A Critique of the Rockefeller Foundation's “Public Stewardship of Private Providers In Mixed Health Systems”. Http://Bit.Ly/Lgpmsq

After 20 years, the evidence for public stewardship of the non-state health sector in low and middle income countries (LMIC) remains elusive. It is indeed fitting to thoroughly discuss this matter. We all should be informed about the pros and cons involved in the task of regulating the private sector in health. An empirical evidence is missing that better ‘stewarding’ of the private health sector through regulation has worked in achieving better quality of care, and accessible and affordable health care for all. We voice our reservations about how this will work in LMIC. To our surprise, the Rockefeller Report does not address access to quality health care from a human rights perspective; it merely recommends technocratic solutions to well known regulation weaknesses and does not reflect any beneficiary viewpoints. We conclude that, the Rockefeller inquiry chose the wrong avenue to be tested - an avenue that will allegedly improve regulation of problem-ridden public-private health systems. The regulations proposed suggest to us that they will never work to regulate private providers. We do not believe the private sector in LMIC can be harnessed through regulation only. The ‘regulation avenue’ is not a substitute for strengthening the public sector. Many of the measures proposed by the Report are not necessarily wrong, but are applied to the private sector; some of the same, applied to the public health sector, with adequate long-term government and donor financing will go a long way to achieve ‘Health Care For All’. LMIC private health markets have only effectively been tamed in countries where the public sector was effective in competing with it. A competitive, well organized and well funded public health system, delivering comprehensive health care (not restricted to vertical programs) is the only alternative to reign-in the excesses of private providers.

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