This background paper by Adetokunbo Lucas describes how collaboration between the public and private sectors can be productive and successful, providing opportunities to achieve goals that could not be achieved by either sector working alone.
Public-Private Mix
Public-private partnerships: illustrative examples
Public-Private partnerships: Monitoring the effects on healthcare
Aids, malaria, tuberculosis and other infectious diseases have reached enormous proportions in many developing countries. Efforts to control and eradicate these diseases are extremely complex. Increasingly, global public-private initiatives are set up to address these issues. The question is whether global public-private initiatives are the most appropriate approach, and whether such partnerships can really serve the direct interests of the people. Public-private cooperation is a relatively new phenomenon, but it has already gained considerable ground.
Public-private partnerships: Whose interests do they serve?
Babymilkaction.org: December 2008
Danone, the world’s second largest baby food company, now sits on the governing body of the Global Fund for Improved Nutrition (GAIN). But there is no mention of Danone’s interest in baby foods on the GAIN website nor any mention that it is a systematic Code violator. GAIN claims to be working to improve nutrition by building markets for fortified foods in the developing world and has now launched a project on infant and young child nutrition. Concerned about this unacceptable conflict of interest, 53 experts from 24 countries, attending the World Alliance for Breastfeeding Action (WABA) workshop in October, have written to WHO and UNICEF calling on them to reconsider their partnership with GAIN. GAIN is bound to undermine breastfeeding and the use of indigenous, traditional and low-cost foods, they say.
Public/Private partnerships and mobilising resources
World Economic Forum
The United Nations-sponsored Financing for Development conference in Monterrey in 2002 concluded that greater cooperation between public and private actors will be required to overcome the inadequacies of development finance and achieve internationally agreed development goals. As a follow-up to this conference, the World Economic Forum's Global Institute for Partnership and Governance in cooperation with the UN Department of Economic and Social Affairs (UNDESA) and the Swiss Agency for Development and Cooperation (SDC) convened a series of nine separate practitioner-driven, multistakeholder roundtable discussions during the period 2004-05. These two day expert roundtables, supplemented by individual meetings and other research, sought to identify where the greatest opportunities and obstacles lay.
Public–private partnerships for health:
their main targets, their diversity, and their future directions
Roy Widdus, Public–Private Partnerships for Health, Global Forum for Health Research
Bulletin of the World Health Organization, August 2001, 79 (8)
A large variety of public–private partnerships, combining the skills and resources of a wide range of collaborators, have arisen for product development, disease control through product donation and distribution, or the general strengthening or coordination of health services. Administratively, such partnerships may either involve affiliation with international organizations, i.e. they are essentially public-sector programmes with private-sector participation, or they may be legally independent not-for-profit bodies. These partnerships should be regarded as social experiments; they show promise but are not a panacea. New ventures should be built on need, appropriateness, and lessons on good practice learnt from experience. Suggestions are made for public, private, and joint activities that could help to improve the access of poor populations to the pharmaceuticals and health services they need.
Putting policy into practice: can local government cope?
Increasingly, the debate over private sector involvement in the delivery of urban water services is addressing pro-poor policies and transactions. Yet, improvements in policy are not being accompanied by support for implementation and little emphasis is being placed on how local governments will cope with such complex processes. What capacity do municipalities need to make policy frameworks work in practice? How do municipalities change from 'providers' to 'enablers' and 'promoters'? How do municipalities focus partnerships on the poor?
REGULATING FOR DEVELOPMENT
Developing countries are now being asked to follow developed countries in the privatisation of goods and services previously provided by the state. It is argued that these countries will gain from the creation of efficient markets which offer their best chance to establish competitiveness, leading to economic growth. But critics claim that privatisation damages the quality of public services and undermines public accountability. Conventional forms of regulation address these two issues; but is it also possible to regulate for development that reduces poverty?
Regulating private health insurance to serve the public interest: policy issues for developing countries
Sekhri N, Savedoff W: The International journal of health planning and management 21(4): 357-392
Private health insurance plays a large and increasing role around the world. This paper reviews international experiences and shows that private health insurance is significant in countries with widely different income levels and health system structures. It contrasts trends in private health insurance expansion across regions and highlights countries with particularly important experiences of private coverage. It then discusses the regulatory approaches and policies that can structure private health insurance markets in ways that mobilize resources for health care, promote financial risk protection, protect consumers and reduce inequities. The paper argues that policy makers need to confront the role that private health insurance will play in their health systems and regulate the sector appropriately so that it serves public goals of universal coverage and equity.
Regulating the for-profit private health sector: lessons from East and Southern Africa
Doherty J: Health Policy and Planning 30(suppl 1), i93-i102, 2014
This article explores the areas of likely comparative advantage of the private sector in delivery of health care services for public health goals. It finds that there is a considerable body of evidence on the private provision of healthcare in low- and middle-income countries, often focusing on SSA. However, the evidence base is not robust. Evidence is often mixed and sometimes conflicting and policy implications are unclear. The arguments in favour of private healthcare suggest it is more responsive and efficient, while arguments in favour of public services suggest they are more equitable and better equipped than the market to respond to health needs. Some studies find that the private sector is unregulated, has financial incentives for inappropriate healthcare, and is expensive. There is very little evidence on the comparative cost-effectiveness of the private sector. This varies considerably across country contexts and types of services. There is no conclusive evidence that the private sector is more cost-effective or more efficient than the public sector. The literature warns that increased use of private services may crowd out or decrease the funding available to the public sector. The major criticism of private sector services is that their higher user fees create inequality of access, limiting their use by the poor. The author suggests that the literature is quite clear that private for-profit health services create inequality. Private non-profit, or services run by NGOs, appear to mitigate some of the inequality effects. In practice, boundaries can be blurred between public and private; both formal and informal cost recovery schemes operate at public facilities. NGOs providing healthcare are generally seen as private, although they may not charge for their services. It is observed that the difference between free-at-the-point-of-use NGOs and out-of-pocket-expenditure on private doctors can be enormous, and that it is important to differentiate between the types of providers when reviewing the evidence on private health care.
Removing user fees for primary care in Africa
User fees are once again a topic of hot policy debate in Africa. They were introduced relatively recently in many countries, but the current call is for their removal, particularly at primary care level. As analysts who have consistently argued against user fees, we broadly support this call. However, we recognise that this action cannot be introduced overnight and, if weakly implemented, may exacerbate the problems facing African health systems.