PUBLIC-PRIVATE PARTNERSHIPS FORM TB CONTROL IN THE AFRICAN REGION: PROGRESS AND FUTURE PLANS Presentation for fifth PPM Subgroup Meeting June, Cairo By Wilfred Nkhoma

Context of PPM projects in the African Region  Historically, government seen as main provider of TB and other health services  Notwithstanding, the private sector, especially “private not for profit organizations” such as FBOs have always played a significant role in the delivery of health services especially in peripheral areas  Thus PPP in all its forms has always been an important component of TB control strategies in Africa  Operational definitions for this presentation: Strictly private for profit Private for profit as well as private not for profit: e.g. involvement of FB organizations workplace DOTS programmes The varying definitions notwithstanding: regional orientation is to embrace PPP as one of DOTS expansion strategies in all countries…NOT A STAND ALONE….however…some special initiatives exist:

Providers of TB care in African countries: an overview  Informal sector and self medication  Traditional healers  Public Health sector: Government  Private not for profit: Quasi public providers - FBOs, Cooperate sector (work place programmes)  Private for profit Nature of care may vary from country to country: advocacy, palliative, diagnosis, treatment, referral, etc

Countries with “formal” PPM initiatives 1. Kenya 2. Nigeria 3. Ethiopia 4. Zambia 5. Uganda 6. Malawi 7. Tanzania 8. Liberia 9. Mali 10. Mozambique 11. Senegal 12. Sierra Leone 13. Ghana 14. Burundi

Countries with GF support for specific TB PPM elements in round 7 of GFATM 1. Burundi : Mapping of PP, training and supervision 2. Liberia: Engaging PP in all aspects of DOTS in Monrovia 3. Malawi: Training for PP and provision of IEC materials 4. Mali: Mapping of PP, training and supervision 5. Mozambique: Mapping of PP, training and provision of free anti-TB medicines 6. Senegal: development and dissemination of operational guidelines, support for PPM for laboratory services and training of PP 7. Sierra Leone: Training for PP, adoption of MOU and development of guidelines

Focus on 7 focus countries CountryNational situation analysis conducted PPM focal point in NTP National PPM guidelines developed KenyaYes NigeriaYes Draft EthiopiaAddis onlyNo ZambiaYes Draft UgandaIncompleteNo MalawiYes Draft TanzaniaYes No

Prof Asso c Corp. secto rHosp Informal provid er Private labs Private Practitioner s/ and or FBOs CountryInvolved KenyaYes Yes (4%)?Yes GhanaYes ? Tanzania??Yes? DRC??Yes? Involvement of various providers: Magnitude of contribution mostly not quantified

Regional Perspectives for  Promote PPP as part of routine DOTS in all countries  Expand partnerships with private sector to increase in-country pool of health staff available for TB control activities  Explore the role of informal providers in TB care with a view to engaging them as feasible

Sample Plans for PPM  Kenya – Roll out with free drugs from Government to extend PPM to slums  Ethiopia – Roll out PPM in Addis Ababa  DRC – Finalize PPM guidelines  Uganda – Finalize situational assessment  Malawi – Roll out PPM in many major towns  Tanzania - Roll out PPM in many major towns

Regional PPP Targets  By the end of 2009 At least all 9 high TB burden countries implementing Public-private partnerships initiatives for TB Control in major cities  By the end of 2010: At least all 34 high TB burden countries (prev. over 300:100,000population) implementing PPP-DOTS initiatives for TB control in major cities.  By the end of 2013  All countries implementing PPP-DOTS in all major cities

Thank you