Private Health Sector

Role and Potential for Partnership

Private Health Sector

Role and Potential for Partnership

MEDHEALTH 2014

Cairo, 12 – 13 March

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• Why assessment of private sector?

• Analysis of private health sector.

• Current status in EMR countries.

• Conclusion and next steps.

AGENDAAGENDA

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Analysis of Private Health Sector: MethodologyAnalysis of Private Health Sector: Methodology

Analysis follows health systems approach – financing, delivery, workforce, technology, governance

Data collected in two phases:– Phase One [2007-10]:

• Assessment of private health sector in 12 counties

– Phase Two [2012 - 13]:

• Review of published reports, ministry of health records and grey literature from EMR countries

• Studies on private sector regulations

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Private Health Sector: DefinitionPrivate Health Sector: Definition

Private sector includes all actors outside of government including for-profit, non-profit, formal and non-formal entities

[World Bank, 2008]

All formal service providers working for profit and/or not-for-profit (e.g. nongovernmental organization). Focus on for-profit sector

[Definition used for the study]

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Free market ideology driven generally towards privatization;

Growth of private sector driven by market demands leading to a public private mix;

Traditional role of state wherein public sector has control and limited interaction with private sector.

Trends in Privatization Policies

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Group1Group 2Group 3

Djibouti

Private Health Sector in EMR Countries: Preliminary Results

Private Health Sector in EMR Countries: Preliminary Results

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(I) Service Provision: Primary care facilities and hospital beds(I) Service Provision: Primary care facilities and hospital beds

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Countries Primary care facilities [includes GP clinics]

Hospital Beds

Estimated number[range]

Percent in private sector

(%)

Estimated number[range]

Percent in private sector

(%)

Group 1203 – 2401

15 - 892086 – 61,036

6 - 26

Group 2880 –

56,4215 - 82

6357 – 131,555

7 - 83

Group 369 –

79,59119 - 92

469 – 128,137

8 - 22

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(I) Service Provision: Pharmacies, laboratories and diagnostic facilities (I) Service Provision: Pharmacies, laboratories and diagnostic facilities

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Countries Pharmacies Laboratories and diagnostic Facilities

Estimated number[range]

Percent in private sector (%)

Estimated number[range]

Percent in private sector

(%)

Group 1 111 – 6,022

27 – 93 51 - 246 43- 89

Group 2 821 – 63,374

58 – 99 1204 – 8,083

52 - 92

Group 3 59 – 55,000

22 - 98 23 – 4,000 22 - 60

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(I) Service Provision: Use of primary care services, private and public providers(I) Service Provision: Use of primary care services, private and public providers

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Public Private Public Private Public Private Public PrivatePakistan Egypt Morocco Jordan

0

10

20

30

40

50

60

70

80

90

100

Poorest Middle Richest

Per

cent

Source: Demographic and Health Surveys

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(II) Workforce: Private and Public Health Workforce (II) Workforce: Private and Public Health Workforce

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Country Groups*

Private sector workforce

[Per 10,000 population]

Public sector workforce [per 10,000 population]

Physicians Nurses Physicians Nurses

Group 1 4 – 16 5 – 38 2 – 20 5 – 44

Group 2 3 –33 9 –20 4 – 20 6 – 33

Group 3 0.1 – 19 0.3 – 6 0.1 – 8 0.4 –7

* Private sector workforce data not available for Group 1 – Qatar; Group 2 – Egypt, Iran, Iraq, Libya, Syria, Tunisia; Group 3 – Afghanistan; Sudan, South Sudan;

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Duality of practice between public and private sectors

Concentration of private workforce in urban areas

Unregulated expansion, lack of accreditation programs for health professionals’ education

Limited data on workforce distribution, salary structure and multiple job holding

Inadequate coordination between MOH and MOHE to plan for public and private sectors

(II) Workforce: Private Health Workforce – Issues and Challenges

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(III) Health Finance: Private Health Sector Expenditure in EMR Countries, 2011(III) Health Finance: Private Health Sector Expenditure in EMR Countries, 2011

Group THE per Capita

US$

PHE[% of THE]

OOP [% of THE]

OOP [% of PHE]

Group 1 991 27.0% 16.7% 61.9%

Group 2 245 52.0% 49.1% 94.4%

Group 3 49 74.3% 69.0% 92.8%

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THE – Total Health Expenditure; PHE – Private Heath Expenditure; OOP – Out of Pocket Payment

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Huge investments in high-tech imaging technology, motived by medical tourism

Irrational use of biomedical devices and technologies leading to high OOP payment

Weak medicine regulatory system and poor enforcement

Availability of core medicines lower in public compared to private facilities

Non prescription sale of antibiotics in private pharmacies (antimicrobial resistance)

(IV) Essential Medicine and Technology

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(V) Governance

Regulations governing PHS need

updating

Policies for engagement between public and private sectors are evolving in most

countries

Limited MOH technical capacity

to formulate policies and fulfill

regulatory responsibility

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Conclusion and Next Steps

Preliminary review of private health sector based on systems approach

Significant gaps in information that need to be plugged

Priority areas that need particular attention are:o MOH regulatory capacityo Partnership with private health sectoro Reduce OOP payment incurred in private sectoro Improve the quality of care

Develop regional strategy that supports countries to engage with private sector for public health goals

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Thank you