Private Sector Interventions Research Articles

Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature

BackgroundThere has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries. The private sector represents an important source of care for all socioeconomic groups, including the poorest and substantial concerns have been raised about the quality of care it provides. Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals. Limited information is available on the extent to which these interventions have successfully expanded access to quality health services for poor and disadvantaged populations. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor.MethodsThe search topic of the systematic literature review was the effectiveness of interventions working with the private for-profit sector to improve utilization of quality health services by the poor. Interventions included social marketing, use of vouchers, pre-packaging of drugs, franchising, training, regulation, accreditation and contracting-out. The search for published literature used a series of electronic databases including PubMed, Popline, HMIC and CabHealth Global Health. The search for grey and unpublished literature used documents available on the World Wide Web. We focused on studies which evaluated the impact of interventions on utilization and/or quality of services and which provided information on the socioeconomic status of the beneficiary populations.ResultsA total of 2483 references were retrieved, of which 52 qualified as impact evaluations. Data were available on the average socioeconomic status of recipient communities for 5 interventions, and on the distribution of benefits across socioeconomic groups for 5 interventions.ConclusionFew studies provided evidence on the impact of private sector interventions on quality and/or utilization of care by the poor. It was, however, evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people. Better evidence of the equity impact of interventions working with the private sector is needed for more robust conclusions to be drawn.

Women Empowerment through Entrepreneurship Development: Bangladesh Perspective

Half of the brainpower on Earth is in the heads of women. They provide an essential opportunity for economic and social development and progress. Women’s participation in any kind of economic activity is of a complementary nature to their family incomes; their participation in no way reduces their family duties. Women’s equal rights are now defined by women’s economic empowerment and the ultimate empowerment is through entrepreneurship. So, Government and private sector interventions have generally accelerated income-generating activities of women both in the urban and rural areas with entrepreneurship development. The ways in which women are involved in this sector are through selling labor (Wage labor), engaging in trading activities (self employment) and operating small industrial productions (enterprise owners).Working as labor may give them temporary employment but it does not improve their conditions or promote their advancement. Scope of trading activities especially in the rural areas, in view of extensive poverty and the large number of people who need to engage in income earning activities, is limited. Engaging in production or rural industrial activities seem to be the most viable avenue for which the women should be assisted to take up. Non-government organizations have equally joined hands with the government efforts for economic salvation and provided various forms of opportunities for women to help them earn living, paving the way for greater entrepreneurship development. Women have now become aware of their socio economic rights and have ventured to avail the opportunities initiated for them. Rural Bangladesh is now a changed scenario for the women who have gathered courage to break barriers and enter the off house working force as entrepreneurs and workers- a situation not appropriate for women or accepted by the society in the past. The urban areas have greater opportunities for business development but the areas where women lack assistance are in the access to credit, provision of skill training, and market facilities

From enslavement to environmentalism: politics on a Southern African frontier

Review: From Enslavement to Environmentalism: Politics on a Southern African Frontier By David McDermott Hughes Reviewed by Bram Buscher Vrije Universiteit Amsterdam, The Netherlands David McDermott Hughes. From Enslavement to Environmentalism. Politics on a Southern African Frontier. Seattle: University of Washington Press, May 2006. 288 pp. (hardbound) ISBN: 0-295-98590-9. (90% Recycled, Acid-free paper) US$50.00. Within the vast and burgeoning literature on community-based conservation in Africa, David Hughes’ From Enslavement to Environmentalism is a welcome addition. With great care, Hughes narrates what life is like in and around two villages on the border between Zimbabwe and Mozambique and shows how outside interventions have over time greatly changed local power dynamics in relation to land and people. But these dynamics differed greatly between the two countries. Interestingly, the book challenges the assumption in much of the literature that African borders are “soft” -- not very meaningful to local people. Instead, the book argues that the border between Mozambique and Zimbabwe is “hard” in that “people cross it, but emigration strips at least some people of rights and securities they regularly enjoy at home” (p. 76). This especially concerned Mozambican refugees, crossing the border to flee from civil war, subsequently finding themselves as “pegs” in turf-wars over land between local headmen, the state and private owners in a country “steeped in cadastral culture” (p. 123). In turn, however, the cadastral politics so characteristic of Zimbabwe increasingly started influencing local politics in Mozambique during the 1990s. Although traditionally more so in former British colonies, Hughes contends that due to conservation and private sector interventions even Mozambique has been making a “sea change” from “rule based on categories of people to rule based on the management of zones of land” (p. 145). And he states that this shift “from enslavement to environmentalism” has not brought more security or prospects for people living in rural Mozambique. In fact, the book suggests that neoliberal “community-based” conservation and tourism projects have made people worse off than they were before. The strong point of the book is the ethnographic detail Hughes brings to bear to embed and “ground” the above two arguments. Yet, what the book wins in ethnographic detail, it seems to lose in theoretical rigor, especially when it concerns the operationalization of liberalism and politics. In itself

