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.
mobilizing private resources to achieve public health objectives . Private Health Policy and Regulatory Options for Private Participation
A government seeking to encourage private participation in health care provision can choose among six basic policy and regulatory options that vary widely in the risks and responsibilities borne by the private (for-profit or nonprofit) entity. At one end of the spectrum the private sector takes on limited responsibilities while the public sector remains the primary provider of health care services (table 1). At the other end, the government establishes a policy environment in which qualified private entities may freely enter and exit the health care market. In this option private providers assume the full risks and responsibilities associated with service provision, and the public sector limits its role to regulation. The responsibilities that make up comprehensive health care provision can be divided into five main categories: ▪ Service delivery—providing specific services relating to health care. ▪ Management—coordinating services and administering the operation of clinics or hospitals , responsibilities that may or may not include the authority to make employment decisions. ▪ Asset maintenance—maintaining public facilities such as hospital buildings. ▪ Construction and rehabilitation—investing in constructing and rehabilitating facilities (excluding the purchase of equipment needed to provide services). Under a service contract a government pays a private entity to perform specific tasks. For example, a public hospital might contract a private entity to provide routine procedures (laboratory services) or specialized services (radiology) within the hospital, to complement its own operations. Or a government might contract out functions Many developing countries face a critical gap between the demand for health care services and their supply. Public resources often fall short of what is needed to provide universal health care, and the typical incentive structure in the public sector may not always be conducive to expanding access, improving the quality of care, and ensuring efficient use of limited funding and expertise. This Note defines options for mobilizing private resources to achieve public health objectives. Tonia Marek (tmarek@ worldbank.org) is a senior public health specialist at the World Bank. Chiaki Yamamoto (cyamamoto@ worldbank.org) is a private sector development specialist, and Jeff Ruster (jruster@worldbank.org) a lead financial analyst, in the World Bank's Private Participation in Public Services Group.
Electronic commerce and the role of the WTO
The study was written as a means of providing background information for the 132 WTO members who are now developing policy responses to this new form of commerce. Written by a team of economists from the WTO Secretariat, it identifies the complexities as well as the potential benefits of trade via the Internet. The book describes the extraordinary expansion of opportunities that electronic commerce offers, including for developing countries.