PPPs likely to undermine public health commitments
Third World Resurgence November 2017
The third International Conference on Financing for Development in Addis Ababa in mid-2015 recommended ‘blended finance’ as well as other public-private partnerships (PPPs) to pool public and private resources and expertise to achieve the SDGs. Development finance institutions (DFIs), particularly the World Bank, are the main cheerleaders for these supposed magic bullets
It should be obvious to all that private sector participation in the development process is hardly novel, having long contributed to investments, growth and innovation. Not-for-profit civil society organisations (CSOs), especially faith-based ones, have also been significant for decades in education and health. Thus, in many developing countries such as Bangladesh and Indonesia, health and education outcomes are much better than what public expenditure alone could fund.
However, PPPs have a long and chequered history, especially in terms of ensuring access and equity, typically undermining the SDGs’ overarching principle of ‘leaving no one behind’, including the SDG and WHO promise of universal healthcare.
Rich and powerful private partners often reshape governmental and state-owned enterprise priorities and strategies, and redirect national health policies to better serve commercial interests and considerations. For example, relying on antiretroviral drugs from PPPs has resulted in conflicts with national authorities, generic suppliers and consumer interests, which have undermined health progress.
Donor-funded PPPs are typically unsustainable, eventually harming national health strategies, policies, capacities and capabilities.
PPPs may divert domestic resources from national priorities, and thus undermine public health due to financial constraints they cause. Such redirection of investment exacerbates health disparities, adversely affecting vulnerable groups.
Health workers often prefer to work for better-funded foreign programmes, undermining the public sector. PPPs can thus lead governments to abdicate their responsibilities for promoting and protecting citizens’ health.
Partnership arrangements with the private sector are not subject to public oversight. Therefore, selecting private partners, setting targets and formulating operating guidelines are not transparent, they only aid in creating more scope for corruption.
PPPs are certainly not magic bullets to achieve the SDGs. While PPPs can mobilise private finance, this can also be achieved at lower cost through government borrowing.
Instead of uncritically promoting blended finance and PPPs, the international community should provide capacity-building support to developing countries to safeguard the public interest, especially equity, access and public health, to ensure that no one is left behind. – IPS
Anis Chowdhury is Adjunct Professor, Western Sydney University and the University of New South Wales (Australia); he held senior United Nations positions in New York and Bangkok. Jomo Kwame Sundaram, a former economics professor, was UN Assistant Secretary-General for Economic Development, and received the Wassily Leontief Prize for Advancing the Frontiers of Economic Thought in 2007.
Third World Resurgence No. 326/327, October/November 2017, pp 6-7
See complete article here
‘Partnership’ or manipulation?
Translated from Rev Prescrire March 2014; 34 (365): 216
The various individuals, organisations and companies involved in the healthcare sector do not all have the same objectives and interests. This is very clearly illustrated by the recent failure of a coalition of UK healthcare stakeholders.
Good bedfellows? A coalition of healthcare stakeholders was formed in the UK in 2011: the ‘Ethical Standards in Health and Life Sciences Group’ (ESHLSG) (1,2). The stated aim of this group was to promote best practice, mainly in terms of interactions between healthcare professionals and the pharmaceutical industry, and clinical trial transparency. Two guidelines on these topics were thus endorsed by a number of medical journals and organisations representing healthcare professionals, the Association of the British Pharmaceutical Industry (ABPI) and representatives from the English, Scottish and Welsh governments (1,2).
Some observers were surprised to see how pro-industry these guidelines were, in which the following statements were left unchallenged: ‘industry plays a valid and important role in the provision of medical education’; ‘medical representatives can be a useful resource for healthcare professionals’; and ‘information about industry-sponsored trials is publicly available’ (1,2). All of these assertions are refuted by numerous studies and are strikingly at odds with current international debate on these issues (1,2). Alerted by an academic, The Lancet was the first to withdraw its support for these guidelines, in February 2013 (2). Amid mounting criticism, the coalition disbanded in September 2013 (1). Some observers requested documents under Britain’s Freedom of Information Act to find out how government representatives came to endorse these guidelines. Some did not want to feel left out. Others had signed after numerous insistent calls from the ABPI, despite their reservations about the process and the guidelines (1).
Don’t be naive about ‘partnerships’. The various stakeholders involved in the healthcare sector — patients, healthcare professionals, the pharmaceutical industry, government, and health insurance providers — have partly divergent and sometimes contradictory interests. It is better that they each defend a clear position, rather than entering into unequal partnerships in which the most influential party is often able to manipulate the others (3). This experience also shows that someone with a mind to it can put a spoke in the wheels (2). It is an inspiration to never give up, and to remain vigilant in safeguarding patients’ interests.
Selected references from Prescrire’s literature search.
1- Arie S ‘Working with the drug industry. How a marriage with big pharma ended in divorce’ BMJ 2013; 347: f6062, 4 pages.
2- Horton R ‘Offline: falling out with pharma’ Lancet 2013; 381: 358.
3- Prescrire Editorial Staff ‘Attitudes must change if we are to avoid another Mediator° scandal’ Prescrire Int 2012; 21 (123): 21-23.