Health Policies & Access to Medicines

3.2.1 Monitoring, information management and dissemination on the detrimental effects of privatisation of health care

The importance of the public perception in the development of privatisation programme cannot be denied and ‘population service’ has become best-selling. This gives an explanation for the health care horror stories at times used by politicians.

Quite often the implementation of privatisation is failing because of not enough preparation, unavailability of pilot studies, and by the urgency of pressure groups. The lack of appropriate information seems to be critical. The information gap produced by the privatisation tends to frustrate operational success, and information requirements are usually over-ambitious.

There is increasing evidence that the reasons given for involving the private sector in the delivery of public services are not necessarily true. Commercial incentives have not led to increased efficiency in many cases. Customer requirements are not always met by the private sector. Business and management expertise from the private sector does not always lead to improved systems, e.g. failure of performance management. Poor salaries and conditions of work as well as attractive private sector opportunities are the main reasons why health workers leave the public sector.

Case Study: Malaysia

This study provides evidence about the real impact of privatisation on health care personnel and patients. The study is premised on the necessity to focus on equity — an understanding of deeper structural factors that determine differential access to resources and health consequences. It flows from the understanding that the ultimate goal, is not only to look for health policies that favor the poor, but also policies that directly address the determinants of the inequitable distribution of resources. The study is located in the framework of Right to Health. Such a framework unequivocally challenges the dominant global discourse of ‘Health care as a commodity’ and ‘safety nets for those left outside the benefits’ and replaces this with a ‘Health care as a human right’ discourse.

Read more on the Study of Malaysia:

Case Study: India

Health services in India were more often than not a function of the socio-economic and political interest of rulers. The development of health services in India can be divided into three broad phases. The first phase – post-Independence till 1970s – was a period of health services expansion in the public sector. Cutbacks on public spending and concessions given to the private sector predominated the period between the late seventies and late eighties, the second phase. During the third phase, India went into loans with the IMF and World Bank for reforming public health services. However, the major disease-load of the population and their health status remain unaltered to this day.

Read more on the India Study:

Case Study: Sri Lanka

Sri Lanka’s drug regulatory system is governed by the Cosmetic Devices and Drugs Act of 1980.  The Drug Regulatory Authority is responsible for the process of registration of medicines under the Director-General of Health Services.  A Drug Evaluation sub-Committee presently advices the DG on reviewing applications submitted for drug registration; the informants to the sub-Committee being the applicants themselves. The cost and need of each drug is not of serious concern during the registration process.

As a founder-member of the World Trade Organisation, Sri Lanka is a signatory to the Trade-Related Intellectual Property Rights agreement (TRIPs). However, IPR status is not considered when taking up criteria for the registration of pharmaceuticals in the country.

Read more on the Sri Lanka Study: