PHM-Exch> OXFAM: Stop spending development funds on for-profit private healthcare Providers

[Claudio Schuftan]

*OXFAM: Stop spending development funds on for-profit private healthcare*

*Providers*
https://oi-files-d8-prod.s3.eu-west-2.amazonaws.com/s3fs-public/2024-06/Open%20Statement_%20Stop%20spending%20development%20funds%20on%20for-profit%20private%20healthcare%20providers.pdf



We, the undersigned, are calling for a stop to funding from Development
Finance Institutions to

private for-profit healthcare providers. (list of signatories available in
the ink above)



Mounting evidence shows that this funding is going to expensive
out-of-reach private hospitals and

clinics in low- and middle-income countries that are widening healthcare
inequalities, exacerbating

poverty and gender-based discrimination and violating human rights. Far
from advancing progress

towards Universal Health Coverage as governments have committed, this form
of development

finance is undermining it.

Research from organisations including Oxfam,1 Global Justice Now,2 SATHI,3
Wemos,4 Akina

Mama wa Afrika,5 Center for Human Rights & Global Justice at New York
University and Hakijami,6

as well as from several academics,7 has found that Development Finance
Institutions (DFIs)

including the World Bank Group’s International Finance Corporation, the
European Investment

Bank, the UK’s British International Investment, France’s Proparco and
Germany’s DEG are

investing in private, for-profit healthcare providers in low- and
middle-income countries that are:8

● too expensive and out-of-reach for the majority of ordinary citizens in
countries where

they operate and are driving up catastrophic and impoverishing
out-of-pocket health

spending whilst increasing women’s unpaid care loads;

● violating patient rights, including reportedly denying emergency care and
even imprisoning

patients, including new-born babies and the bodies of the deceased, for
non-payment of

medical bills;

● prioritising profit at the expense of quality ethical healthcare,
demonstrated through cases

of both alleged and confirmed medical negligence, false diagnosis, price
rigging and

collusion, overcharging - including during the COVID-19 pandemic9 - and
failure to prevent

other exploitation and abuse including alleged organ trafficking;

● failing to reach geographical areas and populations with the highest
healthcare need and

least access, especially people on low-incomes and living in poverty,
notably women,

people living in rural areas, and other marginalised population groups.

● reportedly exploiting and profiteering from government health insurance
and other publicly

subsidised financing schemes resulting in the diversion of desperately
needed public

budgets for health.

In a recent letter10 to the World Bank Group President, the UN Special
Rapporteur on the right to

health11 and the UN Independent Expert on foreign debt, financing and human
rights12 raised their

concern about the impact of IFC private health investments on achieving UHC
and questioned why

a full public account of abuse cases at IFC-funded hospitals and clinics
have not been addressed.

The DFI model of investing in private healthcare ignores the dangerously
inadequate regulation of

private healthcare providers in the countries where they invest. Risks to
patients, communities and

health systems are further exacerbated by the arms-length DFI approach to
investment, which is

both nontransparent and unaccountable.

Most DFI investments in private healthcare are made indirectly via a
complex web of tax-avoiding

financial intermediaries. These out-of-sight investments are mostly
undisclosed and certainly

unscrutinised.13 DFI governance and oversight of these investments is
wildly insufficient. Any

individual or community seeking remedy for harm related to these
investments faces the near-

impossible task of identifying DFI involvement.

DFIs are silent on the proven failures of commercialised approaches to
deliver equitable, gender-

responsive quality healthcare to those most in need. Evidence demonstrates
a clear correlation

globally that the higher the share of private financing for health, the
higher the rate of women’s

deaths;14 the greater the inequality in life expectancy between rich and
poor people;15 and the

higher the rate of COVID-19 infection and deaths during the pandemic (after
controlling for other

factors).16

The DFIs’ favoured model of investing in private healthcare facilities via
private equity funds also

neglects a growing global evidence base that private equity ownership of
healthcare and nursing

care facilities is associated with harmful impacts on costs to patients or
payers and mixed to

harmful impacts on quality and patient outcomes.17

DFI investments in private healthcare providers also fuel the expansion of
corporate healthcare

chains and augment their influence, jeopardising inclusive healthcare now
and into the future.18

Finally, as evidenced by Oxfam’s research, despite multi-million dollar
investments in private

healthcare facilities over the last fifteen years, the DFIs they studied19
have published no evidence

over this period to back up their claims they are helping to advance
Universal Health Coverage.

Oxfam was unable to find any disclosed impact evaluation or any
substantiated impact data for the

healthcare investments in relation to healthcare access for people on low
incomes, or for women

and girls.20

The arms-length, unaccountable and opaque approach to healthcare investing
by both the DFIs

and the governments that own them is unsafe and unacceptable. Using funds
earmarked for

development on expensive, out-of-reach private healthcare in contexts of
extreme inequality with

inadequate regulation and no robust safeguards does not fight health
poverty or gender inequality

and goes against the principles of social justice.

We reject approaches that put profit before patients and wealth before
people’s health. We are

calling for:

● An end to new funding from development finance institutions (DFIs) to
for-profit commercial

private healthcare, including funding channelled via commercial
intermediaries such as

private equity funds;

● An independent and comprehensive evaluation into active and historic DFIs
healthcare

investments with emphasis on impacts on healthcare inequality,
impoverishment, gender,

and patient and worker rights;

● Action to remedy any harm resulting from these investments;

● A redirection of government efforts to increase funding for free,
inclusive and equitable

universal publicly delivered and financed healthcare.
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