From Enslavement to Environmentalism: Politics on a Southern African Frontier

Review: From Enslavement to Environmentalism: Politics on a Southern African Frontier By David McDermott Hughes Reviewed by Bram Buscher Vrije Universiteit Amsterdam, The Netherlands David McDermott Hughes. From Enslavement to Environmentalism. Politics on a Southern African Frontier. Seattle: University of Washington Press, May 2006. 288 pp. (hardbound) ISBN: 0-295-98590-9. (90% Recycled, Acid-free paper) US$50.00. Within the vast and burgeoning literature on community-based conservation in Africa, David Hughes’ From Enslavement to Environmentalism is a welcome addition. With great care, Hughes narrates what life is like in and around two villages on the border between Zimbabwe and Mozambique and shows how outside interventions have over time greatly changed local power dynamics in relation to land and people. But these dynamics differed greatly between the two countries. Interestingly, the book challenges the assumption in much of the literature that African borders are “soft” -- not very meaningful to local people. Instead, the book argues that the border between Mozambique and Zimbabwe is “hard” in that “people cross it, but emigration strips at least some people of rights and securities they regularly enjoy at home” (p. 76). This especially concerned Mozambican refugees, crossing the border to flee from civil war, subsequently finding themselves as “pegs” in turf-wars over land between local headmen, the state and private owners in a country “steeped in cadastral culture” (p. 123). In turn, however, the cadastral politics so characteristic of Zimbabwe increasingly started influencing local politics in Mozambique during the 1990s. Although traditionally more so in former British colonies, Hughes contends that due to conservation and private sector interventions even Mozambique has been making a “sea change” from “rule based on categories of people to rule based on the management of zones of land” (p. 145). And he states that this shift “from enslavement to environmentalism” has not brought more security or prospects for people living in rural Mozambique. In fact, the book suggests that neoliberal “community-based” conservation and tourism projects have made people worse off than they were before. The strong point of the book is the ethnographic detail Hughes brings to bear to embed and “ground” the above two arguments. Yet, what the book wins in ethnographic detail, it seems to lose in theoretical rigor, especially when it concerns the operationalization of liberalism and politics. In itself

France & the United States: the Competition for University Students — Bologna and Beyond

The United States and France have actively implemented higher education policies to attract foreign students. In the case of France, European Union educational initiatives are often a means to further policies that are already in place. This article focuses on the response of two diverse French higher education institutions to the EU's Bologna Declaration and its call for standardized matriculation time for degrees, private-sector intervention, external evaluations, and possible entry into GATS. The article also considers the tension between the Bologna Declaration and the French notion of le service public.

Micronutrient restoration and fortification: Communicating change, benefits and risks

Food fortification has played a significant role in the current nutritional health and well‐being of populations in industrialized countries for over 70 years. A relative lack of a concentrated food processing chain, less developed commercial markets, and relatively low consumer awareness and demand have hindered the same application of the intervention in the transitional, and even more, in the least developed countries until quite recently. The present paper reviews fortification of foods with micronutrients in advantaged (industrialized), transitional (developing) and least developed countries briefly, including reference to bio‐fortification, examining some of the public health issues involved. There are different needs and challenges in getting this technology accepted and making it sustainable. Primary constraints in reaching poor target populations are adequate availability, accessibility, and quality assurance/quality control. The paper then examines some issues of risk and benefit and the communication of these, and finally looks towards the future and draws some conclusions. Despite these issues there has been an enormous increase in fortification programmes over the last couple of decades in developing countries. Along with dietary diversification, supplementation and related public health and private sector interventions, this has resulted in considerable progress in reducing the prevalence of vitamin A and iodine deficiencies, but much less so with iron, even as zinc and folic acid deficiencies have emerged as significant public health problems. Food fortification based on sound principles and supported by clear policies and regulations will play an increasingly large role in the progress towards the prevention and control of micronutrient malnutrition. Success and sustainability require clear communication of the small risks involved and the substantial benefits, particularly to populations with significant levels of micronutrient malnutrition, as a complementary approach with other public health measures, in reducing the prevalence of deficiencies and their health consequences.

Port Privatisation: Objectives, Extent, Process, and the UK Experience

The role of the private sector has expanded significantly in many important economic sectors over recent decades. Ports have not been immune from this advance, and many ports around the world have benefited from private sector intervention. This paper considers objectives commonly associated with the privatisation of seaport functions. A framework is presented (Port Privatisation Matrix) that can be used to help establish the extent of private sector intervention in any given port. This is followed by a discussion of the main methods used to bring about private sector intervention in ports, with examples as appropriate. Finally, the paper considers the rather unique form of port privatisation (i.e. transfer of property rights etc.) adopted in the United Kingdom. The evidence suggests that the state does not need to transfer seaport property rights in order to benefit from private sector expertise. Indeed, due to the specific nature of port investment, and bearing in mind the key objective of ports to facilitate trade, this may be counter-productive.

