Futures Group and the World Bank Institute in collaboration with Abt Associates, O’Hanlon Health Consulting, University of California at San Francisco and Tropical Health LLP JANUARY 2014

MARKETS FOR HEALTH SESSION 8 Making the Case to Work in Health Market Systems Barbara O’Hanlon Futures Group and the World Bank Institute in collaboration with Abt Associates, O’Hanlon Health Consulting, University of California at San Francisco and Tropical Health LLP

MARKETS FOR HEALTH BASIC M4H TOOLS UNDERSTAND THE CONTEXT EXAMPLES OF FINDINGS MAKE THE CASE WRAP UP

Stages of an M4H Program  Identify health /equity issues  Understand health market systems UnderstandInterveneAssess  Select markets  Identify and test interventions  Assess and adapt market intervention  Assess market change and health output  Adapt and Scale-up interventions Making the Case for a Market Approach Intervening and Adapting to Markets Monitoring and Evaluating Results

MARKETS FOR HEALTH Characteristics of a M4H Approach 1.Flexible  Depends on context  Alert to market diversity, complexity and dynamics  Market changes take time 2.Opportunistic  Promotes local ownership  Responsive to market players incentives and capacity 3.Risk management  Diversifies risk  Embraces failure 4.Catalytic  Starts small… builds on success  Leverages wider change … M4H is strongly process oriented

MARKETS FOR HEALTH Implications of M4H Approach 1.Funders  Is the program design sufficiently flexible?  Is the program correctly positioned in country’s landscape?  Will the program fit within the Agency’s funding mechanisms?  Is there agreement on markets? On how to measure success?  Is the program timeline long enough to permit success? 2.Facilitators/Implementing Partners  Does the program design allow for flexibility? Failure?  Does the program offer tools (e.g. portfolio approach, measurement indicators) for successful implementation?  Is there agreement on markets? On how to measure success?

MARKETS FOR HEALTH Tools of the Trade Business Case  Strategic Case - Rationale for a market intervention  Appraisal Case - Market potential and VfM  Define health / system objective  Define market objective  Define market/systematic change  Define broad strokes of intervention strategy  Understand the poor  Map specific market systems/ position to the poor  Identify underlying causes of market gaps  Design market interventions addressing gaps Strategic Framework / Logfram e Market Intervention Results Chains  Monitor and manage for results

Analytical Approaches Overview Overview of Health System Health system assessment, partnership landscape assessment (PLA), Private sector assessment (PSA), other private sector research, consumer use/preference (DHS) Poor and their Health Context Socio-economic studies, census date, poverty assessments, livelihood analysis and consumer research Private actors and their Context Market studies, competitive analysis and provider research Health Markets Landscape and interviews of market actors

MARKETS FOR HEALTH BASIC M4H TOOLS UNDERSTAND THE CONTEXT EXAMPLES OF FINDINGS MAKE THE CASE WRAP UP

6 Stages of M4H Identify issues Understand market systems Understand

MARKETS FOR HEALTH Health Market System Analysis  Learn about the poor and their health context –How to define the poor –What is the poor’s health seeking behavior  Identify health market system gaps –Underperforming systems –Underserved health services / products  Understand and map market actors –Who are the key actors –What are their roles and responsibilities in the health market system  Learn about the private sector and their context –What is private sector capacity? Incentives? Constraints?

Analytical Approaches Overview Poor and their Context Socio-economic studies, census date, poverty assessments, livelihood analysis and consumer research Private actors and their Context Market studies, competitive analysis and provider research Health Markets Landscape and interviews of market actors …..PSA explains supply,demand and operating environmentin the health sector…..PSA explains supply,demand and operating environmentin the health sector ….. overview helps explains health priorities and system gaps Overview of Health System Health system assessment, partnership landscape assessment (PLA), Private sector assessment (PSA), other private sector research, consumer use (DHS) …Health Actors Supporting Functions Rules Partnerships

MARKETS FOR HEALTH Health System Assessments (HSAs) Offers a rapid yet comprehensive assessment of a country's health system  HSAs developed by several USAID projects (Health Systems 20/20, Partners for Health Reformplus, Rational Pharmaceutical Management Plus and the Quality Assurance Project)  Conducted in over 30 countries in Asia, Africa, and the Caribbean  The approach covers key health systems functions and is organized around WHO’s six health system building blocks  Recommends strategies – primarily public sector centric – to strengthen health systems

