1. Private Health Sector Role and Potential for Partnership MEDHEALTH 2014 Cairo, 12 – 13 March 1

2. 2 |2 | AGENDA

3. 3 |3 | Analysis of Private Health Sector: Methodology Analysis follows health systems approach –financing, delivery, workforce, technology, governance Data collected in two phases: –Phase One [2007-10]: Assessment of private health sector in 12 counties –Phase Two [2012 - 13]: Review of published reports, ministry of health records and grey literature from EMR countries Studies on private sector regulations 3

4. 4 |4 | Private Health Sector: Definition Private sector includes all actors outside of government including for-profit, non-profit, formal and non-formal entities [World Bank, 2008] All formal service providers working for profit and/or not-for-profit (e.g. nongovernmental organization). Focus on for-profit sector [Definition used for the study] 4

5. 5 |5 | 5 Free market ideology driven generally towards privatization; Growth of private sector driven by market demands leading to a public private mix; Traditional role of state wherein public sector has control and limited interaction with private sector. Trends in Privatization Policies

6. 6 |6 | Group1 Group 2 Group 3 Djibouti

7. Private Health Sector in EMR Countries: Preliminary Results 7

8. 8 |8 | (I) Service Provision: Primary care facilities and hospital beds 8 CountriesPrimary care facilities [includes GP clinics] Hospital Beds Estimated number [range] Percent in private sector (%) Estimated number [range] Percent in private sector (%) Group 1 203 – 2401 15 - 89 2086 – 61,036 6 - 26 Group 2 880 – 56,421 5 - 82 6357 – 131,555 7 - 83 Group 3 69 – 79,591 19 - 92 469 – 128,137 8 - 22

9. 9 |9 | (I) Service Provision: Pharmacies, laboratories and diagnostic facilities 9 CountriesPharmaciesLaboratories and diagnostic Facilities Estimated number [range] Percent in private sector (%) Estimated number [range] Percent in private sector (%) Group 1111 – 6,022 27 – 9351 - 24643- 89 Group 2821 – 63,374 58 – 991204 – 8,083 52 - 92 Group 359 – 55,000 22 - 9823 – 4,00022 - 60

10. 10 | (I) Service Provision: Use of primary care services, private and public providers 10 Percent Source: Demographic and Health Surveys

11. 11 | (II) Workforce: Private and Public Health Workforce 11 Country Groups* Private sector workforce [Per 10,000 population] Public sector workforce [per 10,000 population] PhysiciansNursesPhysiciansNurses Group 14 – 165 – 382 – 205 – 44 Group 23 –33 9 –20 4 – 206 – 33 Group 30.1 – 190.3 – 60.1 – 80.4 –7 * Private sector workforce data not available for Group 1 – Qatar; Group 2 – Egypt, Iran, Iraq, Libya, Syria, Tunisia; Group 3 – Afghanistan; Sudan, South Sudan;

12. 12 | Duality of practice between public and private sectors Concentration of private workforce in urban areas Unregulated expansion, lack of accreditation programs for health professionals’ education Limited data on workforce distribution, salary structure and multiple job holding Inadequate coordination between MOH and MOHE to plan for public and private sectors (II) Workforce: Private Health Workforce – Issues and Challenges

13. 13 | (III) Health Finance: Private Health Sector Expenditure in EMR Countries, 2011 GroupTHE per Capita US$ PHE [% of THE] OOP [% of THE] OOP [% of PHE] Group 199127.0%16.7%61.9% Group 224552.0%49.1%94.4% Group 34974.3%69.0%92.8% 13 THE – Total Health Expenditure; PHE – Private Heath Expenditure; OOP – Out of Pocket Payment

14. 14 | Huge investments in high-tech imaging technology, motived by medical tourism Irrational use of biomedical devices and technologies leading to high OOP payment Weak medicine regulatory system and poor enforcement Availability of core medicines lower in public compared to private facilities Non prescription sale of antibiotics in private pharmacies (antimicrobial resistance) (IV) Essential Medicine and Technology

15. 15 | Regulations governing PHS need updating Policies for engagement between public and private sectors are evolving in most countries Limited MOH technical capacity to formulate policies and fulfill regulatory responsibility

16. 16 | Conclusion and Next Steps Preliminary review of private health sector based on systems approach Significant gaps in information that need to be plugged Priority areas that need particular attention are: o MOH regulatory capacity o Partnership with private health sector o Reduce OOP payment incurred in private sector o Improve the quality of care Develop regional strategy that supports countries to engage with private sector for public health goals

17. 17 | 17 Thank you