Privatizing Health Services In Africa

Privatizing Health Services in Africa analyzes the disappearance of public health in the form of state services in Africa, and the growth of a private market in health care that will serve primarily an urban elite. Meredeth Turshen considers the implications of introducing private insurance in countries with growing unemployment, a shrinking formal job sector, and a lack of social security programs or other safety nets. She debates the pros and cons of shifting the delivery of health services to the nongovernmental sector in the context of new concepts of the role of the state. Many of the schemes to privatize the purchase and sale of pharmaceuticals reverse decades of United Nations work challenging the power of the multinational drug industry. Turshen weighs these policy changes in light of the World Bank's eclipse of the World Health Organization as the premier UN health policy agency. Until now, no book has disputed the World Bank's plans to privatize health care in Africa. This is the first book-length analysis of policy changes in light of monetarism and globalization. Throughout the book, Turshen examines the implications of privatization for gender equity. She also provides a case study of Zimbabwe and comparative material from Malawi, Mozambique, and Zambia. Her study makes a contribution to current debates on the impact of structural adjustment policies on health and the design of health services in the Third World.

Since the private health sector is an important, and often dominant, provider of health services in Sub-Saharan Africa, it is the job of governments as the stewards of the health system to engage with it. Increasing the contributions that the existing private health sector is making to public health is an important, but often neglected, element of meeting the daunting health-related challenges facing African nations. This Report presents newly collected data on how and how effectively each country in the Africa region is engaging the respective private health sectors; and how the engagement compares across the region. While the approach taken by governments varies greatly between countries, there is much room for improvement in the Africa region overall to engage more effectively and room for exchange of ideas and good practices on how to do so. Improved solutions on the policy/regulatory side should be supported by effective organization of the private sector itself and by adjustments in donor programs that take the dynamics of the private health sector better into account.

Drawing on various disciplinary perspectives, this book re-focuses the debate on what makes a good health system, with a view to clarifying the uses of social science research in thinking about health care issues in Africa. The explosion of the HIV/AIDS pandemic, the persistence of malaria as a major killer, and the resurgence of diseases like tuberculosis which were previously under control, have brought about changes in the health system, with implications for its governance, especially in view of the diminished capacity of the public health facilities to cope with a complex range of expanded needs. Government responsibilities and objectives in the health sector have been redefined, with private sector entities (both for profit and not-for profit) playing an increasingly visible role in health care provisions. The reasons for collaborative patterns vary, but chronic under-funding of publicly financed health services is often an important factor. Processes of decentralisation and health sector reforms have had mixed effects on health care system performance; while private health insurance markets and private clinics are pointers to a growing stratification of the health market, in line with the intensified income and social differentiation that has occurred over the last two decades.These developments call for health sector reforms.

In much of sub-Saharan Africa, governments have demonstrably failed to deliver health services to the poor. In some places, governments and donor agencies have contracted with private companies and non-profits to deliver health services, with considerable success. Ideologically driven Western NGOs oppose further moves towards private provision - seemingly preferring the poor to suffer substandard and erratic government provision than to obtain their healthcare through non-state means.

Since the private health sector is an important, and often dominant, provider of health services in Sub-Saharan Africa, it is the job of governments as the stewards of the health system to engage with it. Increasing the contributions that the existing private health sector is making to public health is an important, but often neglected, element of meeting the daunting health-related challenges facing African nations. This Report presents newly collected data on how and how effectively each country in the Africa region is engaging the respective private health sectors; and how the engagement compares across the region. While the approach taken by governments varies greatly between countries, there is much room for improvement in the Africa region overall to engage more effectively and room for exchange of ideas and good practices on how to do so. Improved solutions on the policy/regulatory side should be supported by effective organization of the private sector itself and by adjustments in donor programs that take the dynamics of the private health sector better into account.

This book focuses on Africa’s challenges, achievements, and failures over the past several centuries using an interdisciplinary approach that combines theory and fact and evidence-based practices and interventions in public health, and argues that most of the health problems in Africa are not a result of scarce or lack of resources, but of the misconceived and misplaced priorities that have left the continent behind every other on the globe in terms of health, education, and equitable distribution of opportunities and access to (quality) health as agreed by the United Nations member states at Alma-Ata in 1978.

This paper examines the promise and challenge of infrastructure privatization in sub-Saharan Africa, with particular emphasis on power, telecommunications, water, rail, ports and airports. The paper places primary emphasis on mobilizing private investment in infrastructure. To realize the potential of infrastructure privatization in sub-Saharan Africa, four main challenges must be addressed: a) concerns over market size, affordability and payment risks; b) establishing adequate legal and regulatory frameworks; c) dealing with non commercial risks; and d) mobilizing local finance. The paper examines these four areas and gives elements of a future strategy for the World Bank Group.