Increased Involvement Of Private Sector Research Articles

Cultivating success: Bridging the gaps in plant breeding training in Australia, Canada, and New Zealand

AbstractPlant breeding is a multidisciplinary applied science that is crucial for enhancing food, fodder, fuel, and fiber production globally. Using detailed surveys in three Organisation for Economic Co‐operation and Development countries, this study investigated the current state of the plant breeding sector across tertiary, government, and industry levels. The findings highlight increasing concerns about the shortage of trained plant breeders, especially in the private sector, impacting food security and the economy. The need for a coordinated approach between the public and private sectors is emphasized. Suggestions for improvements include the establishment of dedicated training facilities, national funds for graduate fellowships, and increased private sector involvement in plant breeding education. The importance of adapting plant breeding courses to emerging scientific and technological advancements is highlighted, along with industry‐relevant training and improved promotion of the sector. The study raises awareness of the global shortage of trained plant breeders and provides valuable insights for decision makers toward strategic planning to address global food and fiber production challenges.

A progress of Public-Private Partnerships in São Paulo's housing policy: challenges and conflicts in accessing decent housing

The article aims to analyze the advancement of Public-Private Partnerships (PPPs) in housing for social interest in the central area of São Paulo. Based on a literature review and document research, it was found that such partnerships have presented limitations in providing housing for the low-income population, leading to conflicts and displacements in strategic areas of interest to the real estate market. This facilitates investor access to housing services and allows construction companies to use urban planning tools for economic exploitation and the mobilization of public lands in the city. Housing PPPs come in a context of weakened housing policies and increased private sector involvement in public services, driven by neoliberal thinking. This situation raises questions about the effectiveness of PPPs in meeting the needs of vulnerable populations living in inadequate or deficient housing. Financing difficulties for lower-income families and the displacements carried out for new housing developments have led to the relocation of local residents and workers, some of whom have been pushed into environmentally fragile and peripheral areas. As a result, there is a growing role of the private sector in decisions regarding the production of housing for social interest, which not only fails to extend its reach to the poorest groups but also creates problems related to urban density and urban sprawl. These issues need to be addressed to promote more just and sustainable cities in their social, environmental, and economic aspects, committed to reducing inequalities, socio-spatial segregation, and promoting democratic governance in cities.

Research overview and outcomes: just transitions to decarbonisation in the Asia-Pacific

This paper presents a comprehensive overview of a study examining microgrids for off-grid rural electrification in Indonesia, Malaysia, the Philippines, and Vietnam within the ASEAN context. Utilising mixed methods, this study delved into the techno-economic aspects of these systems and explored varied business models and governance strategies. It assessed how these models and strategies impact rural electricity access and contribute to a just regional energy transition. The study highlights the dual benefits of enhancing regional energy access and community empowerment while addressing shared challenges in climate change and decarboni- sation. It identified potential market opportunities at the national level, with an expectation of increased private sector involvement amid prospective system liberalisations. Viewed through the lens of energy justice, the regional energy transition is presented not only as an environmental imperative but also as a catalyst for economic growth. This involves creating jobs, expanding electricity access, and mitigating climate impacts for local communities and the broader region. This study also sheds light on workforce and labour support and industry transformation, suggesting avenues for future research.

Evaluation of Process Indicators and Challenges of the Elimination of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B in Bali Province, Indonesia (2019-2022): A Mixed Methods Study.

