I posted this one to THDblog as well.
Richard Smith at the BMJ Blog wrote about last week’s Private Sector Health Systems conference [program PDF] in Wilton Park. The full text is at the BMJ, but here’s my summary. In many developing countries, the poor are much more likely to use private providers than public sector, if they use healthcare at all.
People in Bangladesh get 80% of their healthcare from the private sector. Across Sub-Saharan Africa it’s 60%, and the proportion is increasing. The poorer people are the more likely they are to receive private care, and the middle classes consume more publicly funded care than the poor…Much of the private care that the poor receive in developing countries is, of course, of low quality. It is often provided by unqualified practitioners and is undermined by corruption, but there are – a McKinsey study in Africa showed – “islands of excellence.”
As Smith points out, the private healthcare sector in many low-income countries isn’t the only sector with highly inconsistent healthcare quality.
government provided health care is also commonly poor, throughout Africa public health systems are derelict, and governments cannot fund, provide, and regulate care.
Smith’s intended audience of high-income country donors and policymakers may be reluctant to engage with private sector actors. Some caution is understandable but the need for practical solutions to dramatically improve healthcare provision leads to private sector mechanisms (for a good review of competitive contracting, performance-based finance and similar tools check out “Getting Health Reform Right” by Roberts, Hsiao, Berman, and Reich). The interesting thread I don’t hear as often, but have run across in my own work, is the challenge that low-income governments will have regulating the purchase of private sector healthcare. Smith’s post didn’t address it but the comments that followed did. The first response from Nigeria Health Watch blogger Chikwe Ihekweazu got to the point.
The major problem in many African countries in addition to the resistance of the concept is ‘management’ and ‘strategic thinking’ in the health sector. In Nigeria, where I am from, there is a proliferation of private health care facilities at all levels with no regulation, no accountability and no governance. …the private sector has a huge role to play…but only if there is the strategic leadership by governments to drive and regulate this.
As has been pointed out in the literature, private healthcare deals in volume in many low-income countries, but for these schemes to succeed governments need to lead and donors ought to be willing to invest in effective public management.
