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Private Sector in Health Symposium Review

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Future Health Systems is a research consortium working to improve access, affordability and quality of health services for the poor. We are a partnership of leading research institutes from across the globe working in a variety of contexts: in low-income countries (Bangladesh, Uganda), middle-income countries (China, India) and fragile states (Afghanistan) to build resilient health systems for the future. After a successful first five-year phase from 2006-2011 (see our success stories), we are entering a new six-year phase of research, funded mainly by UK aid.

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Private Sector in Health Symposium Review

Future Health Systems

The beginning of July marked the Third Private Sector in Health Symposium in Sydney, Australia. The one-day event has taken place before the biannual International Health Economics Association World Congress since 2009. Although a broad scientific committee oversees the stewardship of the Symposium, the organisational roles rotate among members of the Scientific Committee. For this Symposium, Future Health Systems partners at the Institute of Development Studies and Johns Hopkins Bloomberg School of Public Health shared the responsibility.

Before the Symposium kicked off, FHS member and co-organiser David Bishai reminded the participants that:

The symposium attracts a broad spectrum of scholars from multiple disciplines. It won’t just be economists, and it won’t be a love-fest for unleashing free market economics in health care systems. The private sector in health is problematic, but we are going to have to live with it for quite some time -- so it’s a good thing so many intrepid scholars have joined forces to find ways to get the private sector to effectively deliver high quality services, to reach the poor, and to reduce the financial jeopardy for patients who access it.

The Symposium itself explored issues such as equity in health provision and difference in quality of care between public and private providers. And some of the results challenged traditional notions of the role of the private sector. For example, results of a study in Sri Lanka suggested that "public sector performs as well/better, than the private sector in many areas of quality, with much less money".

But Keynote presentations from the Symposium also reminded participants of the important role that the private sector can play. Bruce Bonyhady discussed the establishment of Australia's new National Disability Insurance Scheme (NDIS) and the role of the private sector in driving that forward. Noting that insurance companies had helped spur changes in building regulations to address fire safety, a coalition worked to make disability insurance an economic question, not just a question of rights. And Musthaque Chowdhury of BRAC in Bangladesh, one of the world's largest NGOs, challenged participants to re-consider what was meant by the term 'private sector'. BRAC is a not-for-profit, but it takes a comprehensive approach to poverty alleviation, stepping in to provide certain health services, for example, but also working to develop a wide range of markets to provide greater opportunities for poor people to support themselves.

Ultimately, this led to a persistant question throughout the day: what do we mean by the private sector anyway? But in a recent blog by Gerry Bloom, and FHS member and co-organiser of the symposium, he questions whether this is the right question. He notes:

A recent paper by David Leonard et al in World Development argues that there is little point in trying to draw a clear boundary between the categories of public and private. Rather, the authors suggest it is better to frame the question in terms of an analysis of the functioning of health markets and of measures to improve their performance in providing safe, effective and affordable services. They conclude that “improvements in the quality of services offered to the poor in LMICs are most likely to be found by using, extending, and reforming the particular institutions a country already has, rather than attempting to import some allegedly universal best practice”. 

As organisers of this Symposium, we would like to thank all who participated -- not only in the symposium itself but also in the webinar series running up to the day. The baton has been passed now to Freddie Ssengooba and Kara Hanson to organise the next iteration of the Symposium, and we look very much forward to seeing what emerges.