Oxfam recently released a report that basically claims that the only way to get health systems in developing countries on track is using a mainly public-sector approach. Of course,they hedge their position by including a disclaimer that “[t]he private sector can play a role in health care”,  but that is about the only nod they give to any merits of the private sector.

Obviously, not everybody agrees, and reactions have been swift and, at times, scathing; in fact, I have not been able to find any positive comments from non-Oxfam-related sources (but that might be due to the normal bias: it is always easier to be critical than to support somebody without appearing sycophantic).

The rational approach, of course, is: whatever works. Both Oxfam and its detractors seem to have been caught up in old-style ideology. The only rational response that I have seen up to now has come from CGD‘s April Harding: she points out that there might not be any convincing evidence for a blanket private-sector approach, but neither is there one for a similarly blanket public-sector one. Kudos to Harding.

I think it should be clear that every health system is unique, with its own setting, history, and constraints; and that consequently every system has its own optimum mix of public and private sector support. The art is to find that balance in each individual case, which is one of the central issues in public health economics. Blanket statements on which approach works best don’t do anybody any favour.

(Update 16 May 2009): See my recent post on pharmacies for more info on the public/private mix for health logistics.

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