Tanzania Private Health Sector
Assessment:
Key Findings for Private Health Providers
James White R.N., MSc., Assessment Team Co-lead
Towards Increased Public-Private Cooperation in Health
February 26th, 2013
SHOPS is funded by the U.S. Agency for International Development.
Abt Associates leads the project in collaboration with
Banyan Global
Jhpiego
Marie Stopes International
Monitor Group
O’Hanlon Health Consulting
PSA Approach
Key Focus Areas of the Assessment
 Policy and Enabling Environment
 Service Delivery in the Private Health Sector
 Pharmaceutical and Medical Commodities Supply Chain
 Health Financing
 Key Focal Health Areas
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HIV/AIDS
Reproductive, Maternal and Child Health
Tuberculosis
Malaria
Defining the
Private Health
Sector
A diverse landscape of
actors
The Private Health Sector is Diverse
Health
 Private-not-for-profit
 Faith-based organizations
 Not-for-profit entities
 Non-governmental organizations
Commercial / Private for-profit
Non-health private sector
 Private employers, corporations, commercial banks
A Holistic View of the Health Sector
Landscape of the Tanzanian Health Sector
Findings from the Private
Health Sector Assessment
The Private Health Sector’s
National Coverage
Public-Private Mix of Health Infrastructure
 Public owns majority of health facilities
 Distribution skewed by # of dispensaries
 PNFP also owns significant # of hospitals
 PFP concentrated on dispensaries
Total Number of Health Facilities in Tanzania
Source: MOHSW (2012)
Facility Type
Hospitals
Health Centers
Dispensaries
TOTAL
Percent of TOTAL
Public
103
PNFP
101
444
PFP
Total
36
240
134
55
633
4,057
625
787
5,469
4,604
860
878
6,342
72.3%
13.9%
13.8%
100.0%
The Private Sector Contributes
at all Health Service Levels
The Private Health Sector Serves all
Tanzanians
DHS, 2009/2010
Private Providers Make Vital Contributions
to Priority Health Services
To HIV/AIDS Services
To PMTCT and Prevention
Private Providers Make Vital Contributions
to Priority Health Services
To Reproductive and
Maternal Health
To Child Health
Private Providers Make Vital Contributions
to Priority Health Services
To Malaria (Cough and Fever)
Treatment
The Private Sector is an Important Source of
Medical Commodities
 The private sector is involved in all aspects of the
drug supply chain in Tanzania
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659 private health facilities with onsite pharmacies
155 PNFP health facilities with onsite pharmacies
661 private retailers
6,000+ ADDOs and Transitional DLDBs
375 wholesalers
The Enabling
Environment
Supporting Private
Sector Engagement
Conducive Policy Environment in Tanzania
 Progressive policy environment
 Political commitment from different areas of gov’t
and society
 Key groups such as PPP-TWG spearheading
change and collaboration
 Donor commitment and investments in private
sector
 Policy framework and institutional structures
largely in place
 Relatively well organized private health sector at
national level
Challenges in the Enabling Environment
 Difficulties in moving from plans to action
 Pockets of resistance and misinformation remain
 No common understanding of health PPPs
 Key institutions – PPP Unit – are under-resourced
 At local (and national) level the private sector
remains fragmented and disorganized
 Disconnect between service leadership, service
levels, and providers
 Significant market barriers limit growth of
private sector businesses (financing and services)
 Few SLAs with the commercial private health sector,
and limited understanding of SLA potential
Private Health
Services
The importance of local
engagement
Leveraging the Private Health Sector
 Missed opportunities to maximize private health sector
contributions at the local level
 With exception of APHFTA, CSSC and MOHSW
partnerships, no systematic effort to monitor and
collect data on quality in the private health sector
 Information does not flow freely between sectors
 Limited access to continuing professional development
(CPD) and donor training
 No access to subsidized drugs and supplies which
increases costs and affects affordability of services
 Very limited involvement of P.S. in CCHP process
Recommendations to Increase Delivery of
Private Sector Services
 Simplify reporting mechanisms to improve
information sharing
 Increase access to continuing professional
development (CPD) and donor training
 Routinely include private sector members in LGA/
DHMT planning processes (i.e. CCHP)
 Replicate APHFTA/MOHSW model for joint
supervision and use data to monitor quality
 Act on ‘quick wins’ to leverage P.S. contributions
“Quick Wins” for Private Sector Contributions
Coordination of diagnostic/equipment use
Contracting for non-clinical services
Scaling-up promising private sector programs
Create opportunities for CCHP and planning
dialogue
Promote multi-disciplinary and multi-sectoral
knowledge exchange. (i.e. maternal mortality
audits, M&M dialogue at facility level)
Encouraging and Forging Partnership
 Private providers can make contact and demonstrate
value
 Highlight contributions to essential health services
 Seek ways to make P.S. contributions more visible
 Organize, coordinate, collaborate
What steps can APHFTA members take to improve
local collaboration?
Private Sector
Assessment
Conclusions
Pop Quiz
• Health is financed mostly by the Tanzanian
government
True/False
• The Tanzanian private health sector only serves
the rich
True/False
• The Tanzanian private health sector only
delivers specialty services
True/False
Pop Quiz
#1 False
According to the most recent NHA, Development partners
and households contribute 40% and 32%
#2 False
According to the 2009-2010 DHS, 20% of the poorest get
their FP methods and 10% deliver in a private setting
GoT subsidizes the wealthiest – 50% and 76% wealthiest
income group get their FP and deliver in a public facility
#3 False
25% diarrhea, 15% PMTCT, 34% FP methods, etc.
Thank you on behalf of the PSA Team:
James White R.N., SHOPS
Barbara O’Hanlon, SHOPS
Grace Chee, SHOPS
Sean Callahan, SHOPS
Dr. Malangalila, SHOPs consultant
Dr. Kimambo, SHOPS consultant
Jorge Coarasa, IFC
Michelle Wu, USAID
SHOPS is funded by the U.S. Agency for International Development.
Abt Associates leads the project in collaboration with
Banyan Global
Jhpiego
Marie Stopes International
Monitor Group
O’Hanlon Health Consulting
www.shopsproject.org
Questions, Comments and Discussion