Planning and market regulation: strengths, weaknesses and interactions in the provision of less inequitable and better quality health care

This paper argues that planned health care provision and market regulation play distinct roles in relation to the effective provision of equitable health care. Governmental planned provision has as a core objective ensuring that the health system is redistributive and that the poor have access to competent care. Market regulation has as its central objective the shaping of the role and behaviour of the private sector within the health system. Management of the health system as a whole, which is a governmental responsibility, therefore requires the integration of planning and regulation in a manner appropriate to each particular context

Open University Submission : House of Commons International Development Select Committee : Inquiry into Health System Strengthening

DFID’s support for health systems strengthening (HSS) in low income countries (LICs) is welcomed. Our response addresses the following aspects of Committee’s questions concerning the effectiveness of DFID's current approach to HSS: DFID's support for the six building blocks of health system strengthening; DFID's role in ensuring better balance between rural and urban healthcare; and the UK's work with other development agencies, partner governments, communities and civil society on health system strengthening

The ‘Skills Drain’ of Health Professionals from the developing World:a Framework for Policy Formulation

This paper examines policy towards health professionals’ migration from economic and governance perspectives

Can NGOs Regulate Medicines Markets? Social Enterprise in Wholesaling, and Access to Essential Medicines.

Citizens of high income countries rely on highly regulated medicines markets. However low income countries' impoverished populations generally struggle for access to essential medicines through out-of-pocket purchase on poorly regulated markets; results include ill health, drug resistance and further impoverishment. While the role of health facilities owned by non-governmental organisations (NGOs) in low income countries is well documented, national and international wholesaling of essential medicines by NGOs is largely unstudied. This article describes and assesses the activity of NGOs and social enterprise in essential medicines wholesaling. The article is based on a set of interviews conducted in 2006-8 with trading NGOs and social enterprises operating in Europe, India and Tanzania. The analysis applies socio-legal and economic perspectives on social enterprise and market regulation. Trading NGOs can resist the perverse incentives inherent in medicines wholesaling and improve access to essential medicines; they can also, in definable circumstances, exercise a broader regulatory influence over their markets by influencing the behaviour of competitors. We explore reasons for success and failure of social enterprise in essential medicines wholesaling, including commercial manufacturers' market response; social enterprise traders' own market strategies; and patterns of market advantage, market segmentation and subsidy generated by donors. We conclude that, in the absence of effective governmental activity and regulation, social enterprise wholesaling can improve access to good quality essential medicines. This role should be valued and where appropriate supported in international health policy design. NGO regulatory impact can complement but should not replace state action

Submission to the United Nations Secretary General's High Level Panel on Access to Medicines

Much of the current debate on health care goals, medical innovation and trade rules focuses on the misalignment between the need to provide incentives to innovation – mainly through a tight intellectual property (IPR) regime – and the resulting negative consequences in terms of access to medicines. While this clash is certainly crucial, this contribution focuses on a different aspect of the misalignment between innovation and access, concerning essential drugs and generics rather than brand new, innovative drugs. This contribution argues that the promotion of domestic drug production and innovative capabilities in low and middle income countries, and notably on the Sub-Saharan African subcontinent, can may constitute an important step towards achieving significant improvements in public health – as a human right that includes access to essential medicines. We provide background and evidence for this argument. We then draw out policy implications, arguing that increased policy coherence between health policies for medicines access and public health, and industrial and trade policies for Africa-based pharmaceutical production and innovation, are both feasible and beneficial, generating synergies between improved medicines access and local industrial innovation

Health as a Productive Sector: Integrating Health and Industrial Policy

Health care is often represented as a purely “social” sector, implying that health care expenditure is a burden on the economy. We argue in this paper that on the contrary, health care is economically productive, and that health care in Tanzania could be much more economically and socially productive if health policy and industrial policy were more closely integrated. Increasing the depth and breadth of domestic economic linkages between the health services and industrial and commercial suppliers within the Tanzanian economy can strengthen economic development while improving health care. The paper begins by defining what we mean in this paper by “health services”, “health care” and “health sector”. It then examines the economic size of health care (production and financing), the employment it generates, and its linkages to the wider economy through procurement and wholesaling. It demonstrates that the health sector, broadly defined, is economically important as a major service sector, a location of investment, a generator of employment and income, a sector of skilled training and employment, and a location for industrial growth. The health of the health sector is very important for the health of the wider economy. The rest of the paper analyses the linkages between health care and manufacturing in Tanzania in more detail. It traces the declining share of local manufacturers of medicines and other health supplies in the expanding Tanzanian domestic market, quantifies the scale of this missed opportunity for industrial development to supply the needs of health care, and examines its causes. Finally, the paper looks at the scope for integrating health and industrial policy, arguing that reconstruction of these domestic economic linkages is both possible and desirable. Health policy strongly influences industrial development. Furthermore, the Tanzanian public health services suffer severely from shortages of essential supplies. We argue that it is possible for economic and social policy, working together, to strengthen and deepen economic ties within the economy, to the benefit of both the effectiveness of health services and public health, and manufacturing employment and development

Payments and Quality of Ante-Natal Care in Two Rural Districts of Tanzania

This paper surveys women’s experiences with payments for ante-natal care (ANC) and associated issues of quality in two rural districts of Tanzania. We draw on quantitative and qualitative data from interviews in facilities and in households in the two districts to explore these issues, and discuss some policy implications. The paper provides evidence of payments for ANC in the two rural districts. Striking differences in payments between the two districts were observed, apparently reflecting variation in charging practices in different parts of the districts. In the areas surveyed in one district, women were paying little, in both faith-based organisations (FBOs) and in the public sector. In the other district, charges were much higher in facilities that women had attended, including a district hospital and a public dispensary that seemed to have gone into business on its own account. We explore to what extent these higher charges were associated with better-quality care: The women in the higher-charging district had in general received somewhat higher levels of service than the women interviewed in the lower-charging district, with the notable exception of a low-charging FBO-owned hospital that was succeeding in combining low and predictable charges with good services. In both districts, we found few reports of abuse at the ANC level – this appears to be more a problem at birth. The main quality issues at this level are lack of basic ANC services in some of the public health facilities, and having to pay for ANC even in some of the public facilities where these services are supposed to be provided for free. However, the problem of supply shortages seems to have generated a system of informal charging in some contexts. Sale of assets and borrowing to pay for ANC means impoverishment in order to access a payment-exempted service. We also found that health insurance appears to be creating or supporting a culture of charging for ANC. ANC accessible to all women is a key requirement for improved maternal survival. The findings discussed in this paper suggest the need for a more concerted effort to implement effectively strategies that are already in place, and to come up with other alternative strategies that may result into better outcomes. Such strategies should not be considered in isolation, but should be part of effective strategies to improve all aspects of maternal health. Furthermore, an emerging problem needs to be looked into, and appropriate action taken. Health insurance, which is intended to promote access to health care for the poor, seems in this case to be creating a contrary effect by exacerbating the problem of payments for services that should be exempted from payment.\u