Private Sector Role in Health Financing in West Africa
DPs in West Africa recognize the private sector's potential role in healthcare financing. Current collaborations involve support from USAID, WB, BTC, SDC, and others to strengthen private sector involvement in delivering health services, financial flows management, and decision-making towards Universal Health Coverage (UHC). The private sector's possible roles include delivering health services, resource mobilization, and participation in governance processes.
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P4H Network Extended Technical Coordination Group Meeting (ETCG) 2-3 February 2015 in Bangkok How do DPs see the role of the private sector in HF in West Africa? Alexis Bigeard (WHO)
P4H in Benin, Burkina & Mali Benin Burkina Mali Main participants Multilateral WB, WHO EU, WHO, Unicef, ECHO WHO Bilateral USAID, BTC, SDC AFD AFD, Canadian cooperation Others INGOs (SCI, TdH, Help, ACF) SCI Other participants Less involved AFD, EU, Unicef, UNDP AfDB, WB Netherland, UNDP, USAID, UNFPA, Unicef Potential FNUAP USAID, MdM, AfDB, WB, MdM, World Vision, AECID (Spain)
Existing collaborations between DPs & the private sector (in SHP & HF fields) in Benin USAID: LMG (Leadership, Management & Governance) Project Includes support to the private sector & the civil society, as well as public-private partnership devlopment . Objective related to public accountability: To improve the autonomy & capacity of local NGOs & private sector organizations so that they fulfill their roles in the perspective of results, transparency & accountability . Probably also: private health providers seen as an important alternative to the public sector when it comes to UHC. WB: PRSS (Health System Performance Improvement Project) focused on PBF Integration of the private health providers (Mars 2015). Here PBF is seen by the MoH as an important tool to regulate the sector http://www.beninfbr.org/articles/item/108 Blue Square (NGO) http://www.bluesquare.org/ on PBF IT plateform BTC & SDC: support of CBHI & civil society (USAID & AFD used to do as well)
Private sector in Benin supported by DPs as per their role in the system Possible role in moving towards UHC DP Non for profit For profit Delivering public Health services USAID NGO (PSI) Purchasing health services BTC, SDC CBHIs, NGOs Control financial flows Delivery of services at facility level NGOs (in CBHI) Private businesses (Trainings, PBF) Medical Associations, trade unions, lobbies (governance) Participate in decision- making USAID
Potential role for the private sector? Possible role in moving towards UHC Non for profit For profit Ressource mobilization Supplying (drugs...) Delivering public Health services Fundations NGOs, others? Companies (mining ) Companies Confessional & NGO Companies Purchasing health services NGOs, CBHIs Health Insurance companies Control financial flows Delivery of services at facility level Delivery of services at community level Participate in decision- making Watchdog NGOs Companies Confessional Private businesses Civil society Medical Associations, trade unions, lobbies Civil society Civil society
The participation of the private sector in the HCF strategy development DPs have supported private sector reviews that were used in the situation analysis: USAID in Benin: http://www.shopsproject.org/sites/default/files/resources/French%20Version%20PSA%2004_29_14.pdf) WB in Burkina: http://www- wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2012/07/25/000020953_20120725161335/Rendered/PDF/7 145200tude0su0ant00au0Burkina0Faso.pdf) And the participation of the private sector in the technical working groups (Benin): Religious-based private health providers association Health users associations Private offices association Private clinics association Private Insurance companies association Technical support to CBHI associations CBHI associations
Some data & context features % private facilities % drug market Not for profit % of curative health services activity % households health expenditures in the private sector Burkina 20% 52% of importations Benin 60% 65% of importations 25% of beds but 40% of hospitalization days 45% 43% In fact, there are different socio-politic contexts (role of the State & room of the private sector)=> evolutive Paradox between the room given to the private sector in public health policies & its role in health service delivery NB: the private sector often in hands of public agents
Food for thought Little is known, documented or done vs importance of the private sector Public-private dialogue is going on for decades with no progress. The risk that the private sector benefits from public subsidies in such a way that it increases inequity seems to exist; it may be not perceived? The use of resource person from the private sector proved to be helpful. Using one DP to channel all input of the private sector may not be the best. We are not at ease to include private sector issues in the HCF strategy.
How to possibly improve the dialogue To include more resource persons from the private sector in the dialogues; - - Systematic & continuous questioning of: the public sector role in HF functions what may be expected from the private sector i.e the possible arrangements In relationship with a socio- political perspective How the public sector shall keep its soverainty and may change some of its functions to do so Eg: private purchasing or private provision of services = contracting = continuation of norms & regulations provision + role of control instead of implementation. - - To exchange on the role of mutuelles in SHP development To consider separately the issue of private sector & civil society . This one being another huge pilar to develop with the UHC development context, but more related to the governance issue.
