Developing countries have experienced an increase in public-private partnerships (PPPs) aimed at tackling particular health problems. One type of PPP addresses access to pharmaceuticals, and is based around the provision of donated or discounted drugs. This pilot study, carried out in Uganda for the Initiative on Public-Private Partnerships for Health, examines how these PPPs integrate with and impact on the broader development of health services.
Many health problems among the poor remain unsolved due to a lack of commercial incentives, or the failure of efforts by the public sector and non-governmental organisations. PPPs that provide free or cheap drugs from pharmaceutical companies are often the only initiatives for tackling some diseases. But they also raise questions about how their implementation affects wider health services, how they can be expanded and whether they are sustainable. As the number of PPPs increases and donor interventions become more broad-based, there is a need to develop good practices to maximise health benefits for the poor. As part of that process, this evaluation of PPPs in Uganda has been carried out in preparation for a larger study or studies.
The study assesses the impact on health and health systems of drug access programmes for four tropical diseases and HIV/AIDS, based on interviews with national and district-level actors. Key findings are that:
- For tropical diseases, drug donation partnerships are seen as providing real benefits to national programmes, especially in terms of a regular, sustained supply of free drugs without unreasonable conditionalities.
- National elimination programmes have been inspired by drug donations and wider partnerships with the World Health Organisation. Yet there is still strong national ownership and a good fit of objectives.
- National programme managers work mainly with global partnerships and have had little interaction with pharmaceutical companies. Yet they perceive more interest by the firms in researching neglected diseases.
- With HIV/AIDS, drug access PPPs have reduced the price of branded medicines and provided training for health workers.
- However, they raised expectations about drug access that could not be met. Reduced prices are still too high for most people.
Drug access PPPs, where adequately scaled up, have helped improve the health of the poor. In general, they have not skewed national or district priorities, or diverted human and financial resources to the detriment of wider services. However, challenges remain:
- Ongoing support for operations and an assured drug supply is vital to maintain disease elimination programmes. In Uganda, government funding is far short of the level required for its minimum health package.
- Better co-ordination across programmes and more integration within district health systems is desirable.
- Infrastructure and the security of drug distribution systems needs to be improved.
- Generic versions of anti-retroviral drugs have been introduced in Uganda, reducing prices, but the government has yet to develop a strategy to ensure their continued availability.
- Further studies should focus on countries that contrast with Uganda, and should also look at global partnerships.
- There is scope for more work on the role of pharmaceutical companies in the market for AIDS-related drugs, pricing and procurement, secure drug management and equity of access to treatment and care.
