Disguising Trade in Development Partnerships
Public-private partnership (PPP) once christened to improve on quality and economic efficiency of public services in developed countrie s, is now widely promoted as a development tool that could ensure basic social services in LDCs. Th is paper analyses the doctrine of PPP and the application of various models to LDCs health delive ry systems. It examines different types of PPP arrangements including in international trade, othe r economic arrangements, development PPPs and domestic health initiatives. Examples are drawn fro m LDC countries especially Sierra Leone, to illustrate the practice of respective health PPPs a nd regulatory challenges inherent in complex PPP mix. A crucial issue is the appropriateness of mark eting 'Public-Private for profit partnerships' as a development mechanism for health delivery in poor countries. The paper recommends a more pro- active role for LDC governments in the design, impl ementation and surveillance of health PPPs as essential in achieving health development goals.
Health services under the General Agreement on Trade in Services.
The potential for trade in health services has expanded rapidly in recent decades. More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation. As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS). It is possible that Members of the World Trade Organization have been discouraged from undertaking access commitments by the novelty of the Agreement, coordination problems between relevant agencies, widespread inexperience in concepts of services trade, a traditionally strong degree of government involvement in the health sector, and concerns about basic quality and social objectives. However, more than five years have passed since GATS entered into force, allowing hesitant administrations to familiarize themselves with its main elements and its operation in practice. The present paper is intended to contribute to this process. It provides an overview of the basic structure of GATS and of the patterns of current commitments in health services and of limitations frequently used in this context. The concluding section discusses possibilities of pursuing basic policy objectives in a more open environment and indicates issues that may have to be dealt with in current negotiations on services.
World Health Report 2000: a step towards evidence-based health policy
We describe here the methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999. These were based on estimates of the incidence, prevalence, and disability distributions for 109 disease and injury causes by age group, sex, and region of the world, and an analysis of 60 representative health surveys across the world. We used Sullivan’s method to compute healthy life expectancy for men and women in each WHO member country. Japan had the highest average healthy life expectancy of 74·5 years at birth in 1999. The bottom ten countries are all in sub-Saharan Africa, where the HIV-AIDS epidemic is most prevalent, resulting in DALE at birth of less than 35 years. Years of healthy life lost due to disability represent 18% of total life expectancy in the bottom countries, and decreases to around 8% in the countries with the highest healthy life expectancies. Globally, the malefemale gap is lower for DALE than for total life expectancy. Healthy life expectancy increases across countries at a faster rate than total life expectancy, suggesting that reductions in mortality are accompanied by reductions in disability. Although women live longer, they spend a greater amount of time with disability. As average levels of health expenditure per capita increase, healthy life expectancy increases at a greater rate than total life expectancy.