In a December report financed by the Bill and Melinda Gates Foundation, the International Finance Corporation (IFC) estimates that over the next decade $25 to $30 billion will be needed to meet the needs of Africa’s health care. In The business of health in Africa: partnering with the private sector to improve people’s lives, the IFC announced that it will coordinate $1 billion, in equity investments and loans to finance private sector health provision in Sub-Saharan Africa.
The study found that the private sector accounts for about half of the region’s $16.7 billion spending on health care, and that impoverished people are just as likely as the better-off to use private providers. The report argues that this spending will grow to $21.2 billion by 2016. As a result of the proliferation of ‘user fees’ geared toward cost recovery at public clinics – often introduced at the instigation of the World Bank – the difference in cost between public and private services is often limited. The IFC has argued that private providers are better equipped and staffed than their public counterparts, and have shorter waiting times.
Health care professionals and activists are concerned at the quality of the research on which the report is based and fear that the IFC’s push for an increased role for the private sector may not be matched with appropriate regulation and service delivery. They point out that figures presenting the private sector as an equal or majority provider also hide the fact that at least 60 per cent of Africa’s population can not access health care of any kind.
the IFC report is brimming with unsubstantiated and unconvincing claims
An article by US NGO Bank Information Center points out that in many cases of public service privatisation, companies have focussed their efforts on serving those most able to pay and neglected the impoverished majority. Though the IFC emphasises the need for strong regulatory systems to safeguard the interests of less wealthy populations, few specifics about how these would work are provided.
In a December letter to the Financial Times, Barbara Stocking, director of NGO Oxfam asserted that “profits cannot be made in serving people this poor without some form of public subsidy. Without this, poor people either will not get healthcare at all or will have to pay fees they can ill afford.” Stocking refers to Malawi that has used aid money to hire more health care workers, pay them better, and eliminate user fees. Anna Marriot, health policy officer for Oxfam states that the IFC report “is brimming with unsubstantiated and unconvincing claims. In the absence of rigorous research the report’s call to divert public money for private health care is nothing short of irresponsible”.