This book assesses the achievements and limitations of a new set of non-state or multi-stakeholder institutions that are concerned with improving the social and environmental record of business, and holding corporations to account. It does so from a perspective that aims to address two limitations that often characterise this field of inquiry. First, fragmentation: articles or books typically focus on one or a handful of cases. Second, the development dimension: what does such regulation imply for developing countries in terms of well-being, empowerment and sustainability? This volume examines more than 20 initiatives or institutions associated with different regulatory and development approaches, including the business-friendly corporate social responsibility (CSR) agenda, 'corporate accountability' and 'fair trade' or social economy. Several chapters deal specifically with the mining sector in Africa.
Public-Private Mix
This investigation by ActionAid used published financial information, interviews with government officials and research to follow up on corporate tax avoidance across Africa and India. They estimate that as much as £20 million per year may have been lost in the form of corporate taxes or a fifth of the corporate tax bill that could have paid for education, health and infrastructure. The authors argue for strengthened tax law and revenue administration capacity to deal with taxing multinational companies; improved transparency around corporate reporting; for countries to not give away their right to tax royalties, management fees and other foreign payments at source; and to examine and, where necessary, reform the way they tax multinationals.
The private sector exerts a significant and critical influence on child health outcomes in developing countries. This article in the Bulletin of the World Health Organization reviews the available evidence on private sector utilisation and quality of care. It provides a framework for analysing the private sector’s influence, extending its analysis to include nongovernmental organisations (NGOs), pharmacies, drug sellers, private suppliers, and food producers. The article analyses some of the most promising strategies for improving child health, and suggests a number of possible constraints to emulating these approaches more widely.
In June 2009, a new Health in Africa Fund was launched by the International Finance Corporation (IFC), the branch of the World Bank group mandated with supporting and expanding the private for-profit sector. This Fund will be managed by Aureos Capital, a private equity fund manager focusing on emerging markets. Through investment in small- and medium-sized private providers, the Fund will attempt to’[help] low-income Africans gain access to affordable, high-quality health services.’ The Fund targets initial commitments of US$ 100–120 million and intends harnessing private capital and private sector providers to improve quality and coverage of health services. But it is unlikely to improve access or quality of care unless it is complemented by initiatives to strengthen the public sector capacity to regulate, train, oversee and sub-contract (where appropriate) private providers. In addition, the Fund would also require the development of risk-pooling and subsidy mechanisms, so that privately-provided services can be offered free at the point of delivery. If it fails to do so, there is a concrete risk that, contrary to its objectives, it will contribute to the entrenchment of two-tier health-care systems and to a further concentration of human and financial resources in services catering to affluent urban dwellers.
When the world committed to ending poverty, protecting the planet and ensuring prosperity for all with the 17 Sustainable Development goals, we knew no single entity would be able to achieve such lofty goals – it would take collaboration. “A successful sustainable development agenda requires partnerships between governments, the private sector and civil society,” Goal 17 stated. The author argues that in few areas is that more obvious than in the fight to achieve universal health coverage, which falls under Goal 3 of Good Health and Wellbeing. If universal health coverage in all countries is to be achieved, even those where privately-financed market delivery is predominant, this will depend on the ability of governments to harness their potential. In such contexts, she observes, it is critical to build the stewardship capacity of public agencies so that they can frame and implement rules that define the environment and the incentives that guide the behaviours of health system players. Rather than focusing on privatisation, marketisation or the scaling up of private provision, the idea would be to get private actors involved in the pursuit of universal health coverage and financial protection goals. Although the private sector often has a dominant role in the provision of healthcare, too often governments do not know enough about how these providers operate, and there is little, if any, regulation in place. She recommends that countries examine if service delivery models incorporating tools such as franchising and social marketing and utilising economies of scale, standardisation, and/or market incentives can enable universal health coverage within their respective health systems. In recent years, public ownership and not-for-profit service provision and autonomous governance arrangements have been promoted over publicly financed, owned and operated models. However, gains due to hospital autonomy should go beyond revenues for hospitals and incentives for staff and must also enhance quality and equity. New frameworks of participatory governance and appropriate channels of accountability and regulation need to be established. She notes however that the commercial presence of a foreign service provider could create a dual market structure, with high-quality services being provided to affluent consumers to the detriment of the healthcare needs of poorer people. Additionally, the movement of healthcare providers and brain drain – both internal and external – can lead to a loss of trained healthcare providers in the home country. Policy safeguards will be needed to prevent this type of situation.
The demand for nurses is growing and has not yet been met in most low and middle-income countries. In India, Kenya, South Africa and Thailand, there has been a rapid proliferation of private training institutions to increase the supply of nurses. This infogram summarises evidence from RESYST research examining the role of these private institutions, their contribution to the wider health systems, and how governments in these countries have managed the opening of markets to the private sector. Private nurse training institutions are reported to be playing an increasingly important role in producing nurses in many low and middle income countries. Governments need to ensure that graduates from both private and public institutions are of sufficient quality to meet the health needs of their populations, and that training institutions have the capacity to train more nurses. In some countries including India and Kenya, the benefits of expanding nurse production through the private sector have been hindered by high levels of international migration. A balance needs to be struck between producing nurses for export, and ensuring sufficient supply and skill-mix for domestic markets.
In recent years there has been increasing interest in the role played by the private sector in providing health services in low- and middle-income countries. Many countries have a vibrant and growing private sector, which is perceived by some to respond to the failures of the public sector to provide affordable, accessible, convenient and high quality services. There has been little investigation, however, of the extent to which interventions can be successful in expanding access to those who are difficult to reach and to provide services that are 'genuinely pro-poor'. This chapter offers a systematic review of the literature on the equity impact of private sector interventions.
This paper reviews the experiences of franchising and discusses the opportunities and implications for governments and donors of franchising for HIV and AIDS services. The author details how the private sector can offer huge potential to extend and maintain anti-retroviral therapy (ART) coverage. The author outlines how franchising may offer a way of meeting known challenges and thus, increasing the prospects for universal access to HIV and AIDS services.
Public-private partnership in the health sector was introduced to improve the delivery of health services in Tanzania, but the expected outcomes have not been fully realised. This study investigated challenges encountered in implementing public-private partnership (PPP) institutional arrangements in health service delivery in Kinondoni Municipality, Dar es Salaam, Tanzania through interviews and document review. Findings revealed that although PPPs are hailed for supplementing the government’s efforts in the provision of health services, institutional arrangements for the smooth provision of these services are lacking. The challenges include inadequate resources, ineffective monitoring and evaluation, insufficient consultations between partners, inadequate legal and policy frameworks and ineffective implementation practices. The authors suggest that these areas need to be addressed in pursuing PPPs.
This paper describes the changes in utilisation of health services that occurred among the poor and those in rural areas in Uganda between 2002/3 and 2005/6 and associated factors. Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset-based index derived from principal components analysis (PCA). The study found that the rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access. The risk of not seeking care due to high costs did not change significantly. Poor people, females, rural residents and those from elderly headed households were more likely to use public facilities relative to private for-profit (PFP) providers. Although overall utilisation of public and private not-for-profit (PNFP) services by rural and poor populations had increased, PFP providers remained the major source of care. Policy makers should consider targeting subsidies to the poor and rural populations. Public-private partnerships should be broadened to increase access to health services among the vulnerable.