Financing Quality Improvement in
Private Healthcare Providers
The East Africa Healthcare Federation
Conference
Dar es Salaam, Tanzania
February 27-28, 2013
1
What is PharmAccess?
Mission
“Improve access to quality basic health care including HIV/AIDS
treatment and care in sub-Saharan Africa, through building
sustainable health systems”
Office and staff
•
•
•
•
Working in 10 African core countries
PharmAccess is employing a multi-disciplinary team of 100+
experts, including medical specialists, laboratory technologists,
public health specialists, (health) economists, anthropologists and
entrepreneurs
Head Office in Amsterdam, The Netherlands
Branches offices in Namibia (Windhoek), Nigeria (Lagos), Tanzania
(Dar es Salaam, Moshi), Kenya (Nairobi) and Ghana (Accra)
2
PharmAccess: a Group of Organizations
Sharing a Common Goal
• Healthcare Quality
Basic upgrading
Capacity building
Monitoring & evaluation
• Health Insurance
Program development
Capacity building
Technical Assistance
•Health Provider Financing
Loan provision
Technical assistance
• PPPs
Workplace Programs
Consulting (PPP)
• Operational Research
Data collection
Impact analysis
Learning
3
Health Care in Africa Stuck in a Vicious Circle
•
African healthcare systems stuck in a vicious circle of low
demand and supply
Shortage of resources is the major impediment to quality of
healthcare services
Access to quality basic health care among the poor is low
•
•
Demand
Financing
Low
Supply
↓
Solidarity
↓
Quality and
capacity
↑
Out-of-pocket
expenses
↓
Efficiency
↓
Access to health
care
↓
Availability data
↓
Ownership
↑ Risk for owners
Delivery
Low
Patient
↑
Catastrophic spending
↓
Utilization
4
and investors
Breaking the Vicious Circle: Building Trust
Health Insurance
Fund
-Premium subsidies
-Education and
marketing
-
Introducing health
insurance
- Upgrading and capacity
building
- Quality assurance
- Certification and
accreditation
Donors /
governments (tax)
Demand
↑
Solidarity
↓
Out-of-pocket
expenses
↑
↑
Government
(public)
Financing
Higher
Supply
SafeCare
↑
↑
↑
↓
↑
Access to health
care
Ownership
Prepayment
(contribution)
by users
Delivery
Quality
Efficiency
Availability of data
Risk
Investment
opportunities
Higher
Patient
↑
Increased willingness to pre-pay
↓
Decreased financial risk
5
Medical Credit
Fund
“Financing Health Care
Quality Improvement in Africa”
6
Investment Strategy:
MCF works with local partners
MCF
Access to Finance
Program
Quality (SafeCare)
& Business TA Program
Partnership local banks
Partnership local
TA partners
Sub Sahara Private Healthcare providers
Access to Finance Program:
Business planning improvement,
making healthcare providers bankable



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Business planning training
Preparation of financial statements and business plan (local partner)
Support with filing of loan application
Track record building through local banks
Entry loan
Around EUR
2,500
Second
Loan
Around EUR
20,000
Third loan
Over time, the local commercial bank relative
exposure on the client increases
8
Around EUR
50,000
MCF – Results (December 2012)
Portfolio
Performance
• 232 loans disbursed since inception: USD 1,600,000
• Outstanding Loans USD 900,000
• PAR > 90 days: 1.7%
TA
Performance
Partners
274
173
146
197
•
•
•
•
Clinics formally entered the MCF Program
Clinics completed business training
Clinics completed quality training
SafeCare assessments performed
Tanzania: APHFTA, BancABC and NMB Bank
Ghana: SPMDP/GRMA and MBG Bank
Kenya: KMET and PSI Kenya, KREP Bank
Nigeria: Hygeia Foundation and FCMB Bank
SafeCare:
International Standards and Stepwise
Certification for Healthcare Facilities in
Resource Restricted Settings
International Standards, Local Solutions
“Quality is not
necessarily high-tech
or high cost”
SafeCare allows for
realistic, practical
and achievable
solutions in resource
restricted settings
SafeCare - Quality Standards
SafeCare started in 2011, as a collaboration of:

Comprises of innovative and realistic standards for healthcare
providers in resource-restricted settings, ISQua approved

Linked to a step-wise improvement process recognized by
certification that can be used by governments, donors, health
insurers, (social) investors and loan providers for
benchmarking and performance-based financing

These certificates of recognition will eventually improve the
reputation of these healthcare facilities

Clients are expected to have increased trust in services
provided
SafeCare - Activities & Results


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With PAI and partners: 35 local surveyors and facilitators trained
With MOHSW Tanzania: MoU for TA to certify facilities
With MCF: 59 APHFTA facilities surveyed, 4 certified in Tanzania
With MCF: 112 facilities surveyed, 18 certified elsewhere
With APHIA Kenya: 360 facilities to be surveyed (PSI, KMET, FHI)
With NHIFL: TA to NHIF Kenya to develop certification of facilities for
the new outpatient scheme
With MOH Kenya: mapping of patient safety using SafeCare as
basis for a new licensing structure for healthcare facilities
With AHME:using safe care for network in Kenya, Nigeria and Ghana
With Shell Oil: certify healthcare facilities in Nigeria
14
The Partnership of MCF, SafeCare and
APHFTA: Recognizing Achievements
Synergy of Programs: a Multiplyer Effect
Increased
trust and
utilization of
care
Transparancy
of quality of
care
Insurance
creates demand
for quality care
Access to
finance to
allow for
investments
Discussion: Topics
1. Access to Capital:
• What are the barriers for banks to lend to providers?
• What are the barriers for provides to access bank loans?
2. Role of Insurance:
•What is the role of insurance in accessing finance?
•What is the role of insurance in quality improvement?
3. Rural Outreach:
•How to stimulate private provider investments in remote areas?
•Or should these be entirely left to the public sector?
4. Regulation:
•What about the channel for self-regulation of private providers?
•Should self-regulation through certification be self-financing?
•What is the role of the public sector in private sector regulation?
•
5. Regional Cooperation
•
•
•
•
Can providers networks/associations an active role in regulation?
Can they design incentive systems for regulation?
Can they play a role in enforcement of self-regulation?
Is there perspective for a common regional self-regulation format?