This study was conducted to describe the prevalence of and evaluate the processes and challenges in implementing the elimination of HIV, syphilis, and hepatitis B transmission from mother to child in Bali Province, Indonesia. The research method used is a descriptive approach using indicators and a set of processes by the WHO, quantitative methods using descriptive analysis, and qualitative methods using phenomenological paradigms through in-depth interviews and FGD with healthcare professionals involved in the elimination of mother-to-child transmission (EMTCT) program. The indicators that have successfully met the target for 4 years are antiretroviral therapy (ART) coverage in Badung District (≥95%) and ANC coverage (at least one visit) in Buleleng District (≥95%). The study found low prevalence rates of HIV, syphilis, and hepatitis B among pregnant women in the three districts. There are some indicators that show improvement from 2019 to 2022, namely, syphilis (60.44% to 86.98%) and hepatitis B (29.03% to 95.35%) screening coverage showed improvements, with increasing screening rates observed in Buleleng District. However, adequate treatment coverage for pregnant women with syphilis decreased in Denpasar City in 2022 compared to 2019 (100% to 71.28%). Despite data on hepatitis B treatment being unavailable, hepatitis B vaccination coverage exceeded the WHO target in all three districts. The utilization of the information system is not yet optimal, and there is a lack of ability to track cases. Furthermore, there is insufficient involvement of the private sector, particularly in screening, and a lack of standardized procedures in the management of referrals for pregnant women with hepatitis B. The prevalence of HIV, syphilis, and hepatitis B among pregnant women has consistently remained below the Ministry of Health's target for four years. Despite this, there are a lot of targets, and the indicator EMTCT process has yet to reach the WHO target. The challenges for each district in reaching the WHO target include providing syphilis and hepatitis B reagents and benzatine penicillin; increasing private sector involvement; and strengthening information systems, policies, and guidelines for the management of hepatitis B among pregnant women in line with WHO recommendations to achieve EMTCT.

Public-Private Partnerships in Education: A Comprehensive Study of The Right to Education in India

This research article explores the evolving landscape of education in India, focusing on the critical role of Public-Private Partnerships (PPPs) in the context of the Right to Education Act. India's government schools face resource constraints, prompting increased private sector involvement in education. This article discusses the impact of PPPs on education access, equity, and quality, drawing on a field survey conducted in Vadodara. Demographically, the survey reveals heightened awareness of the Right to Education Act, especially among women, underscoring its importance. An overwhelming majority recognizes PPPs' role in enhancing education but highlights the need for greater awareness regarding the nuances of these partnerships. Additionally, opinions vary on the adequacy of the Act's 25% reservation policy, signalling potential room for improvement. Teachers' perspectives showcase widespread compliance with reservation policies in public schools. Yet, concerns arise over private school reservations' efficacy. Respondents emphasize the Act's positive impact on education quality, affordability, and infrastructure, underscoring the comprehensive demand for improved educational access. However, doubts linger regarding PPPs potentially exacerbating educational inequalities, challenging competition, and privatizing the sector. Clear policies and safeguards are imperative to address these concerns. In sum, this research underscores the transformative potential of PPPs in realizing the Right to Education, while advocating for greater awareness, policy refinement, and equitable outcomes to ensure quality education for all in India.

A Review of Web-Based Immunization Information System of Ernakulam District “Unite for Healthy Ernakulam, Kerala (U4HE)”: Perceived End-User Barriers

Background: Reported coverage estimates for vaccine have the inherent problem of missing private entity data, to circumvent this, the National Health Mission, Ernakulam, designed and implemented an Immunization Information System (IIS) to collect routine vaccination reports from the private sector. This study attempted to identify the barriers to reporting by the private sector. Methodology: The study was conducted in Kerala's Ernakulam district. The design of the study was cross-sectional. The end–users, who are from the private sector, were the participants of 28 in-depth interviews in the study. Results: The new reporting system has increased private sector involvement in information exchange, all 78 private hospitals (100%) were reporting to NHM Ernakulam. But the completeness of reporting was not uniform. Major barriers identified were the lack of IIS interoperability with the hospital information system (HIS) being used by the private hospitals, variance because of lack of training of staff entering the data, and the unavailability of dedicated staff for reporting data. Conclusion: Addressing these barriers could improve the reporting of routine vaccination data from the private sector.

Public-private partnership as a tool to foster business innovation activities in the digital technologies field

The unprecedented sanctions imposed against Russia included restrictions on the supply of high-tech products and services have updated issues of ensuring the technological independence of Russia in the digital technologies field by increasing private sector involvement in innovation processes and relying on our own developments. Cooperation between the public and private sectors within the framework of public-private partnership (PPP) can become an effective tool for achieving this goal. The article analyses United States experience in use of PPPs in the digital technologies field as well as Russian practice of using this mechanism to foster business innovation activities. Analyzing specific PPP mechanisms (models), the author identifies their key features, which determine the possibilities of their application in the development and implementation of government-business cooperation projects in the digital technologies field. It is concluded that, unlike the United States, the leading country in digital development, PPP models are not used enough in Russia, which is explained, among other things, by the presence of administrative and legal barriers as well as problems with goal-setting.

