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Rich countries and World Bank must stop pushing privatized health in poor countries

WASHINGTON - Rich country donors and
the World Bank are wasting money and risking lives by continuing to
push unproven and discredited private healthcare programs in poor
countries, international agency Oxfam said today.

Oxfam's warning comes in a new report ‘Blind Optimism: Challenging the myths about private health care in poor countries'.

report gives considerable evidence of the poor performance of private
sector-led health care initiatives globally. In China, for example, one
third of drugs dispensed by private vendors are counterfeit, while in
seven sub-Saharan African countries the WHO found that most
anti-malarial drugs in private facilities failed quality tests. The
World Bank itself has said that the private sector generally performs
worse on technical quality than the public sector.

Anna Marriott,
author of the report, said: "Donors' romantic views of private sector
health providers are completely divorced from the facts. In Malawi 70
per cent of private providers are shops. For the most part, private
health care in poor countries is made up of unqualified shopkeepers
selling out-of-date medicines. Is that what you would want for your
sick baby?"

Oxfam has found that the World Bank uses its
unmatched policy influence worldwide to promote privatized health
despite lack of evidence. At the same time its private sector arm, the
International Finance Corporation, recently announced it will mobilise
$1 billion to finance the growth of the private sector's role in health
care in Africa. Many other donors and influential organizations have
also increased their efforts to encourage and fund more expansion of
private-sector lead health care projects. The United States Agency for
International Development (USAID), the Department for International
Development in the UK (DFID), and the Asian Development Bank have
followed the Bank's example in spending millions of aid dollars funding
large-scale programs to contract-out service delivery to the private

Meanwhile, aid for primary health-care services in poor
countries has almost halved in the last decade. Oxfam warns that cuts
in public health services are condemning hundreds of millions of people
to early preventable death or needless suffering - and a massive scale
up in public health spending is required.

After years of
disinvestment, and with the allocation of aid for primary health-care
services in poor countries dropping by almost half in the last decade,
the public sector in many instances is weak and badly run. "After years
of donor under-investment in government health care, to claim that
government failure is inevitable is like tying a football player's
laces together and blaming him for losing the match," said Marriott.

the past few months have taught us anything it is that the market has
its limitations and that governments need to take a lead. That is why
President Obama is planning to scale up US investment in universal
health care, while China has announced a $124 billion investment in
public health provision to protect its citizens and stimulate economic

Oxfam's research shows that scaling up government
provided health services has been central to rapidly improving life
chances in poor countries. "Thanks to increased state spending on
health in  Sri Lanka, for instance, women can now expect to live almost
as long as those in Germany, despite an income ten times smaller,"
Marriott said.

"The Bank and other donors need to put their blind
optimism about the market behind them. Universal health care is only
achievable with government intervention to provide services. World Bank
President Zoellick has rightly called for a fiscal stimulus to assist
poor countries. This should be spent in part on a rapid scaling up of
government provided health care - it will save lives and get economies
going again."

Notes to editors

  • A
    recent report by the International Finance Corporation (IFC), the
    private sector investment arm of the World Bank, claims that over half
    the health-care provision in Africa comes from the private sector. In
    fact, Oxfam's analysis of the data used by the IFC finds that nearly 40
    per cent of the ‘private provision' it identifies is just small shops
    selling drugs of unknown quality. In some countries such as Malawi, these shops constitute over 70 per cent of private providers.
  • Lebanon has
    one of the most privatized health systems in the developing world. It
    spends more than twice as much as Sri Lanka on health care yet its
    infant and maternal mortality rates are two and a half and three times
    higher respectively.
  • Chile's health-care
    system has wide-scale private sector participation and as a result has
    one of the world's highest rates of births by more costly and often
    unnecessary Caesarean sections.
  • In China immunization
    coverage dropped by half in the five years following commercialization
    of health care. Prevalence rates of tuberculosis (TB), measles and
    polio are now rising and could cost the economy millions in lost
    productivity and unnecessary treatment.
  • In Lesotho research
    has found only 37 per cent of sexually transmissible infections were
    treated correctly by contracted private providers compared with 57 and
    96 per cent of cases treated in ‘large' and ‘small' public health
    facilities respectively.
  • No low- or middle-income
    country in Asia has achieved universal or near-universal access to
    health care without relying solely or predominantly on tax-funded
    public delivery.
    Scaling-up public provision has led to
    massive progress despite low incomes. A Sri Lankan woman, for example,
    can expect to live almost as long as a German woman, despite an income
    ten times smaller. If she gives birth she has a 96 per cent chance of
    being attended by a skilled health worker.

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Oxfam International is a confederation of 13 like-minded organizations working together and with partners and allies around the world to bring about lasting change. Oxfam works directly with communities and that seeks to influence the powerful to ensure that poor people can improve their lives and livelihoods and have a say in decisions that affect them.

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