How to engage with the Private Sector:
Experiences from Establishing a Public-Private
Dialogue in Health in Tanzania
Dr. Samuel Ogillo
Association of Private Health Facilities in Tanzania - APHFTA
GIC Forum on Health and Social Protection, Bonn, Germany
August 27th, 2013
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Overview Private Sector Engagement in Tanzania
 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
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Stakeholder Landscape Tanzania Health Sector
Source: PSA Report, USAID, IFC, WB 2013
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Overview Private Sector Engagement in Tanzania
 Till 2005 - Diverse, fragmented private sector: forprofit, 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
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Engaging the Private Health Sector in
Dialogue- Tanzania: 2005
 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
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How to Engage? Taking Advantage of Opportunities
- 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
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Taking Steps Towards Engagements
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)
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Taking Steps Towards Engagements-2
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
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Building a Platform: The Public-Private Health Forum
 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
Public-Private
Forum for
Health in
Tanzania
Forum Board
Resource
Centre/
Secretariat
Forum
Board
Resource
Centre
Secretariat
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Task Force
#1
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Task Force
#2
Task Force
#3
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The Public-Private Health Forum in Tanzania Composition
Public-Private Health Forum in Tanzania Board
Government of Tanzania
Private Sector in Health
(8)
(12)
MOHSW
(2)
PMO-RALG
(2)
MOF
PMO/TIC
PPP Commission
PPP Unit
Coordinator (1)
(1)
NHIF
(1)
Other Ministry
(by invitation)
(1)
Private Health
Services
(6)
 APHFTA
 PRINMAT
 TAPI/TPM
 CSSC
 BAKAWATA
 Foundation
 Alternative Medicine
still to be nominated
Health
Professionals
(2)
 TPHA
 MAT
rd
 3 slot under
consideration
Related to
Health
(4)
Non-health businesses (1)
 ATE
 API (1)
 PMTI (1)
 Civil Society (1)
Development
Partner
(1)
Source: Draft TOR , GIZ 2013
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Other Platforms for Engagement in
Tanzania Health PPDs
 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 ++
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Successes
Challenges
- Space for all health sector
groups established to discuss
health system issues
- Organizing the divers private
health sector
- Political willingness
- Linkages between various
stakeholders strengthened
- Capacities at public institutions
built up
- Private sector engagement
advocated
- Level of influence and
significance of the forum on
decision making processes
- Accountability and transparency
- Limited capacities
- Develop coherent financing
policy/strategy
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What Was the Force Behind the PPD?
 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
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Way forward
- 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
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Food for Thought
 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 donorrecipient 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?
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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.tz
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