The political practices of gender experts: repurposing women's empowerment

ABSTRACT Gender experts are increasingly employed across governments, multilateral donors, companies, and NGOs where they are defining a new profession and a new field of study, driving calls for research into the relationship between expertise and feminism. At the same time, the instrumentalization of the women's empowerment approach has prompted analysis of whether it can be reharnessed to its radical roots. By interviewing 25 gender experts, this article examines their political practices in navigating their work at a time when there is unprecedented support for gender equality, and yet interventions overwhelmingly focus on women's market inclusion. The article underscores the profound contradictions generated by the privatization of development, where most gender experts support increased private sector involvement but operate in a hostile environment and devote substantial labour to gender-capacity building. Based on the limited scope for re-radicalising women's empowerment, the article proposes advocating for feminist participatory action research as an alternative.

COVID-19-related adolescent mortality and morbidity in nineteen European countries

Prior to the COVID-19 pandemic, adolescents in most countries experienced a syndemic of malnutrition, obesity, deprivation, mental health problems, inequalities, and the effects of climate change. Today, other factors have added to this burden during the pandemic, and it is important to have an updated reflection. We aimed to assess the risk and protective factors for COVID-19-related adolescent mortality and morbidity in the European region. Three double models were fitted to analyze the relationship between different factors with the number of diagnosed cases and deaths. The 1a and 1b use a multiple Poisson regression. The 2a and 2b are optimized models that use the same variables as prior models but with backward selection with a p value < 0.05 as the limit. Finally, the 3a and 3b models (backward stepwise multivariable Poisson regression) include the variable “fully vaccinated.” All models used the at-risk population (15–19 years or total population) as a regression covariate (offset). Increased access to quality healthcare (IRR 0.68; CI 0.55–0.84), increased private sector involvement (IRR 0.86; CI 0.82–0.90), Gini coefficient (IRR 0.93; CI 0.88–0.99), and full vaccination (IRR 0.94; CI 0.90–0.99) represent protective factors of COVID-19 mortality in this population. Additionally, a positive association between pollution and mortality was found. Conclusion: Being fully vaccinated and having access to quality medical care are protective factors against COVID-19 mortality in this age group. Interestingly, the more the pollution, the greater the risk of dying from COVID-19. We stress the great importance of coordination between the public and private sectors to address crises such as the current one.What is Known:• Compared to other age groups, adolescents have been little studied, and most studies focused on mental health during the COVID-19 pandemic.What is New:• In this study, we show how in 19 European countries, different factors interact, such as socio-demographic, environmental, health system, and control measures with morbidity and mortality by COVID-19, in a very little studied age group as teenagers.

Public-private partnership in care provision for ageing-in-place: A comparative study in Guangdong, China.

This paper investigates how the public-private partnership (PPP) functions in the care provision for older people in Guangdong, China, particularly for ageing-in-place programs. Three cities with diversified PPP forms of care provision for older people were chosen as case studies. Focus groups were conducted in these cities for the local authorities and care homes involved in the partnerships. Three forms of PPP, including private sector involvement for the ownership, construction, and operation of the facilities delivering care services, were identified. The public-private co-constructed and privately run model with greater private sector involvement may lead to higher quality care in one specific program. The publicly constructed and privately run program is widely used in many cities, advancing the expansion of ageing-in-place programs in more communities. These PPPs reflect flexible and practical collaboration between the public and private sectors at the local level in the Chinese context. PPP have accelerated the development of a better care system for older people, mainly in terms of more affordable and higher-quality care options for the public. They are also a feasible solution for the local government due to more cost-effective and sustainable care provisions than previous publicly provided programs. The specific forms adopted are primarily associated with the scale of home care provision for ageing-in-place and the local government's financial capacity. Despite increasing private sector involvement, the public sector retains its crucial role in delivering care services targeting ageing in China.

Revisiting private participation, governance and electricity sector performance in Latin America

This paper revisits the relationship between private participation, regulatory governance and the performance of the electricity sector in 18 Latin American countries over the last five decades. Private investment flows have been consistent overtime, providing around 55 % of total electricity investment in the region. We examine the nature, and resultant performance outcomes, of increased private sector involvement in electricity sub-sectors, including generation capacity, non-conventional renewable energy (NCRE), electricity access, electricity losses, and affordability. The results suggest that private investment and the quality of regulatory governance are positively associated with better performance of the electricity sector. Our long-term examination suggests that private investments strongly contribute to enhancing the quality and efficiency of the electricity sector's performance by increasing generation capacity, increasing the share of renewable energy, increasing access, and reducing electricity losses. Affordability of electricity services also improved in countries with high private participation, while subsidies to the electricity sector declined considerably. These outcomes seem to be enabled and reinforced by independent regulatory governance.

