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Strengthening health SyStemS by engaging thePrivate health Sector: PromiSing hiv/aiDS PartnerShiPS
h
i v / a i D
S
P o l
i c y
b r i e f introDuction
r s wd
pss p f
w-f ss
d s ss
ss ss ss,
d hiv/aiDS. a s, s w
p s ps
k sss f
dp s. t
s, d 60 p f
pd
s-S af 2005 ws
fd p ss, s
-f-pk ps.
epds p pds
d f f f s
pd (i Fcp, 2007). i
s p s s
ps sz pp f
ss dd
d ss—
ssss K fd
60 p f
pds wk
p s (bs
, 2009).
as sss spd sd d f hiv/
aiDS, s d
d p s
ppp s ss
hiv/aiDS s
(PePFar rz, 2008;
unaiDS, 2009). F d s
s ssd pps
p ss fd
p s—skd wk
f, f, s d
fs— hiv/
aiDS s. m,
ss p s p
p s f
ss p
s s s dd sff
d wk ds s.
m , s
ss hiv sps
k f
w p s,
s s f kd f s d d f
hiv/aiDS.
Dsp s, p
s—p f-pf
s—ds kd
sss s
s d
fsd p s. a
k p f s s
p s ds
wd s d s
f pzd
sss fwk. ts f
sks ddss s p d
hiv/aiDS pks d
ps w
d p s
hiv/aiDS d
sss s s
• e s Wdh oz (Who)
sss sd ks s fwk df p ss dffps f ss
• is f p-p sd psps s sss w s p
dsd hiv/aiDS sW p p s
s s p
hiv/aiDS js, s pp
fss w p-p
ss
sss
s. S ss-s
s w sp
f f f dd
d: pks d
ps p s d
d s.
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2
each health SyStem
builDing blocK
incluDeS Private
Sector actorS
W s fwks s
p ps d
f f sss, s
pp ss s s s p Who ‘d ks’: g,
if, F, S
D, h rss, d
md d ts. t
p s s
s
d k. if w d ‘pk’
k, w wd s
f p d p s
w p w ss.
F 1 pss s
f p s s d k. t f
ss w ‘ks’
ps f ss,
w ps dfd fwk
F 1.
e d w
p s
ss s :
• bd s-wd p d -q ss dpds
• is dds f psw sks d dd ss,p dsdps
• ip ,dss, d s f f f skds sd spp ds-k s s s
• e ’s s f -q d pds,s, d s
• mz ss f ssss, ps sk p,d zs pdsppp, d
• S s f s, p
f f s dp w s
Dsp ps f p
s, p-p psps
ws sw. Ds d
psp w
p d p ss
q sd d ,
s dps ‘ks’ sd
k s
s w p ff sf pd ffs
s (bs, 2010). i f,
s ssd fw
f
s psp: fs, sd
Figure 1: Illustrative range of private sector actors organized by the WHO building blocks
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dd pss
ps ss
k ddssd
s; d sd, sd
ssd psp w
s ff, ss
q ss (bs,
2010).
ass s ssfd, s pp dss
s f p s
, s w s pps
f
d ks f ss,
d js
.
Private Sector
engagement aS
an aPProach to
Strengthening the
health SyStem
t dff s f p
s . t s
sd ps f wk
w p s s p-
p psps “PPPs.”
b “PPP” s
dff s, f
s w
p ps
dp d f s f
d dsss,
d ps d -
kd spps ps,
- p pds d
ss. as d f
p-p s s,
PPP dff
s dff pp. bsd
fd p wk w
p s,
s f p s
:
• Pubic-PivaeDiaogue pz d df ss
w p s ddss ss ps s f ss ss,dd , ss ffd , f d psf, d s
• Pubic-PivaeIneacion p d sss f p f ps d s sdds d ps f s s
Figure 2: Illustrative range of policy instruments and approaches to dialogue, interact and partner with private
sector actors organized by the WHO building blocks
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4
• Pubic-PivaePaneships pz ps– f pss s s s, s, d , fw– pss ss d/
pds f dsd ps
F 2 pds w f d d sp f s w
p s
p s s
sss. as f ss,
wk w p s
s f s s
pss df p s
skds (p-p d)
dsss w
pd p (p-p
s) kwd
p s s
s sd s
(PPPs). i s s w
s d ff p s
, p-p d
d/ s
pss d fd
w s s
wd pz PPPs.
t fw s pss
f p s
f f sss
s d ks. b
s s sds ds,
w p
s f s
s p d ks
ss, f s
w s k s f
ss.
examining Private Sector
aSPectS oF the builDingblocKS
SeviceDeivey
i s, hiv pd
s sd d pd
pd f hiv/aiDS-
d ss s s sd s,
(art), d tb dd
p ss.
i ss, p s
sd s d .
