Global Health Watch 1 in one file

Health care systems | B1
Box B1.7 Global Public Private Initiatives (GPPIs)
There are currently about 80 GPPIs, the overwhelming number of which
are linked to a specific disease or to the development of a new drug or
vaccine. Examples include the Global Fund for HIV/AIDS, TB and Malaria;
Roll Back Malaria; Stop TB; Global Alliance for Vaccines and Immunization;
Global Polio Eradication Initiative; and the Global Alliance for the
Elimination of Lymphatic Filariasis. WHO and UNICEF are the principal
international governmental or multilateral actors involved, but the World
Bank also plays a prominent role. On the private side, the Bill and Melinda
Gates and Rockefeller Foundations are prominent, as are several for-profit
pharmaceutical companies. Some NGOs are also involved, particularly with
GPPIs they have helped to launch. However, certain groups are systematically
under-represented, particularly poorer countries’ governments and
civil society organizations. On the whole, decision-making power sits in
the hands of multilateral institutions and the commercial sector. (Source:
Wemos 2004)
of vectors for infectious diseases such as mosquitoes, or those related to the
control of acute disease outbreaks, a vertical and centralized approach may
be entirely appropriate. Today, however, there is a growing proliferation of
initiatives and programmes that collectively undermine national planning and
coordination; a biomedical, technological bias towards health improvement;
inappropriate public-private ‘partnerships’; and the lack of more long-term
and sustainable approaches to health systems development.
The rise of selective and efficiency-driven cost effectiveness analysis Cost
effectiveness analysis (CEA) is a tool designed to rank the relative worth of different
health care interventions. In 1993, the World Bank published a ranking
of common health care interventions according to their cost effectiveness and
used it to propose a minimum package of services for use in low- and middleincome
countries (World Bank 1993). Its proposal appears rational at one level,
but reinforced a selective approach to health care and undermined equity.
First, the Bank proposed that only this package should qualify for public
funding – services outside the package that it deemed were not cost effective
were considered discretionary and would have to be funded by individuals
out-of-pocket or through insurance. Middle-income countries could be less
restrictive than low-income ones in determining the content of a minimum
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