SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting Country Assessments of Private Sector Engagement in Health in Africa Dr. Nelson Gitonga SHOPS Sr. Private Sector Policy Advisor, O’Hanlon Health Consulting February Tanzania

Content: Purpose Approach and Methodology Content Examples of PHSA Way Forward

Purpose: Collecting Information on the Private Sector Is Important  Provides objective information helping dispel myths and misperceptions of the private sector  Supplies an accurate idea of who the private health sector, what they are doing and where, and for which population groups  Presents ideas for what potential role(s) they play in the health sector  Helps policy and planning better integrate all resources and activities into one health sector

Private Sector Assessment: a Critical Tool for Engagement Growing interest has prompted several approaches to assess the private sector  Private Sector Assessment (PSA) – USAID SHOPS, WB/IFC & R4D  Participatory Partnership Landscape Analysis (PLA) – GIZ  and others (e.g. provider mapping, PPP inventory, etc)

PSA’s Globally USAID has supported 18 assessments since in Africa World Bank/IFC supported 6 in Africa

PSA Approach Involve All Stakeholders Assess the Private Sector Engage the Private Sector through Public-Private Dialogue Key Features of PSA:  Flexible allowing counterparts to shape focus of assessment  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

PSA Methodology Participatory Public and private stakeholder involvement from start to finish Participation formalized through working group Technical Focus Area(s) Analyzes health and may focus on general or specific health markets Focuses on supply and demand Analyzes all 6 HSS areas – depending on scope Details PPPs Analytical Approach Literature/desk review Stakeholder interviews Secondary and data analysis Support stakeholder dialogue fora Action-oriented Strategic recommendations PPP opportunities Technical assistance

PSA Content  Landscape of all health sector actors and relationships  Comprehensive description of private health role in financing, services/products and other HSS areas  Overview of current PPPs and other forms of collaboration  Roadmap for policy reforms and dialogue  Strategic recommendations to expand and/or create new PPPs

Private Sector Actors throughout the All Health System

EXAMPLES Private Health Sector Assessments

Tanzania PHSA

Malawi Private Sector At A Glance Private sector Definition FBO still considered public, for-profit is very small but starting to grow Private Sector FBO/NGO Sector MOH Hospitals Clinics MD Offices Diagnostics Pharmacies Private sector HRH 25% % of all physicians 44% of all nurses (35% CHAM, 10%PS) Public manage largest share of health infrastructure – 63% vs to 37% private  Private commercial sector – 182 facilities and 220 drug stores  CHAM – 172 facilities

Namibia Private Sector At A Glance Private sector major employer  47% of health workforce practices in the private sector 72% of all physicians 90% of all pharmacists 70% of all social workers Private sector manages considerable infrastructure and equipment  More private than public facilities: 844 compared to 343  Some hospitals and clinics but majority are consultation rooms Majority of private sector concentrated in urban centers  Not where the need is greatest Vibrant private health insurance sector  Private services not affordable to most unless insured Private Sector FBO/NGO Sector MOHSS Hospitals Clinics MD Offices Diagnostics Pharmacies

Kenya Private Sector At A Glance Health is a big market  27 billion KHS Private sector is a major employer  3/4 of all physicians  3/4 of all nurses  9 out of 10 pharmacists Commercial and FBO/NGO manage considerable infrastructure & equipment  More private than public facilities  2/3 of all health facilities  1/2 of all hospitals and nursing homes Private services can be found everywhere Cost of public & private biggest barrier  Private services available at all price points  Growing insurance but still insufficient coverage MOMS MOPHS For- Profit FBO NGO  Hospitals, Clinics  MD Offices & Networks  Individual/ Network Diagnostic Centers  Retail and Network Pharmacies  Pharma Mfg Private Sector Definition Includes FBO/NGO; commercial sector is one of largest and most diverse in region

Result: Critical Tools for Engagement The different analyses have created ……  A new and important body of knowledge on the size and scope of the African private health sector  An opportunity to bring the sectors together to discuss needed policy reforms and identify new PPP opportunities  Fora for engaging private sector on the basis of shared goals and continuous trust building  Initiate partnership between public and private sector towards common goals  Interest in keeping the dialogue going and more importantly, implementation of PPPs together

Moving Forward………….  Need to expand and strengthen data collection on the private sector  Time to update data and continue updating it over time  Private sector data should be integrated into it all MOH policy and planning  Participatory processes should become common practice for all policy and planning in all countries  Capacity development for trust building and partnership between public and private sector is crucial  Keep the dialogue going long after analysis is completed

SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting Dr. Nelson Gitonga Sr. Private Sector Policy Advisor, SHOPS/Kenya