IPN Health Blog

The Gates Foundation: help or hindrance?

I'm on the BBC World Service today discussing the Gates Foundation, and whether or not it is skewing efforts to improve global health. 

Check it out here: http://www.bbc.co.uk/iplayer/console/p0038yg4

India’s innovation boom

Nearly four fifths of health services in India are provided privately, while recent years have seen some liberalisation of the industry. Barriers to investment have been reduced, and tax breaks offered for enterprises in smaller cities and rural areas.

The result? According to The Economist this week, an innovative boom of cost-cutting technologies that are improving the health of India’s middle- and low-income earners.

The process is aided by India’s economic boom, allowing more people to purchase health insurance.

The article includes many examples, such as Apollo Hospitals, who are opening new facilities in small and medium sized cities, saving costs for people who would otherwise have to travel to large cities.

LifeSpring Hospitals, meanwhile, offer maternity services, with normal deliveries available at a staggeringly frugal $40.

Furthermore, standards are often even higher than in wealthy countries. Nearly 60 per cent of Indian hospitals are using health-information technology, while the figure in the USA stands at a mere 20 per cent.

One American company who have switched to India said they did so in order to “escape over-regulation and the political power of the medical lobby.”

There's a lesson here: cut down regulation and enterprise will prosper. Thankfully India's patients are starting to reap the lesson's rewards.

Oxfam's 1950s ideology

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.

CFD book in Portuguese!

Last month marked the launch of the Portuguese translation of the CFD book, Fighting the Diseases of Poverty.

I went over to Brazil for a series of launches, most of which were organised by the inestimable Margaret Tse of the Instituto Liberdade.

A highlight of the trip was presenting a copy to the President of Rio Grande Do Sul, who promised to pass copies onto the rest of the legislative assembly.

You can download individual chapters over at the CFD.

Markets for organs?

Waiting lists and death are too often the outcomes for people suffering from End Stage Renal Disease (ESRD). Sadly, this familiar story occurs in virtually every country across the world.

In the US alone 73,000 people are waiting for a kidney donation and the waiting list is growing. Since 1999, 30,000 people have died whilst waiting for a kidney that never arrived.

These figures are reported by Benjamin E. Hippen, MD, a nephrologist (kidney expert), member of leading transplantation organisations and associate editor of the American Journal of Transplantation.

His report is available here and remarkably notes that Iran is the world’s only country to have eliminated waiting lists. This has been achieved via a kidney vendor program, made possible through the legalisation of kidney vending.

The program allows vendors to approach a not-for-profit body, Dialysis and Transplant Patients Association (DATPA), which matches them with recipients. Vendors are compensated by the government, receive health insurance and additional funds from either recipients or charities funding recipients. Vendors are assessed with non-remunerated donors and the operation vetoed if the vendor is found to be medically unsuitable.

Whilst noting problems within the system, Hippen notes that the involvement of an intermediary not-for-profit organisation and other means of legal framework mitigate concerns about organ donation.

This scheme could work in other countries which have organ shortages, thus reducing waiting lists, saving lives and eliminating illegal organ trafficking.