Improving Access to Reproductive Health Services: How to engage the private sector Jon Cooper

1. Improving Access to Reproductive Health Services: How to engage the private sector Jon Cooper MSI Uganda, Country Director Den Haag, The Netherlands 5 November 2010

2. MSI’s Strategic Focus Mission: Children By Choice Not Chance We aim to contribute to: • eliminating unplanned pregnancy and unsafe abortion, especially among the underserved • revolutionising sexual and reproductive health service delivery • reducing the barriers to SRH services and supplies • strengthening health systems

3. MSI’s Impact: Global MSI’s contribution to CPR in selected countries - 2009 Uganda 20% Philippines 11% Malawi 40% Nepal 13% Sierra Leone 39% Afghanistan 14% Tanzania 24%

4. MSI’s Impact: Global The non-state sector plays a major role in Health Systems, and makes significant contributions to FP and Safe Abortion Service Delivery MSI’s estimated impact January – June 2010 • 4.5 million unintended pregnancies • 1.3 million unsafe abortions • 18,000 maternal deaths • a total cost saving to global health systems of over 500,000,000 euro

5. Role of the Private Sector Urban and rural population receiving care from private for-profit provider of modern medicine Percent for most recent survey year available between 1995-2006 Source: WB Africa Development Indications 2006, team analysis Average for 11 available SSA countries Mozambique Burkina Faso Uganda Madagascar Nigeria Kenya Ghana Gambia Ethiopia Cameroon Sierra Leone

6. How MSI strengthens Public-Private Partnerships Social franchising and accreditation schemes for private providers MSI “contracted out” or “contracted in” by host governments Output-Based Aid (OBA or RBF) Voucher Schemes

7. …to increase FP and safe abortion service delivery …at scale Working with the Private Sector increases results Social Franchising / Accreditation *2008 - Socialfranchising launched

8. MSI Sierra Leone Voucher Programme: Started May 2009 MSI Sierra Leone is voucher management agency and provides vouchers to distributors. Client receives voucher from distributor and redeems at health centre of their choice 2 types of programme: Healthy Life (LAPM) & Healthy Baby (Safe Motherhood): Healthy Life: area-based and targeted at men & women in 15 slums in western Africa. 20 providers Healthy Baby: targeted at poor women in western, northern & southern regions. 7 providers Service included: Healthy Life = 1 LAPM of choice Healthy Baby = 4 antenatal visits, delivery, 2 ultrasound & 1 post-natal visit that includes long-term family planning Demand side financing: voucher schemes

9. Example – Malawi: MSI in Malawi signed national level MOU with the MoH MSI’s OBA programmes in Malawi provide services to people in hard-to-reach parts of the country. Several District Health Management Teams have signed service level agreements with MSI. Through these agreements, MSI provides the Essential Health Package free at the point of delivery to hard to reach rural populations. The cost to government for MSI services is roughly equivalent to the cost of government-managed services ($7.88 vs. $7.77 per service), but MSI is able to reach more remote areas and offers greater choice. Contracting in/out

10. Delivering results via output-based aid (OBA) • …to improve health systems outcomes • …to increase FP and safe abortion service delivery • …for poor/vulnerable women……at scale MSI’s experience with “contracting in” & OBA

11. Future and conclusions MSI Afghanistan • Coordination with community based agents to distribute FP products door-to-door  increased demand and knowledge from women • Working with religious leaders to increase support FP activities Impact in 2009 in Afghanistan: • Over 133.000 unwanted pregnancies averted • Over 14.500 infant deaths averted • Over 1.500 maternal deaths averted • Nearly 26.000 unsafe abortions prevented

12. Future and conclusions • Working in partnership is key to increasing access to essential Reproductive Health services • With governments • With private sector • With donors