1. Page 1 Dr. Samuel Ogillo Association of Private Health Facilities in Tanzania - APHFTA GIC Forum on Health and Social Protection, Bonn, Germany August 27 th, 2013 How to engage with the Private Sector: Experiences from Establishing a Public-Private Dialogue in Health in Tanzania

2. Page 2 Overview Private Sector Engagement in Tanzania PPD-Tanzania 09/10/2015  The private sector is a significant actor in the Tanzanian health care system  40% of primary health care services by the Private Health Sector  Strong presence of faith-based organizations (FBO) in marginalized rural areas  Formal private health sector- with Relevant Registration and Regulatory Bodies

3. Page 3 Stakeholder Landscape Tanzania Health Sector PPD-Tanzania 09/10/2015 Source: PSA Report, USAID, IFC, WB 2013

4. Page 4 Overview Private Sector Engagement in Tanzania PPD-Tanzania 09/10/2015  Till 2005 - Diverse, fragmented private sector: for- profit, non-for-profit, faith-based  Mistrust and misperceptions between the sectors was at highest between 1977 to 1991 due to unconducive healthcare policies and absence of dialogue platform

5. Page 5 Engaging the Private Health Sector in Dialogue- Tanzania: 2005 PPD-Tanzania 09/10/2015  2005: An informal group of key health leaders spearheading the policy dialogue and seeking new approaches for public-private engagement  TECHNICAL REVIEW 2005 Theme: Public Private Partnership for Equitable Provision of Quality Health Service. This was an eye opener to the health sector on Public Private Dialogue  The Joint Annual Health Sector Review 2005: PPP became an important agenda  AGREED: The Ministry of Health and Social Welfare in Tanzania to fully engage with the private health sector in dialogue towards improving healthcare delivery at all levels of care

6. Page 6 How to Engage? Taking Advantage of Opportunities PPD-Tanzania 09/10/2015 -The policy and regulatory environment had to be conducive and welcoming to change if dialogue had to take place -The Review of Health Care Policy in 2007 and the Health Sector Strategic Plan III of 2009 was an opportunity to make Public Private Partnership a cross cutting issue -The private health sector actively participated in the policy formulation and strategy development process

7. Page 7 Taking Steps Towards Engagements PPD-Tanzania 09/10/2015  Health Sector Policy 2007: PPP in health as cross cutting agenda- mentioned through out the policy document  The Policy guided the development of the Health Sector Strategic Plan III 2009-15, where PPP would also be a cross cutting agenda - Strategy (6) dedicated to PPP  Appointment of a Public Private Partnership Steering Committee by Permanent Secretary, Ministry of Health and Social Welfare: Constituted Public and Private Health Sector Representatives  Led to formation of PPP Technical Working Group (2009)

8. Page 8 Taking Steps Towards Engagements-2 PPD-Tanzania 09/10/2015 2010-2011: PPP Policy and PPP Act  Government of Tanzania developed a PPP Policy in 2010  PPP Act passed by parliament in 2011  2013 - PPP Act under review to better accommodate smaller PPPs, including PPP health initiatives  Service Agreements for healthcare delivery have been signed between Government and Private Sector An enabling and conducive environment for dialogue and partnership has thus been created

9. Page 9 Building a Platform: The Public-Private Health Forum PPD-Tanzania 09/10/2015  an inclusive, participatory mechanism in which a diverse range of stakeholder groups come together regularly for exchange  Joint Agreement on vision, mission, guiding principles and how to work together efficiently – clear roles, responsibilities, operating policies and governing structures  Shared Leadership through Forums Board chairs, which is responsible for the strategic direction, policy dialogue with key government officials, and technical leadership  Supportive structure through a secretariat, resource centre and TFs Forum Board Task Force #1 Task Force #2 Task Force #3 Resource Centre/ Secretariat

10. Page 10 The Public-Private Health Forum in Tanzania - Composition PPD-Tanzania 09/10/2015 Source: Draft TOR, GIZ 2013

11. Page 11 Other Platforms for Engagement in Tanzania Health PPDs PPD-Tanzania 09/10/2015  NPPP Steering Committee  PPP Technical Working Group  Reforms of District & Regional Hospitals  Maternal, Newborn & Child Partnership  NHIF & NSSF  Private Hospital Registration Board  Joint Annual Health Sector Reviews  Human Resource for Health Working Group  Health Financing Committee  OTHERS ++

12. Page 12 Successes Challenges PPD-Tanzania 09/10/2015 -Space for all health sector groups established to discuss health system issues -Linkages between various stakeholders strengthened -Capacities at public institutions built up -Private sector engagement advocated -Organizing the divers private health sector -Political willingness -Level of influence and significance of the forum on decision making processes -Accountability and transparency -Limited capacities -Develop coherent financing policy/strategy

13. Page 13 What Was the Force Behind the PPD? PPD-Tanzania 09/10/2015  Realization of the need to dialogue - identification of problem and drivers for change  Strong commitment and leadership:- crucial from both public and private key health leaders  Realization of the need for change in mindset:- Development of a positive attitude towards each other  Integrity: Transparency and openness pre-requisite  Management of a divers group of stakeholders  secretariat needs to be well equipped (human capacities and financial resources)  Political will

14. Page 14 Way forward PPD-Tanzania 09/10/2015 -Formalize dialogue structures at national – regional – local level -Strategic priorities for increased private sector engagement  development of a roadmap and working plan -Identify strategic investments and business models  Develop PPP Pipeline and potential projects

15. Page 15 Food for Thought PPD-Tanzania 09/10/2015  Consider approaches used by developed countries to help improve healthcare services in developing countries: Is there a need for change in our approach?  How can developing countries engage in healthcare business partnerships with the developed countries, and in turn bring a positive change in healthcare through these partnerships instead of a donor- recipient relationship  What is the private health sector’s role in the attainment of UHC?  How can PPP, e.g. Service Agreements, enhance the attainment of UHC?

16. Page 16 Thank you for your attention The Association of Private Health Facilities in Tanzania - APHFTA Dr. Samuel Ogillo, ogillo@aphfta.org Dar es Salaam, Tanzania www.aphfta.org Tanzanian German Programme to Support Health -TGPSH Dr. Inge Baumgarten, tgpsh@giz.de Dar es Salaam, Tanzania www.giz.de / www.tgpsh.or.tzogillo@aphfta.org www.aphfta.orgtgpsh@giz.de www.giz.dewww.tgpsh.or.tz PPD-Tanzania 09/10/2015