Greetings from Washington Dulles Airport. I am packed-up and heading home after four whirlwind days at the International Conference on Global Health.
My “Best Panel Award” goes to a session today on private-public partnerships. It was based more on research than some of the other sessions and the panellists presented some thought-provoking conclusions.
One presentation was on a confidential perceptions survey of international health stakeholders (private/ public/ government/ donor). The findings showed that the vast majority of public health professionals have a highly negative attitude towards the private sector, reporting that the private sector is:
- unwilling to collaborate
- profit-driven
- not health system strengthening.
At best, the private sector is seen as a means to an end: a short-term solution to compensate for overburdened government services. An underlying ideological scepticism leads to the belief that the private sector should not be trusted. This viewpoint is particularly common in Europe and Africa.
The survey also revealed that the private sector is generally fearful of government interference and considers government to be inefficient, corrupt and lacking in capacity. Mutual scepticism prevails.
So what is or should the role of the private sector be in the provision of health services? What form should the relationship between government and private providers take?
The panellists argued strongly that the government should play a stewardship role over private healthcare providers in a mixed health system. Their rationale is as follows: private providers are here to stay and are an important component of most health systems in low-income countries. However, an unregulated sector poses serious problems and therefore government should play a role in monitoring and controlling the private sector.
But the studies presented suggest that this is a long-term vision due to information, political and administrative barriers which prevent most national governments from assuming this stewardship role. In the short-term, the two most promising strategies are:
- Encourage independent organisations to develop networks of private providers through accreditation and quality assurance.
- Foster the development of professional organisations which can set standards.
The first point is pretty much what we are doing at MSI with our social franchising programme. By training and monitoring private providers, MSI is providing this interim support and maybe one day government could take over the regulation part. For me, the session really helped me understand how we as an INGO fit in with both the private and public sectors in order to build an integrated health system.
The final session of the day was also strong. It was all about product registration and procurement bottlenecks. Not exactly the sexiest of topics but a shocking and neglected issue in international health. One of the panellists talked about trying to register generic ARVs for HIV treatment in Botswana.
At the time, there was a backlog of over 2000 dossiers for registering different drugs. Each dossier took 30 hours to review and because there were three paper copies of each submission, the paperwork took up six entire offices. There was only one staff member to review the dossiers and he/she lacked any specialised training.
The panellist was part of a team which went in and prioritised 400 key dossiers and set up a system to process the backlog. As a result, all the priority dossiers were approved in six months and the price of ARVs dropped six times as cheaper generics became available.
FHI presented on their attempts to register Sino-implant (II) in 14 countries. MSI is leading registration in seven of these countries, having successfully registered the product in Kenya. Traditionally, implants have cost about $10 per year but with this cheaper Chinese version, the costs will be 70% lower. Despite the potential for massively increasing access, the national registration process remains time-consuming and complex.
Well, that is it from me. Until next time.