A historical irony in the making? State, private sector and land reform in the South African wine industry

This article traces the development of the land distribution policy of the Department of Land Affairs (DLA) of South Africa. Despite the DLA ‘s political commitment to land reform by way of restitution, redistribution and tenure reform, to date no small‐scale wine farmers have been settled in South Africa by virtue of this policy. Three case studies describe how agricultural labourers have successfully gained access to this lucrative sector through private sector intervention. It is also argued that the small farm versus large farm debate masks the real opportunities for land reform in the wine industry.

Mutual workers’insurance: A historical outline

This article focuses on the historical development of small workers’mutual insurance societies whose members manage the fund themselves. The article begins by describing the remarkable similarities in terms of characteristics and development of these societies in different places and periods. It then discusses various non‐directly democratic competitors in the field of social insurance and forms of State intervention. Finally, the article attempts to explain why competition from the private sector and State interventions forced directly democratic societies to choose between bureaucratization, marginalization and disbandment.

Financing health services in Sub-Saharan Africa: Options for decision makers during adjustment

The financing of health services has become an increasingly critical and urgent issue in many developing countries particularly in Sub-Saharan Africa. This paper analyses options available to policy makers. The possible effects and side effects of strategies are described based on the experience from different countries. The dangers of simplistic solutions are discussed. A cautious approach is recommended taking into consideration the lessons learned in other regions accompanied by a careful ongoing evaluation especially regarding the ability to pay of the poorer sections of the population. Providing for equity in health care should be an important guiding principle. It therefore appears to be necessary to find an appropriate mix of public and private sector interventions with elements of cost-sharing for services and drugs, insurance schemes and more efficient use of available resources.

Environment and Development: Attitudinal Impediments to Policy Integration

Attitudes towards the concept of sustainable development—an approach to development which integrates economic, social, and environmental, considerations in development planning and decision-making—are evaluated according to six sectors of public interest: the private sector, the general public, government, the academic and research sector, labour, and the voluntary sector.The study is empirical. Attitudinal data are gathered from a content analysis of public briefs submitted in 1983 and 1984 to the Royal Commission on the Economic Union and Development Prospects for Canada. For each sector, attitudes towards development planning are assessed, with particular attention given to attitudes affecting the integration of economic and environmental considerations in development planning.The study shows that a commitment to private-sector views is strongly, although negatively, related to environmental concern. Private-sector interventions are not only the least sympathetic of all six sectors towards the integration of economic and environmental policies, but the majority of interveners in this sector are opposed to the very concept. Given this, there are major attitudinal obstacles to the acceptance of the concept beyond the rhetorical level.

The Deprivatization of Employee Benefit and Labor Law: The Surprising Conservative Erosion of Trusts and of the Competitive Labor Model

The accepted wisdom holds that liberal Democratic control of the national government means pro-labor government with the federal authority as a strong advocate of private sector intervention on behalf of workers and their unions, while more conservative Republican administrations favor corporate volunteerism, marketplace labor policy, and the exclusion of governmental workplace intervention. Closely akin to and allied with this dichotomy is a reading of very recent labor history, shared by neo-conservatives and socalled neo-liberals alike, which pictures the post-World War II American workplace as suffering under overly powerful bread-and-butter unions. On this reading, the powerful unions have caused America to lose the highly competitive battle with the Japanese for world markets and economic leadership. This neo-labor policy perspective rests on the myth that by forcing higher and higher non-market pay rates and benefit levels the overly aggressive unions pushed the world's leading auto producers to ruin. A close look at two current labor policy issues raises serious questions about whether these stereotypes reflect reality. An examination of both the Reagan Administration's erosion of the common law trust rules that govern the control of employee benefit investments, and its suggestions concerning a desertion of the half-century old competitive model in labor law, raise doubt about the validity of the stereotypical analysis of the relationship between labor and the government. Pressure toward strict governmental regulation of

Review of Data Related to Energy Use in Residential and Commercial Buildings

This paper reviews data dealing with energy use in residential and commercial buildings and their determinants. Three types of data are discussed: data prepared by and for the federal government on overall trends in buildings energy use, data prepared by and for the federal government related to the details of energy use, and data collected at the state and utility level. The major conclusion from this review is that existing national data sources are inadequate for answering the kinds of questions being raised on buildings energy use and conservation. These questions concern overall trends, recent changes, determinants of changes, roles of the private sector and government intervention in implementing conservation measures, and the effectiveness of different kinds of government programs. Relevant data are being collected by many state energy offices and by gas and electric utilities. However, the existence of these potentially-useful subnational data sources is not widely known.