From Ms April Harding.
Sir, Andrew Jack (“World Bank ‘wrong’ to support private care”, February 13) is absolutely right to cite scepticism about Oxfam’s proposal that the global community focus only on public provision to achieve health improvements in developing countries. If we listen, we will leave behind the many poor people who turn to private providers when they fall ill.
Oxfam dismisses arguments to engage these providers by pointing out their poor training and low skills. They suggest we ignore them, and focus on strengthening public provision. We have done precisely this for years, with the result that in many countries access to malaria medicine is falling, and child and maternal mortality has stagnated at high levels. Why? Because people go to the private sector, and persist in doing so.
If we wish to help them, we can work to improve the quality of treatment they receive from these providers.
And there is evidence we can do so: in Tanzania, accredited drug-sellers have improved malaria medicine dispensing; in Ethiopia, trained informal birth attendants have reduced maternal deaths; and in Bangladesh, informal health workers have contributed to successful tuberculosis control.
The poor go where they want, and persist in doing so. The choice we face is, do we acknowledge this and overcome our discomfort with these untrained people who make their living by selling their services and products or do we not? Oxfam would have us answer No. If we listen, we are giving in to wishful thinking, at the expense of finding ways to improve the lives of the poor.
April Harding,
Visiting Fellow, Center for Global Development,
Washington, DC, US