Public-private partnerships and new models of healthcare access.
OBJECTIVE
The aim of this article is to lay the ground for the engagement and support of a well managed and effectively regulated private sector in the delivery of healthcare in sub-Saharan Africa.


RESULTS
About 60% of healthcare financing in sub-Saharan Africa comes from private sources, and about 50% of total health expenditure goes to private providers, often in the form of out-of-pocket contributions by the poor. Yet, regulatory frameworks are weak and private sector healthcare providers are hardly ever eligible to receive donor funds. Moreover, virtually no investments in healthcare are being made.


CONCLUSIONS
We argue for a healthcare reform in which government and private sector work together and in which the development of prepaid private insurance coverage for low-income people and commercial capital investments in healthcare delivery play a major role. Support for such solutions is growing. Many obstacles remain, however, in particular the stubborn insistence of the donor community to support only government initiatives in health, to the exclusion of the private sector.
Center for Poverty-Related Communicable Diseases, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands. j.lange@amc.uva.nl
Joep M A
JM
Lange
Onno P
OP
Schellekens
Marianne
M
Lindner
Jacques
J
van der Gaag