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An end to the Public-Private ‘Civil War’ in Healthcare

Posted by Thomas Feeny

“The mistrust and suspicion that have characterised the public vs. private ‘civil war’ in healthcare must come to an end… it is time to work together in the interests of the patient.”

In a rousing address to delegates attending the first day of the regional conference on ‘Engaging with the Private Sector in Health in Africa’, Mr Khama Rogo of IFC Kenya reminded all those present that “this is no longer a time to point fingers, but for understanding”.

It would appear that the momentum in support of these sentiments has now reached a critical mass – at least at this conference – with speakers from both public and private sectors referencing numerous country-based initiatives of collaboration and goodwill. No less than 11 African countries have now established some form of Public/Private Partnership unit or office within their Ministries of Health, including South Africa and Uganda (2000), Ghana (2003), Senegal (2005), Nigeria and  Ethiopia (2007), Zambia (2008), Rwanda, Mozambique and Tanzania (2010), and Kenya (2012).

There is still a great deal of work ahead in building the capacity of these PPP units to put these policy commitments into practice through the initiation of dialogue and negotiation of partnerships. Yet, as elaborated by a panel of government PPP coordinators at the conference, the symbolic significance of their very existence remains a source of optimism.

The private sector has also been busy, mobilising different actors in this diverse group to generate the collective voice necessary to take its place at the policymaking and negotiation table. With the recent launch of the East African Healthcare Federation in Kampala, private health stakeholders in Tanzania, Kenya, Rwanda and Uganda have come together under one umbrella to advocate for policy change, and to champion their interests in the region. As is always the case in international development, the language is also evolving to follow suit, with speakers referencing the new PPP of ‘Private-Private Partnerships’ and heralding the replacement of the polarising label ‘for-profit’ with the more palatable ‘self-financing’ descriptor.

Of course, as one delegate reminded us, “we are here because of the problems, not the successes”. A change in lexicon or attitude may be a catalyst, but the level of change that is required is systemic and wide-reaching, as was recognised in the conference plenary discussions. Private sector umbrella bodies must avoid the very real risk of being dominated by the larger, more established companies if they are not able to successfully engage the smaller, local providers that comprise the fabric of healthcare provision in so many communities. The level of political (and financial) commitment underpinning the establishment of PPP units in Health Ministries is also uneven across the region, leading to markedly different levels of the skillsets and incentives required to negotiate partnerships where these may be appropriate.

At the very least, the vast majority of delegates at this conference appeared convinced that in the turbulent relationship between public and private stakeholders in healthcare, Africa is seeing the end of the ‘civil war’, and not just a ‘ceasefire’.

Click here to read the HANSHEP Blog from Day One of the conference.

Click here to read the HANSHEP Blog from Day Three of the conference.

This blog is written in the spirit of generating debate and discussion, and does not necessarily represent the views of the HANSHEP Group or its individual members.

May 15, 2012 12:00 AM | Comments (0)


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