Blind Optimism

The realization of the right to health for millions of people in poor countries depends upon a massive increase in health services to achieve universal and equitable access. A growing number of international donors are promoting an expansion of private-sector health-care delivery to fulfil this goal.The private sector can play a role in health care. But this paper shows there is an urgent need to reassess the arguments used in favor of scaling-up private-sector provision in poor countries. The evidence shows that prioritizing this approach is extremely unlikely to deliver health for poor people.Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide.

Some of the key recommendations from this report are:

For donors

• Rapidly increase funding for the expansion of free universal public health-care provision in low-income countries, including through the International Health Partnership.

For developing-country governments

• Resist donor pressure to implement unproven and unworkable market reforms to public health systems and an expansion of private-sector health-service delivery.

For civil society

• Act together to hold governments to account by engaging in policy development, monitoring health spending and service delivery, and exposing corruption.