private health sector for quality health care private health sector trusted partner in the delivery...
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PRIVATE HEALTH SECTOR FOR QUALITY HEALTH CARE
PRIVATE HEALTH SECTOR
Trusted Partner in the delivery of Quality Healthcare
Dr. Samwel OgilloProgram Manager
Association of Private Health Facilities in TanzaniaAPHFTA
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APHFTA- Association of Private health Facilities in Tanzania
Established in 1994 Advocacy and Private Health
Sector Development 500+ member facilities- All
types of health service delivery
Secretariat- Headquarters and 3 zonal offices
0ver 35 full time employed full time professional staff
Projects: HIV/AIDS, NCD, FP, QI, Finance/Loans others
Partner with MoHSW and DPs
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Why include the private sector?:
1. Provides about 50% of basic health care in Africa
- There is now convincing evidence that the private health sector provides more than 50% of basic health care in many African countries
- The role of licensed drug store as a first point of care in many African countries is usually underestimated
Role of the Private Sector
Urban and rural population receiving care from private for-profit provider of modern medicine
Percent*64
53
45 4439
2621
1712
62
45
51
67
61
48 48
21
45
34
116 7
46
Nig
eria
Ug
and
a
Ken
ya
Eth
iop
ia
Gh
ana
Cam
ero
on
Mad
agas
car
Sie
rra
Leo
ne
Gam
bia
Mo
zam
biq
ue
Bu
rkin
a F
aso Average for
11 available SSA
countries
Survey between 1995-2006
Source: WB Africa Development Indications 2006, team analysis
Why include the private sector?:
2. Many poor in the community access services from the Private facilities (WB & IFC study 2005)
3. Public health sector finances less than half of total health expenditure. Most is financed from out-of-pocket (WB & IFC study 2005)
Most recent survey year available between 1995-2006
Source: WB Africa Development Indications 2006, team analysis
Percent lowest quintile receiving care from private for-profit provider
Why include the private sector?:
4. The private sector already provides a significant amount of public health services
- Most services are provided for free, though some authorities reluctant to go into any formal arrangement/ contract
- Governments, NGOs are willing to join hands with Private Sector to serve better
4. The private health sector already plays an important role in the delivery of public health goods (The Dar Example)
# PUBLIC AND PRIVATE HEALTH FACILITIES IN DAR- Free Public Services in 2007 (Source - DMO’s office)
DISTRICT VACCINATION/ MNCH
TB & Leprosy HIV/AIDS SERVICES
Public Private Public Private Public Private
TEMEKE 29 54 3 3 29 9
ILALA 21 34 18 8 22 19
KINONDONI 33 50 27 16 25 15
83 (38%)
138 (62%)
48(64%)
27 (36%)
76 (64%)
43 (36%)
Why include the private sector?:
5. “The Private Health Sector can have a positive impact on the quality of care- and in many notable cases it is setting the benchmark for higher quality”- in a number of developing countries- IFC study- 2007
- Modern Medical Technology- CT Scans, MRI, Heart Surgery, Advanced Surgery etc
- HIV/AIDS- ARVs first delivered by private health sector
- No question about high quality of care by private facilities compared to public in many countries
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Barriers to achieving more
1. Lack of access to credit Lack of access to affordable Financing
(Results in High Interest Rates by financial institutions)
Situation worsened by Lack of policies that encourage investment in rural and sub-urban areas (No special incentives that encourage investing in such areas, e.g. tax relief)
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Barriers to achieving more
2. Unnecessary competition with NGOs and public sector Lack of planning means that public, private
and NGO end up competing for the same clients, while in other areas there are no providers at all
Situation worsened by DP money
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Barriers to achieving more
3- Cumbersome registration procedures for facilities and products
- While other businesses take less than two weeks to register, medical facilities and products take up to a year to register in many cases
- Corruption cause of delay in many cases
Barriers to achieving more
4. Unnecessary barriers to accessing funds to which they are entitled – e.g. National Health Insurance Funds
- In many countries, public facilities automatically benefit from NHI funds, while private facilities have to do more than required to get registered with the fund
- Chocked again by poor terms/low prices
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Barriers to achieving more
5. Double Standards: - Unrealistic quality standards that
are unattainable in resource-poor settings
- Not applied to public facilities - Used in some cases to “chock the
private sector out of business”
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There is light at the end of the tunnel
Positive changes noted Policies in favor of PPPs Social Insurance schemes- are ready to
work with private sector to serve the poor Governments, NGOs, DPs- include Private
Sector in their strategies towards improving healthcare delivery
Non-Healthcare private sector playing big role- FP, Diseases control
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What would make things better for the Private Health Sector?
Clear policies and guidelines that support private health sector investment in health, supported with legislative powers (Laws)
PPP in healthcare: Contracting out of services to private health sector
Provision of incentive packages to encourage investment in healthcare delivery, especially underserved areas
Use of same yardstick in the enforcement of regulations related to health care provision
Proper utilization of available resources in healthcare provision in both the private and public sector
Thank you for listening