Performance-based contracting for maintaining transportation assets with emphasis on bridges

With a large number of aging transportation infrastructure assets in North America and the growing problem of deterioration across the globe, managing these assets have been the subject of ongoing research. There is an overwhelming amount of maintenance and rehabilitation works to be done and selecting a suitable maintenance, repair or replacement (MRR) strategy is one of the most challenging tasks for decision makers. Limited budget and resources are even making the decision making process more challenging. Maintaining infrastructure to the highest possible condition while investing the minimal amount of money has promoted innovative contracting approaches. Transportation agencies have increased private sector involvement through long term performance-based maintenance contracts or what is called Performance-Based Contracting. PBC is a type of contract that pays a contractor based on the results achieved, not on the methods for performing the maintenance work. By looking into the literature, it is observed that agencies are expanding the amount of contracting they do in order to maintain and achieve a better standard of infrastructure facilities. Therefore, the objective of this paper is to study and review performance-based contracting for transportation infrastructure with emphasis on bridge assets.

O57. Current opportunities for Medical Physics Internship training in South Africa

Introduction Two year Medical Physics (MP) Internships (practical clinical training) are established in South Africa (SA), and are a requirement prior to registration, as a MP, with the Health Professions Council of SA (HPCSA). Over the past decade there has been an increasing demand for registered MPs in SA, thus the number of people in available academic programs has increased. Filling of state funded internship posts has declined and some posts have been scrapped. Recently there is anecdotal evidence of a transition in post availability as the number of graduates applying for any advertised internship post seems to have increased. The aim of this study is to determine current opportunities and intake of students and interns into training and education programs so as to facilitate informed planning of future opportunities. Materials and methods All HPCSA Accredited Departments of MP were contacted and requested to provide information about their current education and Internship programs. The information was summarised and analysed. All information was treated confidentially. Results There are currently about 120 active registered MPs in SA. There are 21 Interns registered against HPCSA Accredited Internships. These are either employed in State funded Internships, self-funded, funded by National Research Foundation Internship Bursaries, or by private sector bursaries. There are currently 29 BSc Honours students with MP subjects (or equivalent courses aimed at internship registration), 25 MSc Students, and 11 PhD students. Structured MSc programs were considered as equivalent to research based MSc programs. Conclusion This study highlights several points. The eight accredited training institutions offer diverse programs and have widely different organizational and training structures, even while complying with the HPCSA accreditation process. Post graduate research programs are active. There is a shortage of Internship opportunities for MP training countrywide. Increased private sector involvement and filling of State posts are suggested solutions. Two year Medical Physics (MP) Internships (practical clinical training) are established in South Africa (SA), and are a requirement prior to registration, as a MP, with the Health Professions Council of SA (HPCSA). Over the past decade there has been an increasing demand for registered MPs in SA, thus the number of people in available academic programs has increased. Filling of state funded internship posts has declined and some posts have been scrapped. Recently there is anecdotal evidence of a transition in post availability as the number of graduates applying for any advertised internship post seems to have increased. The aim of this study is to determine current opportunities and intake of students and interns into training and education programs so as to facilitate informed planning of future opportunities. All HPCSA Accredited Departments of MP were contacted and requested to provide information about their current education and Internship programs. The information was summarised and analysed. All information was treated confidentially. There are currently about 120 active registered MPs in SA. There are 21 Interns registered against HPCSA Accredited Internships. These are either employed in State funded Internships, self-funded, funded by National Research Foundation Internship Bursaries, or by private sector bursaries. There are currently 29 BSc Honours students with MP subjects (or equivalent courses aimed at internship registration), 25 MSc Students, and 11 PhD students. Structured MSc programs were considered as equivalent to research based MSc programs. This study highlights several points. The eight accredited training institutions offer diverse programs and have widely different organizational and training structures, even while complying with the HPCSA accreditation process. Post graduate research programs are active. There is a shortage of Internship opportunities for MP training countrywide. Increased private sector involvement and filling of State posts are suggested solutions.

