1. The Role of the Private for-Profit Sector in Reproductive Health in Ethiopia Mengistu Asnake, MD, MPH and Yilma Melkamu, MD, MPH 131st Annual Meeting and Exposition of the American Public Health Association San Francisco, CA November 19, 2003

2. 131st APHA Annual Meeting and Exposition Program Rationale Huge need for RH/FP information and services High TFR Low CPR Huge unmet need Services limited to public and private non-profit sectors.

3. 131st APHA Annual Meeting and Exposition Flourishing of private for-profit sector (1235) Lower Clinics462 Medium Clinics189 Higher Clinics88 Special Clinics61

4. 131st APHA Annual Meeting and Exposition Program Justification People opt for private health care whenever they can. Private for-profit clinics hardly engage in preventive health care. Encouragement of private for-profit involvement. There was a window of opportunity to mobilize the private for-profit sector.

5. 131st APHA Annual Meeting and Exposition Reduce fertility and improve maternal and child health by involving the private for-profit sector. Program Objectives

6. 131st APHA Annual Meeting and Exposition Specific Objectives Offer services through private for-profit clinics, community-based reproductive health agents (CBRHAs), marketplace and workplace agents (MPAs and WPAs) Increase FP/RH knowledge Improve method mix Improve service quality

7. 131st APHA Annual Meeting and Exposition Program Description FP PAC ANC Delivery PNC IE/BCC Child Health

8. 131st APHA Annual Meeting and Exposition Partnership between different actors : NGOs EECMY AGOS Public HFs Region Zone Woreda Private Program Description Community Financial support from the David & Lucile Packard Foundation

9. 131st APHA Annual Meeting and Exposition What is expected from health facilities? Provide quality services Ensure quality record keeping and regular reporting Charge affordable prices Post service fees Participate in training sessions

10. 131st APHA Annual Meeting and Exposition Technical Support Provide support to the health facilities and community level workers, including:  Contraceptives  Recording and reporting formats  IEC/BCC materials  Training (Basic and Refresher)  Equipment and supplies  Technical assistance

11. 131st APHA Annual Meeting and Exposition General: Public-private partnership strengthened Growing demand to be enrolled into the program Improved access  95 clinics  348 CBRHAs, 97 MPAs, 40 WPAs Achievements

12. 131st APHA Annual Meeting and Exposition FP services (new clients 2001-2003) MethodClinicsCBRHAsMPWPTotal VSC(F)46--- IUCD255--- Norplant523--- Injectables15548--- Pills373932894408241441129 Condoms516419995201180327973 Total252755288960931217 85474

13. 131st APHA Annual Meeting and Exposition Service Providers Trained SubjectNo. VSC(F)34 Norplant64 IUCD29 PAC38 EC101 QOC66 Clinic Management and Supervision 40 FP/RH update163 STIs54 Total 589

14. 131st APHA Annual Meeting and Exposition Challenges and Lessons Learned Lack of continuous contraceptive supply. Difficulties building trust between public and private sector. Interest in program activities varies by clinic. Providers lack basic knowledge and experience in FP/RH. Providers often focus on other related services, such as antenatal care, postnatal care, and delivery.

15. 131st APHA Annual Meeting and Exposition Future Directions Mobilize the private sector around social objectives. Strengthen private, public and NGO partnership. Explore feasible strategies to enhance the role of the private for-profit sector. Explore and implement strategies for sustaining the program. Work closely with private for-profit practitioners. Replicate lessons learned in other projects areas.

16. For more information, please contact: Pathfinder International Headquarters Nine Galen Street, Suite 217 Watertown, MA 02472 USA Phone: (617) 924-7200 Fax: (617) 924-3833 Web: http://www.pathfind.org or Pathfinder International Ethiopia Bole Road, Near Lalibela Hotel 251-1-61-33-30 251-1-61-42-09 Masnake@pathfind.org