PRIVATE HEALTH SECTOR
FOR QUALITY HEALTH CARE
PRIVATE HEALTH SECTOR
Trusted Partner in the delivery of Quality
Healthcare
Dr. Samwel Ogillo
Program Manager
Association of Private Health Facilities in Tanzania
APHFTA
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APHFTA- Association of Private health Facilities in Tanzania
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Established in 1994
Advocacy and Private Health
Sector Development
500+ member facilities- All
types of health service
delivery
Secretariat- Headquarters
and 3 zonal offices
0ver 35 full time employed
full time professional staff
Projects: HIV/AIDS, NCD,
FP, QI, Finance/Loans others
Partner with MoHSW and
DPs
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Why include the private sector?:
1. Provides about 50% of basic health
care in Africa
- There is now convincing evidence that
the private health sector provides more
than 50% of basic health care in many
African countries
- The role of licensed drug store as a
first point of care in many African
countries is usually underestimated
Role of the Private Sector
Survey
between
1995-2006
Urban and rural population receiving care from private
for-profit provider of modern medicine
Percent*
67
64
61
51
53
48
45
48
45 46
45
44
39
34
26
21 21
17
12 11
Source: WB
Africa
Development
Indications
2006, team
analysis
7
6 6
2
Average for
11 available
SSA
countries
Why include the private sector?:
2. Many poor in the community access services
from the Private facilities (WB & IFC study
2005)
3. Public health sector finances less than half of
total health expenditure. Most is financed from
out-of-pocket (WB & IFC study 2005)
Percent lowest quintile receiving care from
private for-profit provider
Lowest quintile
Highest quintile
Lowest quintile
Highest quintile
48
53
39
21
Cameroon
Uganda
Ghana
Nigeria
Ethiopia
Kenya
Uganda
Nigeria
44
48
48 46
45
34
26
Most recent survey year available between 1995-2006
Source:WB Africa Development Indications 2006, team analysis
45
45
21
39
26
17
21
Cameroon
44
51
Average
for
Ghana
11 available
SSA
countries
45
48
Sierra
Leone
53
61
Ethiopia
61
Madagascar
51
67
64
Kenya
67
64
Why include the private sector?:
4. The private sector already provides a
significant amount of public health
services
- Most services are provided for free,
though some authorities reluctant to go
into any formal arrangement/ contract
- Governments, NGOs are willing to join
hands with Private Sector to serve
better
4. The private health sector already plays an
important role in the delivery of public health
goods (The Dar Example)
# PUBLIC AND PRIVATE HEALTH FACILITIES IN DAR- Free Public
Services in 2007 (Source - DMO’s office)
DISTRICT
VACCINATION/ TB & Leprosy
MNCH
HIV/AIDS
SERVICES
Public
Private Public
Private
Public
Private
TEMEKE
29
54
3
3
29
9
ILALA
21
34
18
8
22
19
KINONDONI
33
50
27
16
25
15
83
138
(38%) (62%)
48
27
(64%) (36%)
76
43
(64%) (36%)
Why include the private sector?:
5. “The Private Health Sector can have a positive
impact on the quality of care- and in many notable
cases it is setting the benchmark for higher
quality”- in a number of developing countries- IFC
study- 2007
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Modern Medical Technology- CT Scans, MRI, Heart
Surgery, Advanced Surgery etc
HIV/AIDS- ARVs first delivered by private health
sector
No question about high quality of care by private
facilities compared to public in many countries
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Barriers to achieving more
1. Lack of access to credit
 Lack of access to affordable Financing
(Results in High Interest Rates by
financial institutions)
 Situation worsened by Lack of policies
that encourage investment in rural
and sub-urban areas (No special
incentives that encourage investing in
such areas, e.g. tax relief)
Barriers to achieving more
2. Unnecessary competition with NGOs and public
sector
 Lack of planning means that public, private
and NGO end up competing for the same
clients, while in other areas there are no
providers at all
 Situation worsened by DP money
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Barriers to achieving more
3-
Cumbersome registration procedures for
facilities and products
- While other businesses take less than two
weeks to register, medical facilities and
products take up to a year to register in many
cases
- Corruption cause of delay in many cases
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Barriers to achieving more
4. Unnecessary barriers to accessing funds
to which they are entitled – e.g.
National Health Insurance Funds
- In many countries, public facilities
automatically benefit from NHI funds,
while private facilities have to do more
than required to get registered with the
fund
- Chocked again by poor terms/low
prices
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Barriers to achieving more
5. Double Standards:
- Unrealistic quality standards that
are unattainable in resource-poor
settings
- Not applied to public facilities
- Used in some cases to “chock the
private sector out of business”
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There is light at the end of the tunnel
Positive changes noted
 Policies in favor of PPPs
 Social Insurance schemes- are ready to
work with private sector to serve the poor
 Governments, NGOs, DPs- include Private
Sector in their strategies towards
improving healthcare delivery
 Non-Healthcare private sector playing big
role- FP, Diseases control
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What would make things better for the
Private Health Sector?
 Clear policies and guidelines that support private health
sector investment in health, supported with legislative
powers (Laws)
 PPP in healthcare: Contracting out of services to
private health sector
 Provision of incentive packages to encourage
investment in healthcare delivery, especially
underserved areas
 Use of same yardstick in the enforcement of
regulations related to health care provision
 Proper utilization of available resources in healthcare
provision in both the private and public sector
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Thank you for listening