Public Incentives, Market Motivations, and Contaminated Properties: New Public Management and Brownfield Liability Reform

AbstractBrownfields pose challenges to both communities and policy makers. Public funds are insufficient to remediate these contaminated sites, but, given the uncertainty of contamination and the complexity of liability, private interests are reluctant to become involved for fear of future litigation. From a New Public Management perspective, market incentives can be used to encourage private sector remediation of sites. However, this change implies a shift in administrative function from regulation to “getting the incentives right.” In this research, the authors investigate whether state and federal reforms aimed at increasing private sector involvement have actually done so, and they consider the implications for other goals of brownfield remediation, such as providing economic development assistance in communities where such change is needed. Findings show that developers respond to insurance and tax incentives, but the authors question whether public incentives are making unattractive redevelopment opportunities worth investing in or simply making profitable redevelopment opportunities more profitable.

The effect of increased private sector involvement in solid waste collection in five cities in Ghana

Private sector involvement in solid waste management in developing countries has increased, but the effect is not always clear. This study assesses how it has been organized in five cities in Ghana, what has been its effect and what lessons for private sector development in developing countries can be drawn. Data were collected from 25 private companies and a sample of 1200 households. More than 60% of solid waste in Ghanaian cities is now collected by private enterprises. Sometimes, and increasingly, competitive bidding takes place, although sometimes no bidding is organized leading to rendering of this service and no contract being signed. Local governments and local solid waste companies have not changed to more customer-oriented delivery because of the slow pace of charging users and the resulting low rate of cost recovery. The participation of the population has been limited, which contributes to low cost recovery. However, a gradual better functioning of the system put in place is shown. We observed an increasing use of competitive bidding, signing of contracts and city-wide user charging.

Integrated modeling framework for leasing urban roads: A case study of Fresno, California

Increasing private sector involvement in transportation services has significant implications for the management of road networks. This paper examines a concession model’s effects on a road network in the mid-sized city of Fresno, California. Using the existing transportation planning models of Fresno, we examine the effects of privatization on a number of typical system performance measures including total travel time and vehicle miles traveled (VMT), the possibility of including arterials, and the differences between social cost prices and profit maximizing prices. Some interesting insights emerge from our analysis: (1) roads cannot be considered as isolated elements in a concession model for a road network; (2) roads can function as complements at some levels of demand and become substitutes at other levels; (3) policy makers/officials should consider privatizing/pricing arterials along with privatizing highways; (4) temporally flexible but limited price schedule regulations should be part of leasing agreements; and (5) non-restricted pricing may actually worsen system performance, while limited pricing can raise enormous profits as well as improve system performance.

A centralized decentralization: outsourcing in the Turkish cultural heritage sector

Recently Turkey has experimented with reforming its highly centralized cultural heritage sector by outsourcing commercial activities at museums and archeological sites. We examine three outsourcing contracts executed in 2009–2010 and their implications for understanding New Public Management in Turkey’s cultural sector. The initial project at the Istanbul Archaeological Museum was soon superseded by a ‘monopoly’ model that outsourced gift shop and ticket collection services at over 50 museums and sites to single companies. All three projects have significantly increased visitor numbers and revenues for the revolving fund that controls commercial operations within the Ministry of Culture and Tourism. Yet unlike countries such as Italy, where outsourcing has led to decentralization, increased private sector involvement in Turkey has increased the control of the central government. This ‘centralized decentralization’ is a distinctly Turkish approach that allows for modernization without disturbing a highly centralized administrative tradition.

Dynamics of nanotechnology patenting: An Indian scenario

Nanotechnology reflects the combination/interaction of knowledge which is interdisciplinary in nature. Exclusive monopoly over patents on nano-scale materials, devices and processes is a much sought after concept among technology based industries today. According to many scientists and theorists, this science can lead to solutions of some of the toughest problems faced by mankind and the list of patents on nano-scale materials, tools and processes is expanding at a phenomenal pace. Even India is among the top 20 nations in nanotechnology research as is evident by the number of patents filed each year. Trade regime of the world has brought into focus the ability to generate and secure IPR. The transformation has been rapid and in such a dynamic landscape it is vital to protect the intellectual property. With increasing private sector involvement in nanotechnology R&D, the need for a comprehensive framework for regulating nanotechnology IPRs will be pivotal to the commercial success of the technology. Hence, it becomes increasingly more and more important to learn the various issues in patenting of nanotechnology inventions and address these issues now so as to avoid any problems later. This paper discusses the various methodologies used in the developing countries and what can be done in India to protect the same keeping in mind the interests of various partners in the value chain of nanotech patent from lab to market.

