Public private partnership in the training of doctors after the 1990s' health sector reforms: the case of Tanzania.

Similar to many other low- and middle-income countries, public private partnership (PPP) in the training of the health workforce has been emphasized since the launch of the 1990s' health sector reforms in Tanzania. PPP in training aims to contribute to addressing the critical shortage of health workforce in these countries. This study aimed to analyse the policy process and experienced outcomes of PPP for the training of doctors in Tanzania two decades after the 1990s' health sector reforms. We reviewed documents and interviewed key informants to collect data from training institutions and umbrella organizations that train and employ doctors in both the public and private sectors. We adopted a hybrid thematic approach to analyse the data while guided by the policy analysis framework by Gagnon and Labonté. PPP in training has contributed significantly to the increasing number of graduating doctors in Tanzania. In tandem, undermining of universities' autonomy and the massive enrolment of medical students unfavourably affect the quality of graduating doctors. Although PPP has proven successful in increasing the number of doctors graduating, unemployment of the graduates and lack of database to inform the training needs and capacity to absorb the graduates have left the country with a health workforce shortage and maldistribution at service delivery points, just as before the introduction of the PPP. This study recommends that Tanzania revisit its PPP approach to ensure the health workforce crisis is addressed in its totality. A comprehensive plan is needed to address issues of training within the framework of PPP by engaging all stakeholders in training and deployment starting from the planning of the number of medical students, and when and how they will be trained while taking into account the quality of the training.

The psycho-social malaise of migrant private carers in Italy: a rampant, but hidden health demand.

Despite having become an essential part of the national welfare system, the Italian private care market has developed in a situation of institutional disengagement. As a consequence, this sector, which has a high presence of female migrant workers, is currently characterised by serious flaws. What are the consequences for the psycho-social well-being of migrant private carers (MPCs)? This article highlights and analyses the high correlation between migrant women's involvement in the Italian private care market and their manifestations of psycho-social malaise, the latter being one of the main factors motivating the access to health services for MPCs employed in Italy. Based on qualitative data collected in Italy in 2009-2010: 32 in-depth interviews to MPCs, a focus group discussion involving seven MPCs, and 23 semi-structured interviews to providers working in close contact with MPCs, mostly in health services, it describes how the malaise of MPCs is generated, and how it is interpreted and expressed (or not expressed) by them. In particular, it investigates the social dynamics determining the latent nature of this phenomenon, and its tendency to work silently on MPCs' subjectivities without coming to the attention of health services, which are therefore not able to prevent or limit its negative consequences. Nevertheless, this article also shows that this malaise sometimes surfaces in the health service (albeit too rarely, or too late) and how it is generally managed by health providers. In particular, a timely encounter with the health system involving  the simple externalisation and acknowledgement of this psycho-social malaise can have a crucial therapeutic value, meaningfully helping to prevent it from becoming a serious condition. On this basis, the importance is highlighted of creating channels for facilitating the meeting between this pressing but unexpressed health need and the institutions in charge of the health of society.

Inconsistency in health care professional work: Employment in independent sector treatment centres.

PURPOSE: The purpose of this paper is to investigate the impact of recent outsourcing and public-private partnership (PPPs) arrangements on the consistency of professional employment in health care. DESIGN/METHODOLOGY/APPROACH: A case study methodology is applied. FINDINGS: The paper finds that multiple arrangements for employment within the ISTC creates numerous sources for inconsistency in employment: across the workplace, within professional groups and with national frameworks for health care employment. These are identified as having implications for organisational outcomes, threatening the stability of current partnerships, and partially stymieing intended behavioural change. RESEARCH LIMITATIONS/IMPLICATIONS: The study is a single case study of an independent sector treatment centre. Future research is required to investigate wider trends of employment in heterogeneous outsourcing and PPP arrangements. PRACTICAL IMPLICATIONS: The paper informs both managers and clinical professionals of the unanticipated complexities and practical challenges that can arise in partnerships and outsourcing arrangements. ORIGINALITY/VALUE: The paper presents a unique in-depth investigation of employment within recently established ISTCs, and highlights important employment changes for the core health care workforce and high-status professionals in the evolving health care organisational landscape.

How Could Private Healthcare Better Contribute to Healthcare Coverage in Vietnam?

Private healthcare services in Vietnam are seen as a major part of the solution to the rapid increase in need and demand for healthcare services. Formally recognized over 20 years ago, the private health services coexist with public services and are available all over the country. However, the scale and size of private sector is still small compared to the public sector and public acceptance and reputation still limited. There are substantial concerns with the quality of services and the adequacy of regulation. Human resource for health is currently inadequate to support growth in both public and private sectors. The role of the private sector in achieving Vietnam's population health objectives is not clear. In this emerging economy, there is significant potential for increased dependency on private healthcare to increase health access inequities. This paper discusses how private healthcare could better contribute to healthcare coverage in Vietnam.