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Public Stewardship to Optimize Private Sector Participation in Health

Public Stewardship to Optimize Private Sector Participation in Health. Deus Bazira Mubangizi Results For Development/University of Maryland Baltimore IAS Meeting: Bridging the Divide: Inter-Disciplinary Partnerships for HIV and Health Systems Strengthening Vienna, July 16, 2010.

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Public Stewardship to Optimize Private Sector Participation in Health

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  1. Public Stewardship to Optimize Private Sector Participation in Health Deus Bazira Mubangizi Results For Development/University of Maryland Baltimore IAS Meeting: Bridging the Divide: Inter-Disciplinary Partnerships for HIV and Health Systems Strengthening Vienna, July 16, 2010

  2. Presentation Outline • What makes up the private sector • Evidence of significant private sector involvement in health • Private sector negative outcomes • Public stewardship innovative models • Private sector and HIV interventions • Key questions and way forward

  3. Differences Between Types of Private Sector Entity Adapted from The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives (2007). International Finance Corporation, Washington, DC.

  4. Why Leverage the Private Sector • Constrained public resources resulting in limited reach/access • Magnitude of health challenges far outweigh public and philanthropic investments • Private sector can increase access to needed services for varied population groups • Private sector involvement has a synergistic effect on improving quality of care even in the public sector • Rising health care costs are driving more people into poverty • Less efficient and poorly mobilized significant private sector resources (approximately 50% of expenditure on health care is through the private sector and is financed out-of-pocket) • Need to monitor quality of care and services delivered • Critical for improving referral between the public and private sector

  5. Private Sector Use by Income Quintiles

  6. Country Assessment of the Private Health Sector in Ghana (Source: Makinen, M (2010): Results for Development, Washington DC) DHS 2003: Decision to seek care for children with fever or cough, by wealth quintile DHS 2008: Decision to seek care for children with fever or cough, by wealth quintile

  7. Child Care Provider Classification in Select Countries • Source: Lagomarsino et al (2009). Public stewardship of private providers in mixed health systems. Results for Development Institute. Washington, DC.

  8. Countries with Out-of-pocket Expenditure more than 50%

  9. Private Sector Involvement in HIV/AIDS Source: Center for Health Market Initiatives (2010) Results for Development Institute. Washington, DC.

  10. A Case of HIV Services Delivery through the Private Sector • Over 228 sites involved in prevention, care and treatment delivery in 8 countries (Guyana, Haiti, Ethiopia, Kenya, Nigeria, Rwanda, Tanzania, Uganda and Zambia) • Of which over 161 are private (90% private-not-for profit; 10% private-for-profit) • More than 180,000 clients receiving treatment of which 80% are from private facilities and over 400,000 enrolled in care • Average virologic suppression rate over 87% (48 months+) and lost to follow-up at about 7% (48 months+) Source: AIDSRelief Program, 2010

  11. Potential Negative Outcomes of Private Sector Activity • Uneven quality including sub-optimal diagnosis and treatment • Unethical business practices including unfair pricing • Unchecked inefficiency that leads to increased consumer costs • Atomized providers that negate economies of scale and undermine sustainability and increase cost of regulation

  12. Challenges to Public Stewardship • Lack of adequate knowledge on private sector (formal and informal) functioning • Limited technical skills in the public sector to supervise private sector activities • Atomized/fragmented private sector makes it near impossible for government to engage • Public stewardship is not viewed as a priority

  13. Harnessing the Private Sector – Improving Public Stewardship • Regulation – enforce quality standards • Educate and empower consumers to demand quality services • Financing – promotion of risk pooling schemes • Use technology to expand access and improve quality • Change provider incentives and increase monitoring • Strategic purchasing mechanisms for private sector delivery – through targeted subsidies for the poor • Improve access to private capital • International financing back-up • Equity-focused financing • Local financial institutions education on health care risk profiles

  14. Health Market Innovations – Type and Potential Outcomes

  15. Conclusion –Way Forward • The public sector needs to consider innovative mechanisms even when not ideal to begin effective private sector regulation • The private sector requires better organization and coordination in order to benefit from public sector action • Philanthropic and donor investment should also be targeted at the private sector to stimulate growth that will eventually attract private capital • The negative consequences of unregulated private sector call for immediate action • The reality is that the private sector is significant and serves some of the poorest of the poor. • CMHI at R4D is building a data base that identifies and tracks programs designed to better harness the private sector ( http://healthmarketinnovations.org )

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