Trickle-down health care

A version of this post originally appeared on Devex. Reposted with permission.

Do investments in private hospitals and clinics catering to the wealthy strengthen primary health care systems in poor countries?

At a recent roundtable discussion in New York City, a representative of a private equity group presented plans to build private hospitals in emerging markets, such as Kenya, as one of the best ways to strengthen primary health care delivery. For most of us who have worked on strengthening health systems, investing in hospitals that cater to the well-off doesn’t sound like the best way to meet the health needs of the poor.

Ever since the 1978 Alma-Ata Declaration on Primary Health Care, there has been a strong consensus to promote policies aimed at allocating resources away from expensive curative care to preventive and primary care delivered at the community level. Has an emerging middle class, population growth, the increasing prevalence of noncommunicable diseases and the advance of medical technology over the last 40 years turned this reasoning on its head?

The best way to improve the health status of the poor is to finance programs that directly benefit them. Click To Tweet

The private equity fund manager’s argument is this: The only way to create local capacity for a fully functioning health care system is to start at the top and cascade best practices and standards to lower levels of the system. Building capacity requires experienced local specialists — doctors, nurses, administrators and technicians — who can serve as mentors and trainers to disseminate knowledge and skills through the system.

Read the entire blog here.

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