P w p s
s d s
pd f
ss d ds
s d p
p s, s
PivaeSeco
Acos
Pubic-PivaeEngageen
oSenghenHeah
Syses
IneediaeHeahSysesOucoes
Who Wha Why
P f-pf,ngo, d Fbo
pds
S d s, s, d
ds-f-pf s
is financia access p ps f ppdd ss d ff pds s kd
ss dd
is physicaaccess w pds dsd s
ip coveage ff pds s kd
ip quaiyandsafey d d pds,ff pds q-kd s, d
s f q
Pd sss r fsd d, s, df, f sp f p
q sdds
is physicaaccess df sps f wk f wks d d ds
P pds
is financiaaccess ff p ssds fd d s
cps
cp fd f ps d
ip financiaaccess d coveage pfd f s d s p s
Fd f sss df k ks
pd s dip quaiyandsafey ddss k ss
Table 1: Private sector engagement that strengthens the health system: Service delivery
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6
contracting With Private Sector PhySicianS For hiv treatment:broaDreach healthcare in South aFrica
i 2005, p bdr h, S af’s Dp f h (Doh), d p s ds’ wk d PPP s - s p ms ds f n Ws p. S art ps w
art f s s (p s) ds sp dfd f ‘dw-f’d p d p s p (gP) (bdr h, 2010). tsp gP s sps f f art ps. gPs s ‘p-f’ art ps ds sp f dd. D p, d ds, s, d f ‘p-fd’ ps sps f Doh. bdr h pds pd d d d spps gPs pp ds, ps, p k, d d ds ss. t Doh d sp spd s s f PPP. Ps w s PPP p fs; fd s pdd PePFard Doh.
c w p gPs d art ddsss k S af ss. W 80 p f pp s p s f , 30 p f S af’s ds d p s (n, 2010). F, dd f artsd wd d pss p s art fs. ts p s ddssd s p s ss pd p d art. t PPP ss dff
ss d ks d ps s w . i ps s d f p Doh ss f w ps d ds p d p s s. t PPPs ss f p s. t PPP s pp gPs w ds art f p d d . gPs p w ds s PPP art ps s f . i fs s f p, 918 ps d f art dw-f p s gPs (bdr h, .d.).r s fd PPP d p s (94 p . 75 p), sppss s (88 p . 67 p), d ws s s-ff. Ps s pd f PPP d (n, 2010).
Heahsysebuidingbocks:Sevicedeivey,heahwokfoce,andgovenance
ExAmPlESFrOmtHEFIElD
contracting-out For conStruction anD Service Delivery in leSotho
ls s p f s wd- psps af s. i o2008, f ls d ts’p cs (d n, f Saf’s s p pds) ds, d, d qp 425-d f spd f p s s ms, ls’s p . i dd, ps–d sd f hiv/aiDS d tb– s fs d- ts’p cs. Fds s sp f f p d ss, w fds s dd dd p 100--d Q ez ii sp. tfsd f s p f m 2010 d ss, d hiv/aiDS d tb , pdd p p. t w sp w pd m 2011.
P ps f p pdd ss pf-sd s s p pd f ss ss w pd d q f ss. P s ts’p-pd fs fw p s s, d p sd w f p. t 18- w ts’p cs s pf-sd d
d d p: ps pdfd s d s.
bs ts’p cs s sps f f sp d s ms, ts’p ss ss f ffs– s ps wds f ffs–ss f . as s, s s d f s d d d d s p f ss d ss. ts s d: sss ls n D S oz w s p d spp sss s, d pp-sdp ds ds pds d ss p f, d p q f f f pk d p. t s p w n h t c spzd pfsss (t g h gp, 2009).
