public health sector from nursing agencies. In that period, the provincial spending on agency nurses ranged from a low of just under R36.4m in Mpumalanga to a high of R356.4m in the Eastern Cape. In that financial year, this article reports that more than 5,300 registered nurses could have been employed by provincial governments instead of agency nurses, according to the published research. The government’s spending on agency nursing is argued to be a result of nursing vacancies, poorly managed staff absenteeism, sub-optimal planning for patient loads and not involving nurses in decisions on their shifts or how best to cover hospital wards. Nursing agencies provide a vehicle for nurses to moonlight, as they could be employed concurrently in a public or private sector hospital as well as the agency. These agencies are not obliged to ask nurses whether they have concurrent employment. The author argues that the nursing agency spending is, however, an indication of the bigger crisis in South African nursing.
Each year, hundreds of billions of dollars are spent on research and development (R&D) into new or improved health products and processes, ranging from medicines to vaccines to diagnostics. But the way these funds are distributed and spent is often poorly aligned with global public health needs. in 2017, the World Health Organization launched an initiative to gather information and provide an accurate picture of where and how R&D monies are being spent. The Global Observatory on Health R&D has identified striking gaps and inequalities in investment both between countries and between health issues, with frequent disconnects between burden of disease and level of research activity. High income countries have an average of 40 times more health researchers than low income countries. Serious imbalances in funding flows mean countries with comparable levels of poverty and health needs receive strikingly different levels of Official development assistance (ODA) for medical research and basic health sectors (health ODA). As little as 1% of all funding for health R&D is allocated to diseases such as malaria and tuberculosis, despite these diseases accounting for more than 12.5% of the global burden of disease. Investing in R&D to discover and develop medicines and vaccines is argued to be key to improving access to medicines and quality health care for people across the world and to achieving universal health coverage.
An open letter was submitted by the authors on behalf of 61 signatories for the election of the new WHO Director General (DG) to take into account how the new leadership will ensure appropriate interactions with alcohol, food, pharmaceutical, and medical technology industries. In May 2016, WHA adopted the Framework of Engagement with Non-State Actors (FENSA), a policy due to be fully operational by May, 2018. While FENSA envisages that WHO will “exercise particular caution…when engaging with private sector entities …whose policies or activities are negatively affecting human health..”, the rhetoric and direction of WHO's reform process as well as WHO's chronic funding challenges are argued to have left the signatories concerned rather than reassured. They fear that instead of protecting WHO's mandate, FENSA risks relegating WHO to a limited role, unable to stand up for human rights and democratic decision making. The signatories draw attention to the conflict of interest statement signed by more than 175 NGOs and networks representing more than 2000 groups and first launched at the UN High-Level Meeting on Non-communicable Diseases in 2011: “The policy development stage should be free from industry involvement to ensure a ‘health in all policies’ approach, which is not compromised by the obvious conflicts of interests associated with food, alcohol, beverage and other industries, that are primarily answerable to shareholders.” They indicate that alcohol, food, pharmaceutical, and medical technology industries should comply with policies developed by WHO and its Member States, and that their role is not in public health policy formulation, risk assessments, risk management, or priority setting, nor in determining normative quality standards and legally binding regulations to protect and promote public health. These processes, it is argued, must be undertaken in an environment free of commercial influence. The signatories believe that only a WHO that protects its independence and integrity of decision making will have the ability to fulfil its constitutional mandate.
This open letter signed by presidents, ministers of state, professors and heads of institutions calls for a people’s vaccine against COVID-19, available to all, in all countries, free of charge. The signatories argue that the World Health Assembly must forge a global agreement that ensures rapid universal access to quality-assured vaccines and treatments with need prioritized above the ability to pay. Access to vaccines and treatments as global public goods are in the interests of all humanity. Signatories call for a global agreement on COVID-19 vaccines, diagnostics and treatments — implemented under the leadership of the World Health Organization — that ensures mandatory worldwide sharing of all COVID-19 related knowledge, data and technologies with a pool of COVID-19 licenses freely available to all countries. Further, signatories call for a global and equitable rapid manufacturing and distribution plan — that is fully-funded by rich nations — for the vaccine and all COVID-19 products and technologies that guarantees transparent ‘at true cost-prices’ and supplies according to need. The signatories call for an agreement to guarantee COVID-19 vaccines, diagnostics, tests and treatments are provided free of charge to everyone, everywhere.
This study investigated the level and determinants of out-of-pocket (OOP) spending among individuals reporting illness or injury in Ouagadougou, Burkina Faso and who either self-treated or received healthcare in either a private or public facility. A cross-sectional study was conducted with a representative sample of 1017 households in 2011. Among the surveyed sample, 29.6% persons reported a sickness or injury. Public providers were the single most important providers of care, whereas private and informal providers accounted for 29.8 and 34.0%, respectively. Almost universally (96%), households paid directly for care, with an average expenditure per episode of illness of 17.4USD. The total expenditure was higher for those receiving care in private facilities compared to public ones and the insured patients’ bill almost tripled uninsured. Medication was the most expensive component of expenditure in both public and private facilities. OOP was the principal payment mechanism of households. Considering the importance of private healthcare in Burkina Faso, the authors argue that regulatory oversight is necessary and an extensive protection policy to shield households from catastrophic health expenditure is required.
Many local government authorities in Tanzania have reformed their tax collection systems in recent years in order to increase their revenue. This paper examines how systems of privatised tax collection performed with respect to revenue generation, administration and accountability, based on evidence from urban and rural councils in Tanzania. The paper concludes that outsourcing is not a “quick fix” for increasing local government revenues or reducing tax administration problems.The results showed a mixed outcome; while some councils increased their tax collections, others experienced problems of corruption. The process is susceptible to corruption since local councils have limited capacity to conduct analyses of the tax base and the amounts agents are expected to remit are much less than the revenues they actually collect. The paper suggests that where appropriately managed and monitored, outsourced revenue collection may provide a foundation for more efficient and effective local government revenue administration.
On 30 May 2011, the Drugs for Neglected Diseases initiative (DNDi) signed an agreement with pharmaceutical manufacturer Sanofi for a three-year research project on nine neglected tropical diseases. Sanofi will bring molecules from its libraries into the partnership, and DNDi and Sanofi will collaborate on the research. According to the agreement, the intellectual property (IP) rights resulting from the partnership will be co-owned by DNDi and Sanofi. Publication of results is hoped to benefit the wider research community and the partnership has commited to improving access to health interventions for patients in all endemic countries, irrespective of their level of economic development. The agreement will cover nine diseases: leishmaniasis, Chagas disease, human African trypanosomiasis (sleeping sickness), lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), helminthiasis, dracunculiasis (Guinea-worm disease), fasciolosis, and schistosomiasis.
The Medicines Patent Pool (MPP) has announced a ground-breaking collaboration with a private sector joint venture that will facilitate greater availability of critical generic medicines for children with HIV. The deal allows the royalty-free licensing of a key HIV medicine, abacavir, in 118 countries where 98.7% of children with HIV live, as well as future commitments for licensing of pipeline drugs. The Memorandum of Understanding goes further than previous deals struck by the Pool, which came under some criticism for possibly not being ambitious enough in getting commitments from partner companies. The agreement is expected to include future drugs developed by the industry venture. The MPP has a priority list of antiretrovirals (ARVs) to fight HIV and AIDS, based on the most needed and those that are patented (and therefore not readily available at affordable prices). The company with which the MPP struck the deal, ViiV, has a number of desirable ARVs in the pipeline, and has committed to allow the MPP to licence them for paediatric use for the same geographic territory, once the drugs receive approval.