Oxfam, a state-funded pro-aid lobby group, released a major report yesterday slamming the World Bank for supporting private sector healthcare in less developed countries. (Blind Optimism: challenging the myths about private health provision in poor countries)
Its objections, according to Andrew Jack's report in the FT, are that private care boosts inequality of access, costs more and contributed to a brain drawn of trained health workers.
The study might have more credibility if it wasn't so wilfully selective of evidence.
To determine the level of private coverage, it cited World Bank Demographic Surveys, but then selects only 15 of the 21 countries they cover. Oxfam only counts visits to private doctors, ignoring
visits to private clinics and hospitals. It also ignores the private drug shops where the poor get most their care. This is how Oxfam arrives at a figure for private health coverage that is ten times less than the reality.
Oxfam seems to be arguing that donors should place all their eggs in the public sector basket. But we know public sector health does not produce better quality care. A 2006 study of 278,000 children in 45 countries found "no evidence that nations . . . with relatively large public health systems perform better or worse than those with larger private systems”.
We also know that that "free" public sector health tends to be captured by more affluent, urban dwellers, at the expense of the poor in rural areas.
It is strange that in this day and age Oxfam should be advocating monolithic state health provision, when this approach has failed to deliver after many decades of trying and plenty of money. This is hardly surprising - monopolies rarely benefit consumers, whether they be in supermarkets or mobile phones.
Surely the answer to the healthcare problems of the developing world lies in diversity of provision, with as many players as possible brought to the table? Even countries that are deeply concerned with 'social solidarity' favour this approach (the Netherlands, Germany, France etc).
Fortunately, most journalists have seen this paper for the bit of ideological advocacy that it is, and have not covered it (except the FT). Obviously Oxfam's massive press office needs to be working a bit harder!
April Harding over at the Center for Global Development has more.