Impossible to "wean" when more aid is needed

Kirigia and Diarra-Nama from the WHO Regional Office for Africa say that funding for health in the WHO Africa Region remains inadequate and that, in some countries, is significantly dependent on donor funding. They propose five strategies for these countries to “wean themselves off” donor funding. While each of the proposed strategies might have some value in itself, they will not succeed in the double objective the authors set: to wean countries from depending upon international health aid and to achieve the US$ 34 per person annual health expenditure target suggested by the Commission on Macroeconomics and Health1 – an amount that must now be adjusted to US$ 40 due to inflation.2 Of the five strategies proposed, only the second and third strategy – reprioritizing public expenditure and raising additional domestic revenue – would increase domestic financial resources for health. The other three strategies (reducing inefficiencies and corruption and increasing private sector involvement in health development) might improve efficiency but would not bring countries closer to the US$ 40 per person annual target. It could be argued that with increased efficiency, less money is required. However, the Commission’s target is based on need and does not factor in inefficiencies or corruption. Furthermore, even if countries were to reprioritize public expenditure and raise additional domestic revenue, this is unlikely to generate sufficient additional financial resources, particularly for those countries most dependent on international health aid. To test this, we estimated the impact of these two strategies for the 4 countries where – according to the WHO Statistical Information System – the external contribution to total health expenditure exceeded 40% in 2004 (Madagascar, Malawi, Mozambique and Sao Tome and Principe), plus four other countries where the external contribution to total health expenditure exceeded 40% in 2005 (Liberia, Rwanda, Sierra Leone and Zambia).3 Kirigia and Diarra-Nama propose reprioritizing public expenditure by adjusting military expenditure to the average of the countries of the WHO African Region. We estimated military expenditure per inhabitant by using data from the CIA of the United States of America4 – which are expressed as a percentage of GDP – and multiplied those with GDP per capita estimates of the International Monetary Fund.5 Using the average annual military expenditure of US$ 16 per person provided by Kirigia and Diarra-Nama, we find that the 8 countries of our selection already spend less than US$ 16 per person per year on the military. The proposed strategy would therefore not make a difference (Table 1). Table 1 Impact of strategies proposed to reduce dependency on aid The other strategy proposed to raise domestic financial resources for health is that all countries should aim for government revenue equivalent to 15% of GDP. Five out of the 8 countries of our selection already have higher government revenue. Three out of 8 countries would indeed increase financial resources if they followed the recommendation, but even if they spent 15% of these additional financial resources on health – in line with the Abuja Declaration6 – it would merely raise between US$ 0.8 per person per year (Rwanda) and US$ 1.5 per person per year (Madagascar). Furthermore, 6 out of these 8 countries still face a huge gap between current total health expenditure and the revised target made by the Commission on Macroeconomics and Health: in Liberia, Madagascar, Malawi, Mozambique, Rwanda and Sierra Leone, total health expenditure is still below US$ 20 per person per year, even with 40% coming from international health aid. Even if some countries of the African region might be able to wean themselves from international health aid, others obviously cannot: they need increased aid, urgently. This can be achieved through sustained international health aid, which should not be seen as an act of charity to be overcome as soon as possible, but as an act of global solidarity, with health recognized as a human right that entails both national and international duties. For these reasons we agree with the position of WHO’s Director-General who has called for much greater, and more predictable, international health aid for Africa.7 We hope that her voice will be heard and understood throughout WHO and the wider international community. ■

Can countries of the WHO African Region wean themselves off donor funding for health?

More than 20% of total health expenditure in 48% of the 46 countries in the WHO African Region is provided by external sources. Issues surrounding aid effectiveness suggest that these countries ought to implement strategies for weaning off aid dependency. This paper broaches the following question: what are some of the strategies that countries of the region can employ to wean off donor funding for health? Five strategies are discussed: reduction in economic inefficiencies; reprioritizing public expenditures; raising additional tax revenues; increased private sector involvement in health development; and fighting corruption.