Who is in? WHO is out?

Jeremiah Norris – Senior Fellow, Hudson Institute

In 1962, Thomas Kuhn authored a book entitled: The Structure of Scientific Revolution. He pointed out that progress in science takes place because fundamental paradigms shift. That is, over time facts that are observed to be true do not match previous predictions about those facts, and—gradually, a whole new worldview emerges.

Such a shift is occurring in international health: the shift from old aid dependency to new private sector involvement.

On October 7, the International Finance Corporation (IFC), the private arm of the World Bank, hosted the Africa Private Sector Health Conference at the State-Plaza Hotel.  The Minister of Health from Kenya was the key-note speaker at a Round Table discussion with resident and expatriate investment and banking leadership from Kenya.  He announced that his first priority for Kenya was to reform its regulatory system, permitting the emergence of an enabling policy and investment environment that would increase the participation of responsible, private entities in contributing to national health goals.

As a set-piece for the discussion, the IFC had completed two years ago an extensive study on The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives.  An outgrowth of that study was a publication by the World Bank, USAID, Banking on Health, and the IFC: Private Health Sector Assessment in Kenya. This study was released on October 7 and was the subject at the Round Table.

This Round Table discussion contrasted sharply with the content the usual global health related meetings held at WHO (discussed below). Not one of Kenyans was holding out their hands and requesting financial support from the World Bank or USAID.  Instead, they were using the Private Health Sector Assessment in Kenya as the investment basis to pursue these broad objectives:

  1. Increase the availability of health care by expanding the private sector;
  2. increase equity in the health system by making private care more affordable;
  3. improve the quality of private sector health care to improve health outcomes;
  4. and, improve efficiency in the health system by targeting public subsidies where they are most needed and by promoting the comparative advantage of each player in the health system.

As an example of the above, the Executive Officer and founder of The Nairobi Women’s Hospital spoke of how he had used the original IFC findings to encourage a group of investors to support his concept for building Kenya’s first private sector women’s hospital. It found an immediate market and has now been expanded to the construction of women’s clinics in rural areas. He mentioned that Bristol Myer-Squibb, Abbott Laboratories and Baylor Medical College are currently building a Center of Excellence in HIV/AIDS care and treatment, and another donor is building an Eye Hospital, both to service public and private patients.

Various Kenyans in the audience then suggested that these examples would serve as signals to other private investors to build centers of excellence in Cardiovascular Diseases, Diabetes, Cancer, and others. One source of funding: there is a large group in Kenya’s Diaspora community looking for investment opportunities in their home country. The Kenyans at this meeting, led by the Minister of Health, were saying: this is what’s happening in Kenya: let’s do business together.

In contrast, on September 28, WHO hosted a meeting in Washington, D. C. at the National Press Club to launch its 2010 Report on Universal Access to HIV/AIDS Interventions.  Presentations were made by various members of WHO, UNICEF, UNITAID, a minister of health from Ecuador, and one advocate from civil society—but none by any private sector representative.

All had their hands out to raise additional funds for global AIDS, lamenting the fact that there is a fiscal shortfall in meeting universal access. None mentioned the fact that earlier in the year, WHO had elevated the universal number to be treated from 9.7 million to 14 million by 2015–and the fiscal requirements to meet this new goal were also increased dramatically. At a subsequent AIDS pledging event at the UN on October 6, donors committed to $11.7 billion in new funds, though the minimal level needed to meet the new universal goal was set at $13 billion.

While the WHO is asking for money, African leaders are seeking to remove their countries from an aid dependency and hope to increase private sector involvement. A paradigm shift is occurring, and the WHO seems to be stuck in the past.

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