Home > CFP > CFP: Reproductive Health Matters 18(36) November 2010

CFP: Reproductive Health Matters 18(36) November 2010

Theme:  **Privatisation and commercialisation of sexual and reproductive
health services
***

Submission date:  1 March 2010 (negotiable due to late distribution
of this call)*

The past two decades have seen important growth in private health care all
over the globe. Whereas private health care used to be available only to the
rich in almost every country, private services of many different kinds are
reaching out to more and more patients, including in the poorest countries
and among the poor in more affluent societies, some funded through
development aid. This is happening across sexual and reproductive health
care, from private assisted conception clinics (including in countries with
high rates of secondary infertility due to unsafe abortions and unskilled
delivery care), to private midwives’ cooperatives offering antenatal and
delivery care to some women while the majority still deliver at home without
a skilled attendant, to small private hospitals and NGO clinics offering
abortion and many other reproductive and sexual health services in the
absence of public services.

The growth of private health care has been supported above all by the
so-called Washington consensus from the 1980s onwards, that free market
capitalism is the only economic model to follow and should be applied not
only in finance, business and trade, but also to social welfare services and
agencies, including health care. This ideology has dominated the development
aid policies of the World Bank, other international agencies and most if not
all donor governments. Most aggressive have been commercial health
corporations (mainly originating in the US) who are tendering for contracts
from a growing number of governments to replace or supplement public health
services.

The now entrenched situation of mixed public and private health care has
been exacerbated by the failure of public health systems in many countries
to ensure universal access to health services with a decent quality of care.
Once private services have been set up, they can use their “monopoly”
position to charge high fees and reduce quality of care in order to keep
their costs low. There has also been rapid growth (often with donor funding)
of international NGOs which provide a range of reproductive and sexual
health services in fee-charging clinics, mainly to high- and middle-income
patients. While these may be non-profit organisations and/or charities, they
often behave like profit-making/corporate entities in order to compete for
patients and finance their own expansion. There are also a growing number of
religious-run hospitals and clinics whose anti-choice policies mean they
refuse to offer sexual and reproductive health (SRH) services apart perhaps
from maternity care, yet they may provide the only health services in their
area.

There has also been the phenomenon of the migration of providers and
patients into the private health sector, whether on a full-time or part-time
basis. Disillusioned, under- and unemployed public health care workers are
setting up on their own or in small hospitals and clinics, whether on a
non-profit or profit-making basis, in order to increase their income and
improve and control their working conditions. Policies supporting formal and
informal fees, payments demanded under the table and other out-of-pocket
costs, and non-governmental health insurance schemes have all encouraged
people, even those with little money to spare, to try the private sector,
since they are forced to pay anyway. For the most part, although some SRH
health indicators have been improving in middle-income countries due to
economic development and a growing middle class, the poor everywhere,
especially those living in rural areas, are missing out. The lack of equity
in access to health and health care has remained and may even be getting
worse following the economic downturn.

These trends have consistently been opposed by those who support universal
public health services funded from the public purse, e.g. by a tax-based
national insurance system, a return to a primary health care approach,
public health systems strengthening, increased education and training to
increase the skilled health care workforce, and good salaries and working
conditions for health professionals, mid-level providers and other staff.

However, when countries refuse to support their own public system
adequately, or are afraid and unwilling to ensure that contested services
such as contraception, safe abortion and assisted conception are available
in the public sector, especially where fundamentalist opposition to these
services is strong, if private clinics step in to offer them, shouldn’t
those private clinics be supported and even encouraged? On the other hand,
there are many unethical practices such as offering monthly antenatal
ultrasound scans or ultrasound for sex determination, or promoting cosmetic
genital surgery, as a way of taking money from vulnerable women. Many
private services are unregulated, even in the most developed countries.

We are seeking papers for this journal issue about what is happening in
countries as regards commercialisation and privatisation of sexual and
reproductive health services in the context of wider trends.

·         What is the current picture in countries for one or more specific
SRH services and what does the future hold? Is the public sector being
restricted, starved of resources, or falling apart, giving the private
sector more space to move into? Are there public sector initiatives to stop
or reverse such a decline and are these efforts working?

·         Do people cross back and forth between public and private SRH
services – what are their pathways? With what outcomes? Who is using
private/commercial SRH services and do these people end up in the public
sector if there are complications or problems? What about cost issues for
patients?

·         Are private services actually doing a better job than the public
health sector in any areas of SRH care provision, that is, are they
achieving better outcomes, providing more and better services with a higher
quality of care, or is this a false assumption/perception? Is there any
evidence one way or the other?

·         Are there innovative public-private projects worth supporting in
SRH care (or are there good reasons not to support them even if they are
bringing improvements)?

·         Are there examples of well-regulated, ethical, inexpensive private
SRH services that are improving women’s lives and supporting the delivery of
SRH care that the public sector cannot or does not provide? Can these be
accommodated alongside and reconciled with the public sector?

·         What realistic models for 21st century public sector SRH services
are worth promoting in the context of today’s policies and realities?

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