Dr Abby Bloom
Sydney Medical School & Menzies Health Policy Inst
Nossal Global Health Institute, Univ Melbourne
Dr Dominic Montagu
Univ California San Francisco, Global Health

Out-of-pocket spending on health as a percentage of national Total Health Expenditure
Source: WHO, 2006 National Health Accounts Data: http://www.who.int/nha/country/en/index.html

Out-of-pocket spending on health as a percentage of national Total Health Expenditure
Source: WHO, 2006 National Health Accounts Data: http://www.who.int/nha/country/en/index.html

Source of Healthcare by Wealth Quintile
Source: DHS Data (Cambodia 2005; Indonesia 2007; Philippines 2003; Vietnam 2002)

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Contracting (“PPPs”)
Purchasing
Social marketing
Social franchising
Social entrepreneurship
NGO and FBO direct provision of care
Vouchers
Insurance (including Social insurance)
Accreditation
Certification
Output Based Aid
Provider Training
Patient Education
Manufacturer-based supplements
Manufacturer-based product subsidies

83% of healthcare from private providers
78% of healthcare from private providers
Source: DHS Data Cambodia 2005

 Poor health, but steady improvements
 Private Out of Pocket (OOP) is main source of financing
 80% of population treated in private facilities
 Good examples of government & private collaboration to increase access & quality for priority health services

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70% of fevers treated in the private sector
Aim: to assure widespread coverage of
ACTs.
Government & PSI are partners in
Affordable Medicines Facility-Malaria
(AMFm) initiative.
PSI co-packages ACT and rapid test kits
Comprehensive training provided
IEC and BCC create market demand
270,000 units sold in 2009
Will be available in both private and Govt shops and clinics

83% of healthcare from private providers
69% of healthcare from private providers
Source: DHS Data Indonesia 2007

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Private sector provides ¾ of all health services
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½ of all financing for health is private
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“Dual practice” by government clinical staff
 Decentralization has led to financing challenges within the national delivery system
 Self-treatment for simple ailments is common

 USAID-supported initiative to improve quality standards among private midwives
 BidanDelima program for training and certification
 7,800 members: 10% of all Indonesian
Midwives

75% of healthcare from private providers
46% of healthcare from private providers
Source: DHS Data Philippines 2003

 Private health expenditure > than government expenditure
 Poor most often seek healthcare from informal sector: shops, friends, and relatives
 Pharmaceutical sales = 46.6% of THE
 Strong national leadership + well-managed national health insurance program = foundation for collaboration

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Philippines has highest retail drug costs in EAP
Government response: BotikangBayan franchise of private drug stores
Operated by PITC, governmental trade company
Central procurement from India, China, and local generic manufacturers
1,971 participating pharmacies across the country photo: www.pia.gov.ph/press/

Key Message 1:
The private sector is pervasive and has been filling the gap in EAP for some time
What’s wrong with the current situation?
 The private sector is often unqualified, usually unregulated, overservices or provides ineffective care
 And… out-of pocket payment (OOPS) is regressive and penalizes poor.

Key Message 2:
Government engagement, let alone
"stewardship“, is very limited.
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“Stewardship Lite”
 But there is opportunity now to review and strengthen.

Key Message 3:
There are already very impressive examples of private sector initiatives contributing to the health of children:
 Cambodia
 Indonesia
 Philippines, Vietnam, Fiji, etc.

Key Message 4:
There is a very broad menu of mechanisms from which Government can choose .
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Options are much greater than is generally considered – and
Most are much easier, and less risky, than traditional
“PPPs”, and
Have much greater impact on the poor and on equity.

Key Message 5:
Government must answer 3 questions:
1. What are we trying to achieve?
 Lower infant mortality? Build and equip new hospitals? Replace inefficient work practices? Improve equity????
2. What options have been proven to achieve these objectives?
 Look at the long list of options available – and choose the ones that are likely to have the outcomes Government wants for poor children.

3. What is our country’s capacity to support these initiatives and mechanisms?
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To engage and manage the private sector for the "public good"?
What is our capacity for stewardship?
Are we ready now? If not, what can we do to be ready to manage technical, financial and economic risks?
Ex: Review & revise legislation, regulations and funding (Mongolia,
Vietnam, Indonesia)
Ex: This Workshop: bringing together stakeholders, including
Ministries of Finance and NSPs, not just MOH, to consider strategies.

Contact details :
Dr Abby Bloom healthinnovate@optusnet.com.au