In response to shortages in public budgets for government health services many developing countries around the world have adopted formal or informal systems of user fees for health care. In most countries user fee proceeds seldom represent more than 15 percent of total costs in hospitals and health centres, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial or full waivers to the poor often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees compatible with the goal of preserving equitable access to services, says this paper from the World Bank.
Public-Private Mix
Protecting the Vulnerable: The Design and Implementation of Effective Safety Nets
Providing Antiretroviral Treatment in Southern Africa
This report from the Health Systems Trust outlines experience with Antiretroviral Treatment (ART) in a number of sub-Saharan countries. ART is provided through a number of different avenues, which include the public sector, the non-profit sector, the corporate sector and the private sector. ART programmes may involve collaboration between two or more sectors with such partnerships being encouraged in recognition that the magnitude of the task may exceed the capacity of any one sector. Particular attention is paid to Botswana, the first sub-Saharan country to provide ART on a wide-scale through the public sector.
Public and private sector partnerships in the AIDS response: An opportunity for innovation and leadership
UNAIDS: 7 December 2008
The event ‘Public private partnerships against HIV: How can we together turn the tide?’ was organised by UNAIDS and explored the benefits and challenges of public-private partnerships in the global response to AIDS. Participants agreed that attention should be paid to ensure wide participation and representation across the private sector including from the labour unions, employers’ federations, small and medium enterprises and the informal sector. There is still a lot to do to improve participation by small and medium enterprises and the informal sector which employ most of the labour force in Africa. The group identified four factors as critical in creating and sustaining successful PPPs: clear definition of partners’ roles and responsibilities, transparency and respect for ethical standards, coordination between partners, and periodic assessments of the partnership.
Public health approach is key to scaling up HIV treatment, says WHO HIV/AIDS director
Speaking in December at the 14th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA), in Abuja, Nigeria, Jim Yong Kim, Director of the World Health Organization (WHO) HIV/AIDS Department, emphasized the importance of a public health approach in promoting long-term sustainability and equity of HIV treatment access programmes in resource-limited settings.
Public health care under pressure in sub-Saharan Africa
Health Policy. 2005
Taking as point of departure the need for a strong public health care sector in developing countries the article firstly outlines how in sub-Saharan Africa enhanced scarcity has characterized the content and quality of health care in the public sector. This has eroded the trust among the public in the government as provider of health care and guardian of public health. Secondly, it describes how workers in the public health domain have dealt with the implications of scarcity by etching out a "puvate" zone in health care provision and how these informal activities need to be interpreted as "muddling through".
Public health in the new era: improving health through collective action
The world is entering a new era in which, paradoxically, improvements in some health indicators and major reversals in other indicators are occurring simultaneously. Rapid changes in an already complex global health situation are taking place in a context in which the global public-health workforce is unprepared to confront these challenges. This lack of preparation is partly because the challenges are large and complex, the public-health workforce and infrastructure have been neglected, and training programmes are inadequate.
Public is as private does: The confused case of Rand Water
McDonald D (Ed.), Ruiters G (Ed.), Van Rooyen C, Hall D: Municipal Services Project, Occasional Paper (15), August 2007
This paper explodes Rand Water’s rhetoric about itself as a promoter of “public” services.The paper discusses the context of changes in public sector management and in the water sector. Rand Water (RW), the biggest public water utility in Africa entering the market on the continent engage in other activities that are beyond its core function of providing bulk potable water to local government in the industrial heartland of South Africa. This report examines the expansion of RW into non-core activities in the period 1994-2006, the rationales offered by RW for that expansion, and deliberates on this expansion in the context of similar activities by other public sector operations both in South Africa and in other countries.
Public not private: Key to ending global poverty
Oxfam / WaterAid Press Release, 1 September 2006
Classrooms with teachers, clinics with nurses, running taps and working toilets: these basic public services are key to ending global poverty, according to a new report from Oxfam and WaterAid. And, the agencies say, only governments are in a position to deliver them on the scale needed to transform the lives of millions living in poverty. The report, “In the Public Interest”, calls on developing country governments to devote a greater proportion of their budgets to building these vital services for their citizens - and for rich countries to support their plans with increased, long-term aid commitment.
Public Policy and Franchising Reproductive Health: Current Evidence and Future Directions
World Health Organization, USAID and PSP-One: 25 October 2007
This Guidance Note is based on the proceedings of the meeting and offers policymakers and researchers the latest evidence on private-provider networks and franchises, lessons learned in the field, and policy recommendations on how to mobilise private-provider networks and health franchises to help address reproductive health care needs in developing countries. Recent evidence from sub-Saharan Africa indicates that about a third of all family planning methods are obtained through the private sector. For the poor, these expenses can be substantial, even catastrophic. Although specific public policy efforts regarding the private sector largely depend on individual country context, three broad approaches may be useful in guiding discussions: (i) Expanding healthcare access by engaging a range of private sector providers; (ii) Harnessing and organising existing private sector providers into a cohesive network to improve quality and ensure equity; (iii) Shifting the burden of public financing of private healthcare sector among those able to pay for its services.
Public Policy and Franchising Reproductive Health: Current Evidence and Future Directions
Huntington D, Sulzbach S, O’Hanlon B: WHO, 2007
The rapid growth of the private health sector in low-resource countries is widely recognized. Private providers commonly deliver a substantial proportion of health services in most settings, particularly outpatient primary care, that include reproductive health services. Whether the reason is convenience,proximity or the perceived higher quality and confidential nature of private healthcare providers, the fact remains that a considerable number of women turn to the private sector for their reproductive health needs. This Guidance Note is based on the proceedings of the meeting and offers policymakers and researchers the latest evidence on private-provider networks and franchises, lessons learned in the field, and policy recommendations on how to mobilize private-provider networks and health franchises to help address reproductive health care needs in developing countries.