Contracts can be used to govern the relationship between the public and the private sectors where the private sector delivers services on behalf of the state. On occasion, this allows the state to offer services such as basic medical provision where public sector provision does not reach. Researchers examine the case of primary care in South Africa where such contracts are being utilised. They argue that understanding the relationship between client and contractor requires a thorough understanding of some of the factors that govern the relationship, such as the role played by individual motivation.
Public-Private Mix
Contracting out: the case of primary care in South Africa
Contracting-out primary health care services in Tanzania towards UHC: how policy processes and context influence policy design and implementation
Maluka S; Chitama D; Dungumaro E; et al: International Journal for Equity in Health 17(118) 1-13, 2018
This paper reports on the design and implementation of service agreements between local governments and non-state providers for the provision of primary health care services in Tanzania. The authors used qualitative analytical methods to study the Tanzanian experience with contracting- out. Data were drawn from document reviews and in-depth interviews with 39 key informants, including six interviews at the national and regional levels and 33 interviews at the district level. The institutional frameworks shaping the engagement of the government with non-state providers are rooted in Tanzania’s long history of public-private partnerships in the health sector. Demand for contractual arrangements emerged from both the government and the faith-based organizations that manage non-state providers facilities. Development partners provided significant technical and financial support, signalling their approval of the approach. Although districts gained the mandate and power to make contractual agreements with non-state providers, financing the contracts remained largely dependent on external funds via central government budget support. Delays in reimbursements, limited financial and technical capacity of local government authorities and lack of trust between the government and private partners affected the implementation of the contractual arrangements. The authors indicate that Tanzania’s central government needs to further develop the technical and financial capacity necessary to better support districts in establishing and financing contractual agreements with non-state providers for primary health care services; and that forums for continuous dialogue between the government and contracted non-state providers be fostered to clarify the expectations of all parties and resolve any misunderstandings.
Council for Medical Schemes Annual Report 2012
South African Council for Medical Schemes: 2012
In this annual report, the South African Council for Medical Schemes details its support for the Department of Health in its efforts to strategically review the entire health system of South Africa. Council provided input to the technical sub-committees of the Ministerial Advisory Committee on the proposed National Health Insurance (NHI) system, and submitted a formal document on the NHI policy paper. Ever-escalating costs in the industry, which are driven by private hospitals and medical specialists, have always been one of Council’s concerns, and this financial year proved no different. This worrying trend of inflation-exceeding price increases in the private health sector has serious and negative implications for the well-being and sustainability of the entire health system. Council therefore continued to motivate for the establishment of a regulator to oversee the price determination of private healthcare provision. Council believes that a real need exists for a platform where medical schemes and healthcare providers can meet and negotiate prices for the benefit of all South African consumers. Private healthcare providers should also be regulated, specifically the hospitals and specialists. The practice where beneficiaries are exposed to unfair billing practices must be addressed.
Counting the cost of HIV in Southern Africa
Southern Africa is the region with the highest rates of HIV infection in the world. An estimated 9.4 million of the total population of 97 million were HIV-positive in 1999. What impact will the HIV/AIDS epidemic have on the provision of health services in the region? Is there any scope for improving access to highly active antiretroviral therapy (HAART) in low-income countries? A study by the International Monetary Fund warns that health services in southern Africa are already over-stretched. The current cost of providing health services to HIV patients accounts for a very large proportion of total health expenditure for most countries in the region. As the number of AIDS patients increases, the situation will deteriorate.
