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

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'.

The
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selling out-of-date medicines.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
sector.

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.

"If
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
growth."

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.