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Outline

What are the responsibilities of the private sector in health care?

International visions on the future of health care in resource-poor settings

International companies like Heineken accept more direct responsibilities for health care and related activities. The company’s main concern is to safeguard the health of employees, rather than organising public national health care, which is primarily the responsibility of governments. Yet companies do accept additional responsibilities in those countries where primary public health care is insufficient and if this has an impact on employee performance.

As a result of the HIV/Aids epidemic in Africa, Heineken has upgraded its own clinics by enhancing the health care provided and by attracting good quality medical staff. This has resulted in relevant infrastructure, which provides health care to approximately 30,000 people in Africa alone, including employees, partners and children.

This development was taken onto another level, when in various African countries the company was asked to support and or fund operations or specialised medical care provided outside the African continent. Tough decisions sometimes had to be made. Consequently, company policies were amended, both by Heineken and by NGOs and new strategies were developed. Heineken decided, among other things, to extend Aids treatment and HIV prevention programmes and by doing so the company has achieved - financially, organisationally and medically – a leadership position.

In the meantime, large organisations, including the Global Fund, the USA PEPFAR programme, private institutions such as the B&M Gates Foundation, have created a wide variety of health care programmes, focusing on HIV/AIDS, Tuberculosis and Malaria prevention and treatment. To an increasing extent, the private sector is regarded as a partner of governments, universities and NGOs to help tackle world health issues. Yet these developments may have serious consequences.

1. How do companies deal with responsibilities for health care outside the spectrum of their own employees and their relatives?
2. What do companies do when employees ask for treatment in other continents?
3. Which decisions do companies make if they are asked for large contributions to the Global Fund (in addition to what companies already do)?
4. To an increasing extent, companies are involved in advisory bodies and are asked to contribute to e.g. Millennium Development Goals in order to help resolve world issues. What are the roles and responsibilities of these companies?
5. Top-managers, including CEOs, are expected to have enough knowledge of the relevant issues and to pay ample attention to world health care issues. What can we expect from them in concrete terms?

Companies have now started to redefine the limits of their own responsibilities. At best, peers meet to discuss these issues. Sometimes companies prepare models for practical care by others or they prepare clear messages about the limits of their responsibilities. In this context, transparency is required. Answers need to be sought to medical, ethical and social dilemmas. When will employees be treated, when will they be able to make use of health care in other continents? How far do companies go in providing health care, health insurance and in developing relevant strategy? Where do responsibilities start and end?

Companies need to engage in dialogue with external stakeholders, such as the World Health Organisation, UNAIDS, the International Labour Organisation, national governments, ethics, doctors and nurses. Special bodies need to be established to facilitate and support this. This symposium will attempt to seek answers to these relevant issues and questions.