Advancing Partnerships for Universal Health Coverage HANSHEP Workshop Dr. Rehana Ahmed 9 July 2015 Nairobi 1

Primary Healthcare Facility Private Sector TZ 2

Primary healthcare Provider Ms. Elice Muno Nursing Officer Owner & Provider 3

Session Topic Exploring opportunities to leverage the use of an intermediary to expand the provision of primary health care services by the private sector. Rules of the Game Facilitator minutes of overview on topic Challenging discussion questions for group to discuss ( 3 -4) Plenary presentation 4

What do we know…. We know…the growing significance of private providers We know…. that there is a blurring of boundaries between public and private providers We know in addition to services there are many health related goods markets for primary care eg: pharma, diagnostics, even food supplements 5

We know the critical gaps Scale of many development partner funded initiatives remains small. Range of services is limited, more curative. Financially not viable for preventive care Quality of care remains an area of grave concern. Data and low regulation Lack of research 6

We know the progressive path to Universal Health Coverage needs.. Financing :A combination of financing sources Purchasing: Strong arrangements that make use of both public and private providers and include an emphasis on health promotion and disease prevention Payment system that includes incentives for both cost containment and quality of care Infrastructure: Strong primary care and local- level infrastructure with appropriate geographic spread 7

An intermediary can be catalytic …. 8

Activity List Intermediaries 9

Intermediaries– some in this workshop …. 10

Opportunity A Social Franchisor as an Intermediary is a good investment : SF provides oversight and organization of the private sector and can carry this out in partnership with the government SF provides accreditation of facilities and services SF provides in-service training SF provides quality assurance etc. Sources: World Bank and International Finance Corporation 2011; Prata et al World Bank and International Finance Corporation

12 Social Franchising Business Model for Primary care Analyze Research Design and Produce Products, Services & Brand Strengthen Supply > Increase outlets > Train Providers Increased Use by Consumers Strengthen Demand > Increase promotion

Social Franchising strengthens the health system WHO system building blocks SF contributions Quality service delivery Safe, effective with positive client experience Human ResourcesCompetent service providers Health InformationProduction, dissemination and use of information Medicines & Technologies Commodities and equipment efficacious and cost effective GovernanceFranchisee agreements, accountability and regulation FinancingClients can access needed services vouchers or insurance for the poor 13

Social franchising is also aligned with the ancient professional oath and the UN resolution ‘ skilled, well trained and motivated providers ‘... UN resolution Hippocrates (father of medicine) ancient oath that every graduating doctor must enhance skills and use them ethically. 14

Corporate social responsibility Halo effect ( The Economist 27 June, 2015) 15

Discussion: How do the intermediaries at the intersection of public, private and corporate sector contribute to the phc goals of: Health Impact ( DALYS) Quality ( structural, process and outcomes) Equity ( reaching the lowest two quintiles) Cost effectiveness ( cost per DALY ; cost per CYP) and Utilization of services 16

Follow on Discussion to # 1 How do the contributions by the intermediary support public, private and corporate sector? 17

Other possible questions for discussion How can intermediaries help to dispel perception of competition and mistrust between public and private sector ? What can be the intermediary role of insurance in primary health care through private sector? What management model does government need to have for services provision? 18

Summary Government Government must lead Quick wins – Establish effective dialogue – Know who is doing what Start now – Review policies and practices – Focus on implementation – Expand insurance – Support quality enhancements Private Health Sector Organize; then, seek dialogue Encourage members to – Formalize – Join provider networks – Build capacity in clinical practice and in business management 19 Support engagement and take active role Include private sector in country support programs Align programs with priorities coming out of national dialogue Donors, Third Parties

Smart Actions Intermediaries such as social franchisors need to articulate and show evidence about their value add and get recognition for their role in UHC Governments must decide (asap ) to contract intermediaries, because if they don’t Universal Health Coverage will be toast. 20