People use a 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. Many encounters with health workers and suppliers of pharmaceuticals involve a cash payment. 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 with safety, efficacy and cost. This editorial of id21 insights explores some of the responses to these problems.
Public-Private Mix
Making health markets work for poor people
Editorial: Id21 insights 76, March 2009
Making health systems more equitable
Lancet 2004; 364: 1273-80
If access to health services were distributed according to need, the poor would come first. But they do not. Within developing countries disparities are less pronounced, and they vary greatly from place to place and from sector to sector within the health system. However, these disparities are almost always regressive, or pro-rich. This fact can be seen from the information available about the public and private components of health systems, and about specific services that health systems deliver. (requires registration)
Making public in a privatised world: The struggle for essential services
McDonald D: Zed Books, 15 February 2016
In the wake of recent widespread failures of privatisation efforts, many communities in the global south now seek new, progressive ways to revitalise the public sector. From rural Guatemalan towns holding the state accountable for public health to an alliance of waste pickers in India and decentralised solar electricity initiatives in Africa, people worldwide are rising up with innovative public service solutions to difficult issues. Making Public in a Privatised World explores such cases, with essays that uncover the radically different ways grassroots movements have proved themselves as successful alternatives in providing essential public services where privatised efforts have failed. Using numerous in-depth case studies, this book offers probing insights from a diverse range of contributors from across the world, including academics, activists, unionists, and social movement organisers. Making Public in a Privatised World addresses the growing worldwide interest in exciting alternatives to privatisation in both developed and developing countries.
Malawi govt backtracks on hospital user fees
Chauwa A: Nyasa Times April 5 2015
The Malawi government has said that medical services in all public health facilities will remain free. Minister of Health spokesperson Henry Chimbali told Nyasa Times that government has introduced by-pass fees [and not user fees] in referral hospitals in order to decongest the facilities. He also noted that the ministry will review the current arrangement between the Ministry and Christian Health Association of Malawi (CHAM) saying the current Memorandum of Understanding (MoU) dates back to 2002, is well overdue for review and needs to take into account some of the emerging issues that have taken place such as the passing into law of the new Act on Public Private Partnership Agreements (PPPs) which is the basis of the arrangement between the Ministry of Health and CHAM. The proposal is to work out a mechanism that will see greater access to quality health services by all Malawians especially those in rural and hard to reach areas. He also noted that the Ministry of Health seeks to establish a Health Fund to support health service delivery and widen coverage of medical insurance for those who can afford it.
MALAWI SUSPENDS PRIVATIZATION PROGRAMME
Malawian authorities said Monday the countrys privatisation programme had been suspended for review following a cabinet decision early this month. "It's a moment of soul searching. We want to look back at what we have done and see whether we are in the right direction," Charles Msosa, principal secretary for privatisation, told AFP. Malawi has privatised 36 of its 100 loss-making parastatals since the program begun in 1995.
MALAWI: Home based care eases pressure on public health sector
Faced with the devastating impact of an HIV/AIDS epidemic compounded by abject poverty, Malawians have eased the pressure on state hospitals by caring for chronically ill family and neighbours at home. A home based care (HBC) project in Northern Malawi has assembled 225 young volunteers in the region's nine districts to provide community based support to homes and guardians looking after people living with AIDS (PWAs). The aim is to ease their suffering and prolong their lives.
MALAWI: TOWARDS TOTAL PRIVATISATION
Often some government and donor officials have denied that Malawi will privatise nearly every lifeline. But progress indicates that the government intends to privatise institutions providing food security in Malawi, water, electricity and more. This will translate into the livelihood of the people being at the mercy of 'forces of the market'. This privatisation behaviour has been opposed by civil society, says this briefing from the Malawi Economic Justice Network.
Managing the public-private mix to achieve universal health coverage
Hanson K; McPake B: The Lancet, June 2016, doi: http://dx.doi.org/10.1016/S0140-6736(16)00344-5
The private sector has a large and growing role in health systems in low-income and middle-income countries. The goal of universal health coverage provides a renewed focus on taking a system perspective in designing policies to manage the private sector. This perspective requires choosing policies that will contribute to the performance of the system as a whole, rather than of any sector individually. This paper draws and extrapolates main messages from the papers in the Lancet series and additional sources to inform policy and research agendas in the context of global and country level efforts to secure universal health coverage in low-income and middle-income countries. Recognising that private providers are highly heterogeneous in terms of their size, objectives, and quality, the authors explore the types of policy that might respond appropriately to the challenges and opportunities created by four stylised private provider types: the low-quality, underqualified sector that serves poor people in many countries; not-for-profit providers that operate on a range of scales; formally registered small-to-medium private practices; and the corporate commercial hospital sector, which is growing rapidly and about which little is known.
Manto targets private health care
Fin24, 14 February 2008
Private health care has been specifically targeted for interventions by the health department in the coming year, according to South Africa Health Minister Manto Tshabalala-Msimang. She said the government was paying particular attention to 'improving accessibility and affordability of private health care.' The minister said that private hospitals were also agreeing to comply with the single exit price legislation with regard to the billing for anaesthetic gases which were previously overcharged. She said that the department was building on the progress made in regulating medicine prices to develop regulations that would allow the whole private health sector to be regulated.
Mapping global health partnerships: what they are, what they do and where they operate
Department for International Development Health Systems Resource Centre (DFID HSRC), 2004
This paper, from the DFID Health Resource Centre (HRC) aims to provide a common understanding of what Global Health Partnerships (GHPs) are, how they might be classified and how they operate. The document reviews definitions of GHPs, outlines a classification system used in the Resource Centre’s broader GHP project, describes the key findings, and provides a detailed list of GHPs with their missions, aims and/or objectives. It also details a global GHP mapping exercise, which examined prevalence or cases of specific diseases of interest to target GHPs, poverty, and political and health systems characteristics.