Public Policy towards Public- Private Collaboration in Strengthening Health Systems World Bank Commitments and Challenges Donor Forum Paris, May Cristian C. Baeza The World Bank

Private Provision of Health Services Play a Key role in serving the needs of the Poor Source: HNP Strategy Facilitation team, adapted f rom WBI data (Yazbeck A.), Bank HNP Strategy 2007

Private Financing accounts for the vast majority of resources through OOPs but, with severe impoverishing consequences Health spending source breakdown, as percentage of total health spending, FY98-02 trends in Low Income Countries, not population-weighted Note: This figure represents simple (not population weighted) averages Source: World Bank HNP Strategy team from WHO/SIMA data Urgent need for Increasing Risk-pooling

The Bank Strategy for HNP Results “Despite increasing awareness of the large role of private financing and delivery of health services, public policy action has been insufficient in most client countries. Private providers deliver most ambulatory health services in most LICs, and even the poorest people often seek private care ). Nevertheless, public policy is still not attuned to ensuring public-private complementarity and synergies and effective resource use in the health sector”. “Bank advisory capacity on health system strengthening needs to be able to provide sound, feasible, timely, and sustainable advice on when and how to invest in in-house public risk pooling and/or service delivery infrastructure and when to contract out with the private sector (for-profit and not-for-profit) in LICs and MICs”.

The Bank Strategy for HNP Results “… the current tendency of the Bank HNP sector to focus on the public sector and of IFC to focus on business development for the private sector has created a vacuum in the Bank Group in terms of supporting client-country development of public policy toward the private health sector…” Public and private sector financing/delivery are essential to scale up access to services and protection against impoverishing due to illness. But they are instruments. What ultimately matters is achieving results on the ground. – Level and distribution of health outcomes – Financial Protection (preventing poverty due to illness) – Sector financial sustainability and sector contribution to sound fiscal policy and country competitiveness

Bank-IFC-Partner Country close dialog and collaboration How can government engage and regulate a predominantly private delivery sector in LICs to improve equity, ensure consumer protection through improved public-private collaboration to achieve HNP results? What are the public and private sector roles in the quest to expand risk polling coverage and supply of priority health services in general but for specific areas an populations in particular? How can policy makers extend health insurance (public and / or private) to the large informal and self-employed sectors?; How to leverage, for that purpose, high, private household (out-of-pocket) expenditures among the non-poor? When facing specific need for program/project interventions to solve lack of access to services and/or lack of protection against impoverishing due to illness, when should in house (public) capacity be created and when should contracting out with public financing be used? What are the innovations in financial instruments / financial aid / fiduciary safeguards needed to succeed?

Future role of Private Sector in Providing Coverage for the poor intrinsically linked to public sector reform Within normal fiscal constraints, private provision of publicly financed services will not be scaled up until: Resolving the frequent confusion in sector policy makers in the allocation of public funding generated by their role “hosting” policy efforts for improving HNP outcomes of the population while, simultaneously, hosting the HNP sector inputs to achieve those outcomes. Resource allocation moves from financing inputs to financing results These two objectives are at the core of most health system reform/strengthening efforts in HICs, MICs, and LICs today

Public Policy towards Public- Private Collaboration in Strengthening Health Systems World Bank Commitments and Challenges Donor Forum Paris, May Cristian C. Baeza The World Bank