Criteria for evaluating evidence on public health interventions
Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
Criteria for evaluating evidence on public health interventions
L Rychetnik, M Frommer, P Hawe and A Shiell
Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
Critique of Oxfam paper inaccurate, unconstructive and ideologically biased
Stocking B: 7 April 2009
A primary objective of Oxfam’s new paper ‘Blind optimism’ is to encourage and advance an evidence-based debate on the appropriate role of the private sector in health care delivery in poor countries. Montagu’s response detracts from this important debate by misrepresenting the paper. Oxfam advises against investing in risky and unproven private -sector approaches to expand health care in poor countries. It is not the same as advocating that all engagement with the private sector should cease. Unchallenged enthusiasm for private sector solutions is neither justified nor helpful. Based on the evidence available, there is an urgent need for more honesty about the significant risks to efficiency and equity associated with private sector growth in health care, and more openness about the paucity of comprehensive evaluations of private sector approaches and the lack of evidence that these approaches can be scaled up properly.
Crowdfunding and global health disparities: an exploratory conceptual and empirical analysis
Kenworthy N: Globalisation and Health 15(70, Suppl 1), 1-10, 2019
The use of crowdfunding platforms to cover the costs of healthcare is growing rapidly within low-, middle-, and high-income countries as a new funding modality in global health. To map and document how medical crowdfunding is shaped by, and shapes, health disparities, this article offers an exploratory conceptual and empirical analysis of medical crowdfunding platforms and practices around the world. Data are drawn from a mixed-methods analysis of medical crowdfunding campaigns, as well as an ongoing ethnographic study of crowdfunding platforms and the people who use them. Drawing on empirical data and case examples, this article describes three main ways that crowdfunding is impacting health equity and health politics around the world: 1) as a technological determinant of health, wherein data ownership, algorithms and platform politics influence health inequities; 2) as a commercial determinant of health, wherein corporate influence reshapes healthcare markets and health data; 3) and as a determinant of health politics, affecting how citizens view health rights and the future of health coverage. Rather than viewing crowdfunding as a social media fad or a purely beneficial technology, researchers and publics must recognize it as a complex innovation that is reshaping health systems, influencing health disparities, and shifting political norms, even as it introduces new ways of connecting and caring for those in the midst of health crises. More analysis, and better access to data, is needed to inform policy and address crowdfunding as a source of health disparities.
CSOs voice concerns over corporate takeover of WHO
Raja K: Third World Resurgence, 298/299, 35-37, 2015
At the World Health Assembly in May, civil society organisations criticised the rich countries for refusing an increase in their assessed contributions to WHO and opposing actions by the agency which would be contrary to the interests of their corporations. THE Framework for Engagement with Non-State Actors (FENSA), initiated to safeguard the independence, integrity and credibility of the World Health Organisation (WHO), now seems to bear the threat of facilitating and legitimising corporate capture of the organisation, civil society groups have charged. 'Many proposals by rich countries in draft FENSA text [are] promoting corporate capture of WHO in the name of promotion of engagements without discussion on any comprehensive mechanism to avoid conflict of interest. These proposals, if accepted, would institutionalise the undue corporate influence on WHO,' said Lida Lhotska of the International Baby Food Action Network (IBFAN) in a press release. Over the last 20 years, the proportion of WHO's budget which is met through mandatory assessed contributions has fallen from 75% to 20%. This is a consequence of continuing new functions being added to the organisation and a continuing freeze on assessed contributions. The remaining 80% is met by voluntary donations, including from the rich countries, the World Bank and the Bill & Melinda Gates Foundation.
Current climate and prospects in Africa for Private-Public Partnerships in Health
Kistnasamy B: Network for Africa: Public-Private Linkages for Health, 7-10 May 2008
It is a myth that health in Africa is financed primarily by the public sector. About 36% of funding in Africa is from out-of-pocket payments, with 7% from other private sources and 27% from donors. Only 30% of African health care funding is public funding. In addition, 32% of healthcare access for rural Africans comes from the private sector, and 46% of doctors in sub-Saharan Africa work in the private sector. The for-profit private sector provides significant care for sub-Saharan Africans, across income groups, and this is expected to double by 2016. Since there are not enough resources in the public sector and governments cannot rely forever on development partners (donors) funds, Public/private partnership can help expand the pool of human resources.