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Key Text Blind Optimism: Challenging the Myths About Private Health Care in Poor Countries

Author: Oxfam
Date: 2009
Size: 55 pages (372 KB)

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Summary

The realisation of the right to health in poor countries depends upon a massive increase in health services to achieve universal and equitable access. A growing number of international donors are promoting an expansion of private-sector health-care delivery to fulfil this goal. This briefing paper from Oxfam contends that while the private sector can play a role in health care, prioritising this approach is extremely unlikely to deliver health for poor people. Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide.

Despite the poor performance of private sector-led healthcare solutions over the past two decades, there has recently been a noticeable increase in efforts by international donors and organisations to encourage and fund an expansion of health-care by the private sector. The approach is promoted not only as a matter of ‘common sense’ but as essential to reverse the lack of progress in health-care and to save the lives of poor people. There is considerable and increasing evidence, however, that there are serious failings inherent in private provision which make it a very risky and costly path to take.

While the private sector may currently be a significant provider in some poor countries, it does not necessarily follow that it is meeting the needs of the poor and filling the health gap.
The private sector does not always bring greater investment to the health system. On the contrary, attracting private sector providers often requires significant public subsidy.
Far from being more efficient, private participation in health-care is generally associated with higher per capita expenditure, leading sometimes to perverse outcomes.
There is a lack of evidence that private sector provision is of superior quality than publicly provided healthcare.
Private provision can increase inequity of access because it naturally favours those who can afford treatment.
There is no evidence that private health-care providers are any more responsive or any less corrupt than the public sector.

In short, the evidence in favour of private-sector solutions is weak. Making public health services work remains the only proven route to achieving universal and equitable health-care. Public health systems can take advantage of economies of scale, standardised systems for regulation and improving quality, and, most importantly, the legitimacy and capacity to redistribute resources and reduce inequality.

This is not to understate the scale of the challenge facing public health systems. In tackling some of these issues, there can and should be a role for the private sector, but to achieve universal and equitable access to health-care the public sector must be made to work as the majority provider. As such, donors should:

Rapidly increase funding for the expansion of free universal public health-care provision in low-income countries, ensuring that aid is coordinated, predictable, and long-term, and where possible, is provided as health sector or general budget support
Support research into successes in scaling-up public provision, and share these lessons with governments
Consider the evidence and risks, instead of promoting and diverting aid money to unproven and risky policies based on introducing market reforms to public health systems and scaling-up private provision of health-care
Support developing-country governments to strengthen their capacity to regulate existing private health-care providers.

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Source: Oxfam International, 2009, 'Blind Optimism: Challenging the myths about private health care in poor countries', Oxfam Briefing Paper 125, Oxfam International, Oxford
Organisation: Oxfam, http://www.oxfam.org.uk