Africa: Grant call: Impact of private capital flows in health care

Rhodes University Institute of Social and Economic Research (ISER), Training and Research Support Centre (TARSC) and, Southern and Eastern African Trade Information and Negotiations Institution (SEATINI) in the
Regional Network for Equity in Health in east and southern Africa (EQUINET)

CALL FOR RESEARCHERS

Capital flows in the health care sector in east and southern Africa: Implications for equity and access to health care

Call closes: 28 June 2007

Project focus

This project explores the manner in which private capital flows are impacting on the health care sector within the region, and the effect this has on national health systems and equitable access to health care.

Background

The SADC region has identified the combating of poverty as a priority, through building up the capital assets of the poor, reducing inequalities, and promoting knowledge and health in poor areas. The profile of health in east and southern Africa shows a high prevalence of diseases of poverty. While access to health care has expanded, there are continuing problems of lowest income groups having poorer access to health care. The region has also in the past decade experienced reductions in financing for public services and a growth in commercialised services, from informal sector primary care level services through to specialised private hospitals. Proponents of private for profit sector expansion in health care have argued that the private sector is cost effective, provides quality care, is able to complement government in expanding coverage and relieves pressure on public funding. The private sector has, however, had a mixed record in health systems in the region, with report of poor quality of care, limited reach beyond higher income groups, barriers to access due to user charges and fragmentation of risk pools. Despite these problems there is evidence that privatisation of health care services is expanding and new pressures for liberalised trade in health care services are being exercised through global and bilateral trade agreements.

This three year research programme seeks to better understand the flows of private capital that lie behind the growth of the for profit health care sector in the region, particularly as it is being effected through,
- Changes in ownership from public to private of medical infrastructure and of the anciliary and health related services that support health care: the clinical aspects- drug procurement, laboratory services, etc - the ‘hotel’ aspects– accommodation, food, waste and hygiene; the transport and communications services- ambulances, communications- and the health worker and knowledge support - medical and other training schools, health worker recruitment and deployment etc
- Changes in ownership and share of financing by private for profit financing- voluntary health insurance, medical aid, prepayment schemes and health management schemes

The programme is being implemented under the umbrella of the Regional network for Equity in Health in east and southern Africa led by the Institute of Social and Economic Research (ISER), South Africa, with the Training and Research Support Centre, Southern and East African Trade and Information Negotiations Institute (SEATINI), and in co-operation Health Economics Unit, UCT and York University, Canada. It is supported by Southern Africa Health Trust and from EQUINET through IDRC Canada and SIDA Sweden. The programme will over two years 2007-9
Review literature on capital flows and develop the analytic frameworks and methodologies for the work.
- Identify four country teams for background mapping of current capital flows and select three countries for follow up work
- In early September hold a workshop for selected country teams and research institutions on the research methodologies and work-plans.
- Implement in 2008 fieldwork in three countries
- Compile evidence from the region and provide web accessible reference materials on trends in capital flows, the impact on health systems and policy responses
- Integrate the evidence and analysis into existing capacity building and research programmes in EQUINET and into web based training on social policy
- In 2009 prepare reports on the evidence gathered and review these with key stakeholders at national and regional level to identify potential policy responses
- Prepare scientific reports, briefs, leaflets on the findings to disseminate to policy, official, parliamentary and civil society actors in ESA.
- Hold a regional meeting in ESA on the findings involving key stakeholders

The call

The programme is making a call to researchers from east and southern Africa to apply to participate in the programme. Research teams will be expected to show evidence of expertise in health systems, trade, economics through one or more members of the team.
The research teams are invited to submit concept notes to carry out an initial mapping and review of the capital flows outlined above in the health sector in their own countries drawing only from secondary evidence that will present documented evidence on:
- The current composition of the health sector, particularly showing the public-private mix and detailing the nature of the private for profit sector
- The current situation and trends over time post 1995 in private capital flows to the health sector (differentiating sources and targets of capital flows)
- The key entry points for capital (eg construction of health facilities, contracting out, PPP, management contracts etc) including within the public sector and distribution by area, level of health service of capital invested
- Documented evidence on the impact on the health care sector, in terms of financing, resource allocation, service provisioning, and access
- The arguments used to support private flows, the role of trade agreements, and the policy, regulatory, institutional and public responses to the capital flows
- Issues arising in relation to methods used to analyse capital flows and their impacts, including data availability and bias
The concept notes should detail in brief the major areas of analysis, the key sources of evidence and any expected difficulties in preparing the review.

The reviews will be prepared in July 2006, first complete drafts submitted by 3 August 2007 and final drafts by 20 August 2007. The first drafts will be used to select three countries for follow up field work and participation in the methods workshop to be held in Tanzania in September 2-3 2007. A grant of US $5 000 will be given for the production of each of the reviews and applicants for the workshop will have full costs met for the workshop and a grant for follow up field work in 2007/8.

This is an open call. Applications should be emailed to be received by 5pm June 28 2007 with:
- CAPITAL FLOWS in the subject line
- A brief one-two page concept note as above
- CVs and contact information including email of the project leader and the names and qualifications of any team members
- The names and contact information of two referees
- A sample of an output that the applicant has produced in an area closely related to that of the case studies

Applicants should submit this information to [email][email protected] AND to Katie Farrington [email][email protected] at the Institute of Social and Economic Research (ISER). Accepted delegates will be notified by Thursday 5 July 2007 on the outcome of their submission. For further enquiries, please contact [email][email protected] AND Katie Farrington, ISER at [email][email protected]