1. Can the Private Sector Work for Public Goals? Mohga Kamal-Yanni @MohgaKamalYanni www.globalhealthcheck.org

2. Yes Yes private sector can play very important role in health outcomes Paying tax so govt revenue increases and health spending increases Roads: so pregnant women can go for ANC,.. Mobile and other technology Pharmaceutical Specific projects : training, capacity for financial management /planning.. What about service delivery?

3. What is private sector?

4. 1. Better Quality? “Thousands of Indian women are having their wombs removed in operations that campaigners say are unnecessary and only performed to make money for unscrupulous private doctors” http://www.bbc.com/news/magazine-21297606 Systematic review found no evidence to support this(Basu et al 20120) Systematic review of malaria treatment: CHWs offered better quality (http://www.malariajournal.com/content/11/1/414)http://www.malariajournal.com/content/11/1/414 The only NHS hospital run by private firm provides ‘poor’ care, inspectors say-UK (Independent 26.9.14)

5. 2. Efficiency? Source: UNITAID Sales of ACTs v Clinical needs In Chile –High PS provision- world’s highest rate of birth by CS

6. 3. Equity? “I asked how much it will cost to have cataract operation? They told me it would cost 7000 pounds. I had 7 pounds in my pocket so I decided to go blind” Poor patients receive far worse quality of care than rich people (Laos, Bangladesh,..) Creation of 3 tiered systems:

7. 4. Relieve/complement public sector? RSA: majority of private medical schemes members receive higher govt subsidy via tax exemption than users of publicly provided service Internal brain drain Lesotho PPP hospital: 51% of health budget, at least 3 x cost of old hospital “but big doctors do not want public hospitals to improve. As long as public service is bad, patients will continue to go to the private clinics and pay as told”

8. So in conclusion PS can contribute to public health apart but not in service delivery Countries that achieved or made great progress towards achieving UHC relied mainly on a strong public sector. Given the scarcity of resources where do you put the money to achieve effective efficient equitable health care?

9. Resources A dangerous diversion https://www.oxfam.org/sites/www.oxfam.org/files/bn- dangerous-diversion-lesotho-health-ppp-070414- en.pdf Investing for the few https://www.oxfam.org/sites/www.oxfam.org/files/file_a ttachments/bn-investing-for-few-ifc-health-in-africa- 100914-en.pdf Never again: Building resilient health systems and learning from the Ebola crisis https://www.oxfam.org/sites/www.oxfam.org/files/file_a ttachments/bp-never-again-resilient-health-systems- ebola-160415-en.pdf

10. Thank you www.globalhealthcheck.org

11. Principles for public-backed private finance Partnership and project principles 1.Adhere to development effectiveness principles 2.Show additionality and value for money 3.Share risk and minimise debt 4.Ensure transparency, accountability and participation 5.Ensure good corporate governance Sustainable development principles – maximise benefits: 1.Poverty alleviation and social development 2.Equitable environmental sustainability 3.Inclusive and sustainable economic development