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Some time ago, I wrote about SIPRI’s report on the link between humanitarian aid transporters and the (illegal) arms trade. Recently, SIPRI has followed up and started ethicalcargo.org, what they call a ‘clearinghouse’ for information about transporters being used by the humanitarian community. This is definitely an interesting development, and a direct contradiction of a particularly lame comment from MSF’s Gerald Massis, “It’s like you hire a taxi. After your trip you don’t know what they do afterwards.”

Sadly, I cannot get access because I am currently not connected to a “bona fide organisation engaged in humanitarian relief, crisis response or peace support-related activities” (whatever they may mean by ‘bona fide’), so I cannot really comment on the contents of the database. I would appreciate comments from any reader who does have access (anonymous comments welcome).


Continue Reading 1 comment }Aid and aid work, Logistics

Humourless links for 4 November 2009

by Michael Keizer on November 4, 2009


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The public/private mix in health logistics

by Michael Keizer on May 3, 2009

Some time back I went on a tangent to rant about the wisdom (or rather, the lack thereof) of concentrating on the public sector for health, to the detriment of the private sector. The word “logistics” was conspicuously absent in that post, a lacuna that I am going to repair in this one.

I guess that it will be clear how important the public sector is for health logistics in developing countries. But how about the private sector? What could be its role?

Combine the words “logistics” and “private sector” in one sentence, and obviously third party logistics (or 3PL) will jump immediately to mind (or it should, if you have all been paying attention and read my post on visibility and transparency). However, there are very few logistics companies (or, for that matter, health ministries or health NGOs) in developing countries who would be able to implement the necessary visibility; so I am afraid 3PL lies rather further in the future than one might wish.

An existing example of more or less successful inclusion of the private sector in the health system, are the private retail pharmacies you can find almost everywhere in developing and middle-income countries. In many of those countries, it would be (almost) impossible to get the necessary medical supplies to the patients without this private initiative.

However, it is not all sunshine and laughter. For example:

  • There are serious questions about the quality of the supplied medications by private retail pharmacies in developing countries. Not only can this be extremely harmful for the patients themselves, but it can also contribute to the further spread of resistant strains of viruses, bacteria, and parasites.
  • Likewise, the quality of advice given by private pharmacists is not always the best. Research shows that not only is this advice not always up to par due to a lack of knowledge, but there is the obvious problem that the pharmacist wants to sell items on which he can make a (larger) profit; and so they would be clearly tempted to advice e.g. anti-diarrheals instead of ORS.
  • Private pharmacies will go where there is profit to make. This means that sparsely populated areas or especially poor populations are more likely not be served by any pharmacy.
  • Likewise, private pharmacies will not give away their goods to their poorest customers either. This would mean that the poorest parts of a population that is served exclusively by private pharmacies might not be able to access the necessary medicines.

None of these issues are insurmountable; e.g., quality of supplies and advice can be increased by better supervision and training, incentives can be given to pharmacies to establish themselves in sparsely populated areas, and a voucher system can be instituted to safeguard the needs of the poorest. However, all this costs money too, and in the end it might actually be more effective to have a public (government-owned or sponsored) pharmacy than a public one. This is not something that can be decided on a system-wide level; more likely, the most effective and efficient solution is a mix of private and public pharmacies, supplemented with adequate supervision, training, and financial incentives. Finding the right mix is not an easy task, and probably finding this right mix will include a number of painful mistakes. Don’t forget that the most successful systems in developed countries are the result of many years (and sometimes centuries) of ‘tinkering’.

However, one thing is clear: an all-public system of pharmacies is as likely to be ineffective of hugely inefficient as an all-private system. Dogmatics will not help us at all, and that is as true for pharmacies as for many other issues in health logistics.

(Image courtesy of Getty Images through daylife).


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Blindly optimistic or blindingly obvious?

by Michael Keizer on February 25, 2009

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.


Continue Reading 1 comment }Public health