Publications

	Table of Contents
p. 22 of 27 BACK | NEXT Executive summary Introduction Regional health context The Bank’s involvementin the health sector Issues and options The health of the poor, women, and indigenous peoples Setting clear priorities Mobilizing resources for the public health sector Building managerial capacity Testing innovative approaches Introducing effective, new, and affordable technologies Focusing on functions which constitute public goods Increasing collaboration between public and private sectors The Bank’s health policy

Policy for the Health Sector : Issues and options

---

Increasing collaboration between public and private sectors

The private sector in health is growing rapidly in the region and already accounts for the majority of total health care expenditures. In spite of its size, many DMC governments have avoided working with the private sector, partly because of a lack of familiarity with mechanisms for such cooperation. The collaboration between the public and private sectors can take many forms, including (i) contracting out the delivery of health services to private providers or NGOs; (ii) contracting ancillary services such as equipment maintenance, food service, or laundry services in hospitals to for-profit firms; (iii) training private pharmacy operators on the proper case management of important diseases such as TB; (iv) working with traditional healers, such as traditional birth attendants; and (v) employing private sector management approaches in public sector hospitals, such as establishing autonomous, local boards of directors to oversee their operation. Efforts at public-private collaboration may have far-reaching consequences because there are likely synergies between the two sectors that can benefit consumers. Despite its potential, the evidence for the effectiveness of public-private partnerships, thus far, is mostly anecdotal and of recent origin. Nonetheless, the potential of such collaboration is large and a variety of approaches are possible.

NGOs. Domestic and international NGOs provide a significant share of health services in developing countries. For example, they supply more than 10 percent of clinical services in India and Indonesia. Collaboration between governments and NGOs has been expanding over the last decade in the health sector, and there are many opportunities for coordinated action. Since NGOs are already actively involved in providing services to poor communities, it is natural that governments should look to them to improve the coverage and quality of health services. This may take the form of governments contracting with NGOs for the delivery of health care, an approach the Bank is helping to test formally (see Box 7). However, NGOs should be seen not solely as substitute service providers for government. Given their experience in delivering services and their proximity to the community, NGOs, together with community-based organizations, can play a vital role in the area of regulation of private sector activities, the organization and operation of health financing schemes, the development of innovative health activities, and policy formulation.

Private drug sellers. Expenditures on drugs (modern pharmaceuticals) in the Bank’s DMCs are very high and in some countries sales are increasing rapidly. In Cambodia and the Philippines, pharmaceuticals account for nearly 80 percent of total health care expenditures. Throughout the region, people often bypass cura-tive care providers and go directly to private pharmacies. Thus, the operators of private pharmacies, many of whom are untrained and unlicensed, are the first line of health care for much of the population. This provides both risks and opportunities. The major risk is that the management of diseases such as TB or STDs may be mishandled, resulting in the evolution of organisms that are resistant to available drugs. An important opportunity is that, if properly trained and alerted to diseases of public health importance, they can be an effective means of disease control. The dynamic and extensive sales networks of the private sector can also be used to market important commodities such as contraceptives and oral rehydration salts for the treatment of diarrhea.

Private providers. Individual private health care providers and private hos-pitals account for much of the growth in the health sector in the region. Despite its size, there has been little collaboration between the modern private health care sector and governments. Issues that need to be explored jointly include (i) means for improving the quality of care, which is closely related to regulation and licensing; (ii) incentives for the establishment of private facilities in underserviced areas; (iii) government purchase of services from the private sector; and (iv) use of private hospitals as teaching facilities for training health professionals.

Traditional healers. Traditional medicine remains an important part of the health care system in the DMCs. The number of traditional health care providers—- including acupuncturists, bonesetters, ayurvedic and homeopathic doctors, and traditional birth attendants—-is typically many times larger than the number of medically trained physicians, particularly in rural areas. These traditional providers may represent an important opportunity for governments to improve the delivery of certain essential health services. Examples from the DMCs include training and supporting traditional birth attendants to improve pregnancy outcomes in Indonesia, and the Philippines, and utilizing traditional healers to screen for malaria and distribute antimalarial drugs in Thailand. These programs appear to have been effective and were implemented at modest cost.

Back Focusing on functions which constitute public goods	Next The Bank’s health policy