Heahsysebuidingbocks:Financing,sevicedeivey,andHIS
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the health inSurance FunD: Strengthening health Financing innigeria
t Pass Fd s fdd g f nds s sss af. i 2007, fd’s h is Fd, D s psd s, pd w h, n’s s z, p
s- h c h P (hchP). t psp dpd s d fw- wks d fs ls d Kw s. hchP d w f s pd 13 p s s d sps pd ss, d hiv/aiDS-d ss.i Kw s, pp w wk d f S . i ls,hchP s w w wk ks d fs.
i s, w- dds f ssds s p. D p, sd ps 5 13 p f w p, w his Fd ssdzs d. F s, Kw s, s p s q f $27 p ps p . i fs , s Kw sps f 5 p f p, $1.35 p ps p . a f f wd p $13.50 f fs d f f d. as f 2008, 50,000 pp ss s w sd hchP p. Pp s pdd hchP d pd ss d-q hiv f hchP s (unaiDS, 2009).
i dd p s p s f p sp spd ds f ss ss, hchP pds f pds d ss w p d p pds. m, hchP s ps s d dds d p f sff d fs (Pass Fd, .d.).
Heahsysebuidingbocks:Heahfinancing,heahwokfoce,andsevicedeivey
PPP unitS in health: Strengthening governance anD leaDerShiP
Within the health SyStema w f s-S af s—d ep, g, K, n, S af,ud, d Z— ssd PPP s w ss. PPP s s s f p f p s . a p PPP s psd f s psw df, k, d spp s PPPs p s. t s d sff w dff ps— s s s sss ds, w, s—w sp s p. t k f PPP s s s s s f sff, ff ss d d, s d, sss, p spp, spp, d p d p s d PPPs . t PPP s f p swdsp s.
W PPP s s s s, w ds s f .t f PPP fs ds f p , d fs ss dwksss f . F s, Z d S af, PPP s d w n
Dp f F. ts, s s p ssss s ffss f ppsd PPPs.a, ud’s PPP sds Fd ms f h’s Dp f P. ts s PPP d p k dsks w ss. F, PPP s f dzd d f .
i n, PPP s s fd d s , w s ss k f PPPs. PPP s fs PPPs f ws : s d p pds; ds sss, s s, sw p fs; pd ss, p fs, z; p pds d p z; d f d d sd psps w p d p s (o’h, 2009).
Heahsysebuidingbock:Govenance
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8
ds k s,
dd f ss
f ss . Wk
w p ps
s ds d d
s p
s p d ps f p
. t 3 pss s
s f w p s
p d d
f .
medicaPoducs,Vaccines,and
technoogies
t f d-q
s, d ds,
d s s fd
q f d ff
ss. Wdspd ss
f ds, s, d d
ds ssps f p f
ss, d s
p p
dp s. P w
p s ddss s
s s spp d
w ss f ds, s,
d d pds,
p spp
w sks d s
p s ssd,
d dp ff ds
d s. t 4 pss
s s f PPPs
sss s
d pds, s, d
s d k.
HeahFinancing
t js f d
f ss s dq
s f , s d
f ss ss,
p s ss fps d s s,
d ppp s
f s d d s. ts
fs sk w
wd f hiv/aiDS s. t
s, ds hiv/aiDS
d () ps
d qd p
s, s ds hiv/aiDS
d k dss.
F, f s
q f f d fsp f pp
w hiv/aiDS (Plhiv)
f w d s
dpd
p ps. h
f ss p
w hiv-d ds d ps,
pd f ffd
ds d ss, d p
Plhiv f f sp
ssd w s ss
hiv-
p s. t 5 pss s s f w p
s p
f.
PivaeSecoAcos
Pubic-PivaeEngageenoSenghenHeahSyses
IneediaeHeahSysesOucoe
Who Wha Why
Pps
P d p sd ss ds
is ss d f ss dp w s
d f
cpd
dss dks as d s sss,
d pds, ds ksis ps ss d
p f ss d,d/ p f ss p ss hiS p/ d
ss
Pps
P pds
c p dfps
as f s s p
dpd p/ f s d p p f f
9P d p sd ss dpd d / p pfs
Pfsssss
P s spp f pfss sss pd d f pfsss
ip q d sf pdd pdd pd kwd
adss
cs p d d d z s pfs d sk
d ss s
is ps ss d p s ps f
d mk sps
Table 3: Private sector engagement that strengthens the health system: HIS
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Govenance
eff s d ,
d, ps f
ppp s d s
k w-f ss ,
s ss ss
p f p s
p js.