MARKETS FOR HEALTH Partnership Landscape Analysis A participatory process to foster public private cooperation…  PLA is a participatory process that paves the way for improved public private cooperation  Broader than health – education and water  The study provides a firm basis for serious and joint cooperation between the sectors  Implemented PLAs in the health sector: Kenya (2010), Tanzania (2011), Ghana (2012)

MARKETS FOR HEALTH Private Sector Assessment Key Features of PSA Approach  Flexible allowing counterparts to shape focus  Comprehensive pulling together data from multiple sources  “Snap shot” of private sector activities at one point in time  Participatory involving all stakeholders with a focus on commercial sector  Action oriented recommending policy reforms and PPPs Involve All Stakeholders Assess the Private Sector Engage the Private Sector through Public-Private Dialogue

MARKETS FOR HEALTH Other Private Sector Analyses Private Sector Mapping In Malawi, the survey identified training needs by location Private Health Facility Census After an initial survey in Lagos, a 2nd more intensive survey was conducted in a sample of 30 (out of 853) randomly selected facilities

MARKETS FOR HEALTH BASIC M4H TOOLS UNDERSTAND THE CONTEXT EXAMPLES OF FINDINGS MAKE THE CASE WRAP UP

MARKETS FOR HEALTH Examples of Findings: Health Sector Landscaping

MARKETS FOR HEALTH Sources of Health Finances Examples of Findings: 100% = 20.7 billion ksh Kenya 2005/6 NHA

Examples of Findings: Description of Public/Private Mix Private Sector Stakeholder Groups Public/Private Mix of Health Infrastructure Public/Private Mix of Health Professionals  3 out of 4 doctors  3 of out 4 nurses  4 out 5 pharmacists work in the private sector

Examples of Findings: Donor Mapping USAID DFID SIDA GIZ/KfW WB/HIA Maternal Health USAID DFID CHAI WB/HIA Child Health GFTAM PEPFAR DFID CHAI HIV/AIDs FP/RH Supply Chain Malaria USAID DFID KFW WB/HIA GFTAM USAID PMI CHAI USAID PEPFAR GFTAM

Examples of Key Findings: Public/Private Mix: Deliveries Source of Delivery by Income Group Deliveries by Source Type of Private Sector Facilities Used for Deliveries

MARKETS FOR HEALTH BASIC M4H TOOLS UNDERSTAND THE CONTEXT EXAMPLES OF FINDINGS MAKE THE CASE WRAP UP

Preliminary Analyses / Make the Case Data Collected Offers  Strategic Case  Identifies preliminary health needs and underserved population group’s needs  Prioritizes health areas and/or system gaps where the private health sector can play a role  Anticipates expected outcomes from working with the private health sector  Proposes several market areas for consideration

(New?) Concepts in the Design Phase Who are the poor?  Do traditional approaches work to define the poor?  Is the group appropriate for private sector response? Who is the private health sector?  Commercial sector only? What about social entrepreneurs?  Or do we also include FBOs/NGOs? Where to intervene?  Intervene/avoid where donors operate? How long?  Longer time horizon for market changes compared to direct interventions?

Organizing Findings into a Strategic Framework Define equitable health outcome: What is the anticipated health outcome? Who is the target group? Define market change: How can the market address the poor’s health needs? What changes are needed in the health market and enabling environment to better serve the poor? Define broad thrusts: What actions can facilitate the changes in the market and/or operating environment? Equitable Health Outcome Strategic Intervention(s) Health Market Change

MARKETS FOR HEALTH BASIC M4H TOOLS UNDERSTAND THE CONTEXT LEARN ABOUT THE POOR MAKE THE BUSINESS CASE WRAP UP

Examples of Key Findings: Public/Private Mix in FP Source of FP Methods by Income Group FP Methods by Source Type of Private Sector Facility Used for FP Method

Doing M4H — Three Phases Funders  Stop, learn, and design  Be entrepreneurial / go with opportunities Implementing Partners  Conduct more analysis  Stop, learn, and design  Be entrepreneurial / go with opportunities Funders  Be flexible  Open to new results measurements Implementing Partners  Make deals  Establish partner relationships  Co-implement  “Nudge” the partners  Assess and learn  Make pro-active changes in course Funders / Implementing Partners  Be a neutral observer  Report accurately  Learn to improve  Be open and honest Understand Intervene Assess Business Case Market Intervention Result Chains