Chapter 6: Addressing the failings of public health systems: should the private sector be an instrument of choice?
Arguments about an increased role for the private sector in the health systems of low- and middle-income countries (in terms of both the funding and the provision of health services) have been taking place since the 1990s. The debate intensified in 2007 with the release of a report by the International Finance Corporation of the World Bank Group. Titled The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives, the report remains one of the most fervent expositions to date in favour of the commercial sector. It went as far as to suggest that, in order to strengthen their health systems, African governments and donors should facilitate private sector expansion through more business-friendly policies and even subsidize private sector initiatives. This chapter uses the example of the health sector to highlight some of the issues that confront analysts of social policy when thinking through how to harness the strengths of the private sector in the service of social objectives. It also reflects on the contextual differences between low- and middle-income countries (LMICs) on the one hand, and high-income settings on the other, that affect the policy choices in this area. Examining these issues is important because of the current international focus on universal health systems. The 2010 World Health Organization report, titled Health Systems Financing: The Path Towards Universal Coverage, defines the core of universal coverage as providing financial protection from the costs of health care, as well as access to needed health services, for the entire population.
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