Kenyan pharmacists are taking advantage of government-subsidised anti-malarial medications to maximise their profits, according to this article. Media reports from different parts of the country, including rural areas, revealed that retail prices of the subsidised anti-malarial drugs varied from 80 KES (US$1) to 240 KES ($3). Some private pharmacists claimed that they inflated the price to cover distribution costs and other inputs, while many do not stock the subsidised drugs, as profits from subsidised medications were considered too marginal. In order to reduce instances where pharmacists are inflating the cost of the subsidised drugs, the Kenyan government has embarked on awareness campaigns through the media to inform Kenyans of the availability of the drugs, and the recommended prices per dose. Technically, the government of Kenya does not have control over drugs sold in pharmacies in the private sector because the pharmaceutical market in the country is based on ‘a willing seller, willing buyer’ concept, but the author argues that this does not appear to be working for poor consumers.
Public-Private Mix
The authors reviewed the market strategies deployed by processed food manufacturers to increase and consolidate their power from a systematic review of public health, business, legal and media content databases and of grey literature. The market strategies identified related to six interconnected objectives: i) reducing competition with equivalent sized rivals and maintaining dominance over smaller rivals; ii) raising barriers to market entry by new competitors; iii) countering the threat of market disruptors and driving dietary displacement in favour of their products; iv) increasing firm buyer power over suppliers; v) increasing firm seller power over retailers and distributors; and vi) leveraging informational power asymmetries in relations with consumers. The authors note that analysing such market strategies promoting unhealthy foods helps to identify countervailing public policies, such as those related to merger control, unfair trading practices, and public procurement, as part of efforts to improve population diets.
Poverty is a major factor in the continuing burden of malaria in sub-Saharan Africa. The gross national product (GNP) per capita is around US$306, or less than $1 per day. On average, these countries spend less than $20 per head of population per year on health care. Patients urgently need new therapies to combat malaria. However, malaria is not an economically viable disease for drug developers and new antimalarials are therefore usually developed within public–private partnerships.
Medical aid coverage is lowest among black South Africans, with only 7,4% of individuals covered, and highest in the white population, with a 66,5% coverage, Statistics SA said on Thursday. In the general population, 79,7% of those who were ill or injured consulted a health worker, according to the General Household Survey for 2007. The survey has been conducted annually since 2002. More individuals who used public-sector healthcare facilities were satisfied with the service they received in 2007 (87,6%) than in 2006 (84,2%) and in 2002 (81,6%). In the private sector, satisfaction levels increased slightly from 95,35% to 96,5% between 2002 and 2007.
Each year 100 million people slide into poverty as a result of medical care payments. Another 150 million people are forced to spend nearly half their incomes on medical expenses. That is because in many countries people have no access to social health protection - affordable health insurance or government-funded health services. Paradoxically, people in the world’s poorest countries contribute relatively more for health care than those in wealthy industrialized nations. In Germany, for example, where the average GDP per capita is US$ 32 860 and almost everyone has social health protection, 10% of all medical expenses nationwide are borne by households.
Medical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. The authors draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts.
"This paper reviews the current status of the global pharmaceutical industry and its research and development focus in the context of the health care needs of the developing world. It will consider the attempts to improve access to critical drugs and vaccines, and increase the research effort directed at key public health priorities in the developing world. In particular, it will consider prospects for public-private collaboration. The challenges and opportunities in such public-private partnerships will be discussed briefly along with a look at factors that may be key to success. Much of the focus is on HIV/AIDS where the debate on the optimal balance between intellectual property rights (IPR) and human rights to life and health has been very public and emotive."
Despite the significant adverse social and economic costs of mental illness, psychiatric and related services receive a low level of priority within the health care system. A public–private mental health leadership initiative, emanating from a patient access to care programme, was developed to build leadership capacity within the South African public mental health sector. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants’ daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included with personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. Participants acquired both skills and the confidence to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum for specialist training.
While African governments, such as Zambia, are often singled out as grossly corrupt, not enough is said about corporate tax ‘avoidance’ on the part of mining companies, which costs the nation billions of US dollars annually, according to this article. And the much-lauded Extractive Industry Transparency Initiative (EITI) is not helping, the author argues. The EITI standard is meant to ‘facilitate transparency’ by assessing net discrepancies between resource rents - royalties and taxes remitted by multinationals and received by governments. In 2010, Zambia published its EITI report, disclosing payments from mining companies for the year 2008. It revealed that mining companies remitted US$463 million in payments to the government in 2008, with ‘significant discrepancies’, noting a net total of ‘unresolved discrepancies’ of $66 million. Tax havens such as Switzerland are essential to resource-seeking corporations operating in Africa, the author of this article argues, and she estimates more than 85% of asset portfolios for sub-Saharan Africa passes through tax havens. She concludes that EITI’s figures for revenue leakage are underestimated by billions because it does not consider what multinationals ought to have paid Zambia, and it never investigates the means through which corporations were able to circumvent taxation.
Pax is a private sector rural manufacturing enterprise in Edo State Nigeria that is a joint endeavour of the monastic and local communities. It has professionalised the production of traditional natural remedies to demonstrate that herbal medicines can be a force for innovation and progress in health care. An estimated two-thirds of Nigerians are reported in this paper to use these products, often in tandem with other medicines. The company holds that open dialogue, scrutiny and regulation are crucial if the economic potential of the sector is to be realised, and that traditional medicine must be modern, professional and based on science if it is to contribute to improving health systems and outcomes. More than 30 Pax products are reported to be government-certified. The paper argues that traditional medicine and pharmaceutical industries could be fostered in Nigeria; but that indigenous knowledge, resources and enterprise still remain under-exploited.