1. Scaling up to achieve health care for all Anna Marriott 1 June, 2010

2. Oxfam Papers: Health Insurance in low-income countries. Where is the evidence that it works (Joint Paper: 2008) Blind Optimism: Challenging the Myths about Private Health Care in Poor Countries (Oxfam 2009) Your Money or Your Life: Will Leaders Act Now to Save Lives and Make Health Care Free in Poor Countries? (Joint Paper, Over 60 Organisations 2009)

3. Health Financing Don’t work: Private health insurance Private for-profit micro health insurance Community based health insurance Have potential but no evidence for poor countries: Social health insurance (mandatory tax subsidization, per capita >$2000) Has worked at all income levels: Tax based funding – free/nominal payments at point of delivery

4. Blind Optimism Challenging the myths about private health care in poor countries

5. Six arguments for private provision currently majority provider in many countries and should therefore be at the heart of scaling-up; can take strain off public health services; is more efficient; is more effective and of better quality; can reach the poorest; can improve accountability through competition

6. Argument one Because the private sector is already significant, it will be key in scaling up

7. ‘A poor woman in Africa today is as likely to take her sick child to a private hospital or clinic as to a public facility.’ IFC: The Business of Health in Africa, 2007

8. Malawi: Private health-care providers for poorest fifth of population Based on data from the Malawi Demographic and Health Survey (2000)

10. What about those who have no access? India: Private sector provides 82% of outpatient care (IFC) But 50% of women have no medical assistance whatsoever during childbirth Proportion says nothing about fulfillment of right to health

11. Argument two Private sector is more efficient and can help reduce costs

12. Lebanon and Sri Lanka Privatized Lebanon spends twice as much per capita as public Sri Lanka Yet infant mortality is 2.5 times higher And maternal mortality is 3 times higher

13. Argument Three Private sector can improve quality of care and accountability to patients

14. Argument Four Private sector can help reach the poor

15. Private Care in China and Vietnam Substantial increase in rural people reporting illness but not using health services Increase in unattended home deliveries Delay of care, particularly for women and girls Chinese reforms now being reversed

16. The public alternative

17. Public failure? Many domestic factors contribute to poor performance –Political will –Technical capacity –Corruption Also role of donors –SAP legacy –Tiny proportion of aid to budget support –Side effects of vertical initiatives

18. Advantages of public provision Economies of scale Easier to regulate quality Redistributive capacity (to reach poorest) Public ethos of service And longer-term: –Builds government legitimacy

19. Public success stories Old ones: –Kerala –Sri Lanka –Botswana –Caribbean & Pacific islands –Cuba More recent ones: –Timor Leste –Eritrea

20. Where’s the difference? In public or private provision?

22. Download “Blind Optimism” at: www.oxfam.org PUBLIC FIRST