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Findings from the Private Health Sector in West Africa: A Six-country Macro-level Assessment

Findings from the Private Health Sector in West Africa: A Six-country Macro-level Assessment. Bettina Brunner Regional Manager, Francophone Africa, SHOPS. West Africa Macro PSAs and mHealth Scan.

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Findings from the Private Health Sector in West Africa: A Six-country Macro-level Assessment

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  1. Findings from the Private Health Sector in West Africa: A Six-country Macro-level Assessment Bettina Brunner Regional Manager, Francophone Africa, SHOPS

  2. West Africa Macro PSAs and mHealth Scan • Macro-level private health sector assessments in six countries to explore opportunities for USAID’s flagship family planning (AGIR-PF) and HIV and AIDS (PACTE-VIH) projects • mHealth landscape of 17 countries to identify regional opportunities for public-private mhealth partnerships Benin, Burkina Faso, Cameroon, Cape Verde, Gambia, Ghana, Guinea, Guinea Bissau, Cote d’Ivoire, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo

  3. Macro-Level Private Sector Assessment 5 components Legal and regulatory review Recommendations for partnerships Role of theprivatesector Public private partnerships (PPP) & CSR Key NGOs and FBOs

  4. Timeline Ghana Implementing Partners Meeting Ghana Dissemination Event Côte d’Ivoire Burkina Faso Cameroon Niger Togo Mauritania Dec. 8-17, 2013 Jan. 11-19, 2014 Jan.13-17 Mar. 17-21, 2014 Feb. 1-10, 2014 Mar. 1-10, 2014 Feb. 22 - Mar. 2, 2014 Mar. 19-20, 2014 May 20-21, 2014 May 2014 Country Visit Final report publication Event

  5. Methodology • Plan • Draft scope of work • Select assessment team • Engage stakeholders • Finalize scope of work • Learn • Desk review • Prepare field survey instruments • Fieldwork • Debrief key stakeholders • Analyze • Analyze data • Formulate recommendations • Draft report • Share • Disseminate draft report • Validate and prioritize recommendations • Finalize the report

  6. Health Stakeholders Interviewed

  7. Key Motors for Change in West Africa • Regional program in RH & HIV with KfW • Diagnostic survey of private health sector • eHealth Strategy underway • Six local manufacturers identified for local production of ARVs • Assistance to 5 laboratories to provide quality control • 1 million new FP users by 2015 • “De-medicalize, de-centralize, democratize” • Engagement of countries in collaboration with donors • Relaunch of FP strategies in all USAID West Africa focus countries except Cameroon

  8. FP and HIV in Six Focus Countries • Extremely low contraceptive prevalence rate coupled with high total fertility rate • Provision of FP & ART by private for-profit providers varies by country • Pharmacies are major source of FP products • Strong stigma against PLHIV and MSMs in most countries • Service delivery highly concentrated in urban areas • Contraceptive security committees not operationalized

  9. Public Private Dialogue • Strong public sector dialogue with NGOs and FBOs in FP and HIV service delivery • Poor engagement with private for-profit sector • Dialogue mechanisms exist but not operationalized • Private sector not included in health information systems • Wide range of professional bodies but poor interface with MOH • Regulatory environment is weak

  10. Corporate Social Responsibility • Nascent local concept in West Africa • Low presence of multinationals, except in extractive industries, large-scale agriculture • Company foundations active in HIV • Main CSR actors: Private sector coalitions for HIV, chambers of commerce, CSR associations, patronat

  11. Examples of CSR in West Africa Potential Impact • Togo: Brasserie BB finances Espoir Vie’s work with OVC • Mauritania: BMCI finances STOPSIDA’s activities with fishermen • Burkina & Cameroon: Total Foundation finances activities of NGO for HIV activities with truck drivers • Regional: Training and outreach on sexually transmitted diseases Community Families Employees

  12. PPPs and Partnerships • Lots of contracting out with NGOs & FBOs, much less with private for-profit sector • Health PPP idea nascent in region • No health PPP units among 6 focus countries • No health PPP guidelines in health • No private sector strategies in place (Burkina’s is underway)

  13. Burkina Faso Private Health Structures, 2012 Private Health Structures, 2012 • Donor coordination committee and coordinating meeting on contraceptives meet irregularly • APROCLIB is key private sector player • WBG has strong public-private dialogue program Source: Burkina Faso Ministry of Health 2013

  14. Cote d’Ivoire Health Facilities by Type, 2010 • Private health facilities are 52% of total • Of 2,036 private health facilities, 73% were unauthorized (2009) • Growing manufacturing sector (7), but only supply 4% of market • Over 800 pharmacies • Strong professional organizations: ACPCI, SYNAMEPI • Strong business coalitions (CECI) COSCI Government of Cote d’Ivoire, 2013 Number of Sites Providing HIV and AIDS Services by Sector (2010) Source: Barnes et al, 2013

  15. Cameroon Cameroon Hospital Attendance, 2012 • Of 4,351 health facilities identified in 2011, 44% in private sector • 34% of health personnel active in private sector • PPP exists with Confederation of Private Enterprises for distribution of ARVs • Coca Cola Africa Foundation provides medical supplies to Ad Luchem Foundation clinics including malaria & HIV medicines work over $15 million • AFD has invested 22.8 Euros to standardize and streamline the contracting out process with the MOH. Funding for HIV by Source, 2012

  16. Mauritania • Private for profit facilities in Nouakchott & Nouadhibou include: • 15 medical & surgical facilities • 47 medical consulting offices • 15 primary health stations • 118 pharmacies • 280 shops selling pharma products • Private sector Engagement • No public private forum (FP Multi-sectoral working group doesn’t include private for profit sector) • Private for-profit poorly represented in MCH and HIV, but private nonprofit well integrated with public sector CPR, Any modern method, by location

  17. Niger Niger Private Health Sector Health PPPs in Niger

  18. Togo Togo Private Health Sector Overview • 51% health-related spending is out of pocket (2010 CARMMA) • For profit private sector is 33% of total • Platforms exist but not functioning well: Comité de Coordination du Secteur de la Santé (CCSS), Groupe Inter Bailleur Santé

  19. Thank you Bettina Brunner Bettina_Brunner@abtassoc.com

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