Healthcare for all? How UK aid undermines universal public healthcare

Date: 27 January 2021

The UK government is at the forefront of a trend to invest large amounts of development funding in private healthcare. Over half a billion pounds of UK public funds have been invested in private healthcare in the global south in the past decade alone. What’s more, this figure is likely to increase in the years to come as the UK seeks to expand its post-Brexit economic role as a key exporter of health services.

Our research has found that the UK development bank, CDC Group, has a private healthcare portfolio of £420 million. This includes financial support for a series of highly questionable projects, including:

• The now defunct Abraaj Growth Markets Health Fund, the former CEO of which is facing fraud and corruption charges for his involvement in the “biggest collapse in private-equity history;
• Serious allegations of systemic overcharging made against a UK-backed hospital in Kenya. The Nairobi Women’s Hospital, unaffordable to many Kenyans,  has been accused of overcharging patients, with staff claiming the hospital “resembled a trading floor”;
• Hospitals in Bangladesh and Pakistan accused of overcharging patients throughout the Covid-19 pandemic, including Evercare Dhaka and Evercare Lahore which lists its price for a hospital room with a ventilator as approximately £350 a day (over four times the average monthly wage);
• Other UK-backed hospitals face criticism for closing departments during the coronavirus pandemic or, in the case of Vikram Hospital in Bengaluru, India, being forced to close after refusing to treat government-referred coronavirus patients.
• Investments with no apparent development impact, including a “premium and budget” fitness club chain in Brazil which runs “one of the most expensive fitness centers based in Sao Paulo”.

In this new report, we set out how these investments fit into the UK’s wider development strategy which, in recent years, has prioritised supporting private, for-profit businesses over services which reach the world’s most marginalised communities. We provide detailed evidence on CDC’s investments, discuss the reasons why private healthcare is so problematic, and set out a series of alternative means for financing global, public, universal healthcare.

Recommendations

1. The UK government should commit to ensuring that all UK aid supports strong public health systems and is not used to invest in private healthcare companies or promote Public-Private Partnerships.
2. CDC should stop investing in private healthcare and should review all of its existing private healthcare investments to devise an exit strategy that protects jobs. Until this happens, CDC should not receive the additional £779 million capital injection it is due to receive from government between April and June 2021
3. The UK should exclude public health services from all trade and investment deals, not only protecting our own NHS, but also allowing developing countries the policy space to build their own public, universal systems.
4. The UK should advocate for a new international approach to public health financing based around:
   • stronger co-ordinated international action on tax avoidance.
   • debt cancellation for global south countries, including bilateral, multilateral and private sector debts.
   • developing models for a global wealth tax to redistribute wealth and ensure that governments in the global south have the revenues they need to finance strong public health systems.