S dsp d d
sd s
p
f p
s s
p , d s sp
p d q f
p s ks p s. i f, s
pd dsp d
f p s s s
f s p
s w p s
s k
s d, f
pp f f
p ss pp
f ss. g
d d w
p d p ss ss ds d s
d ss, s
pps f PPPs .
t 6 pss s s f
w p s
p w
ss.
PivaeSecoAcos
Pubic-PivaeEngageenoSenghenHeahSyses
IneediaeHeahSysesOucoes
Who Wha Why
Pps, d/
dss
P d p sd s p s df w s
s. ts d d fd sp s ss
is ps ss d dp ws s s d d
s-ff
ip f ss r&D ffs p s, w k p d s
spp f d ds
ip q d sf s q f dsd pds fd s
P d p sd ss f, .., s f
pp, f
ad k s p fd s f p
ps k ss f s d dp s
f s
c
pddss d
ks
as s k ds ds, s pds ks
is ps ss d sspp f ds, s, d d ds
is f ss w k p f ds, s, d ds
ip q d sf q f dsd pds
c p/fps
as f s sp dpd p/ fs f spp
p fs
is ps ss d s d p sk-s f ds, s,
d d ds
cs
as f s f ps f ds ss
is ps ss d p s sks d qp d
ds ss
ip f ss w s s (f ) w ss pd f s w s
ip q d sf ssdz s d q sdds d ff
pds pf s kd q
Table 4: Private sector engagement that strengthens the health system: Medical products,
vaccines, and technologies
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10
PivaeSecoAcos
Pubic-PivaeEngageenoSenghenHeahSyses
IneediaeHeahSysesOucoes
Who Wha Why
css dsds
Dd-sd ssds f p ssdd dd p pds.
is ss d s s sfs
is physicaaccessandcoveagepd f pds w ff
ssdzd p ss
P f-pfpds
ip financiaaccess w () -f-pk ps p f
s
n-f-pf pds
ip quaiyandsafey ssdz ssdd p pds w d
q sdds d ff pdspf s kd q
P sps
c-sd f zs
h s ss p sk. tp-p ss dpds dsf s. P d s
ss p pds dp s dss. o
d, p d ss d p d d s ps w- ps.md zs ff s
s sps
is physicaaccessandcoveagepd f pds w ff p
ss
mdzs
ip financiaaccess p sk dw ( ) -f-pk ps
p f s
css dsds
ip quaiyandsafey d ppds w d q sdds
d ff pds pf skd q
P f-pfpds
S d s, d/ s
is financia access p ps f p pdd ss d ff pds
s kd ss dd
is physicaaccess wpds d-sd s
ngo/Fbo pds
ip coveage ff pds skd
ip quaiyandsafey dd pds, ff pds qs d s f q
cp wkpscp p fd
f f ss
is financia access d s f wks d
p ss
is physicaaccess pd f pds d p ss
ip quaiyandsafey pd -q s pds
Pps
ad k s p fd s f p
ps k ss f s d dp s
f s
is physicaaccessandcoveagedp w s s
s d d s ff
ip financiaaccess r&Dffs p s, w k p
d s spp f d ds
ip quaiyandsafey s qf ds d pds fd d
fs
Table 5: Private sector engagement that strengthens the health system: Health financing
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concluSionS
h sss s
ffs fs s
p s k
ss ss
ddss hiv/aiDS pd.
t p s—
d pf—ffs wd
f dd ss s s skd
sff, fs d qp,
fs, ps, d
s dd
s ps f Who
sss d ks.
P s s w
k p
hiv/aiDS s ds s
ps f PPPs. t s p
p s skds d
f d d sd p
pds s w s s
ps f ,
p ps ff hiv/
aiDS ss, p
ps pd
ds d d pds d
dss s d ss
ds.
t s f
p s :
• Pubic-PivaeDiaogue pz d df ss ddss ss ps
• Pubic-PivaeIneacion p d sss f
• Pubic-PivaePaneships pz ps p ss hiv/aiDS ss d pds dsd ps
P-p s d
s p s
sss f ddss
d k ss
d p s w
s d ks. hiv/aiDS
ps d w sss s sd
f sd s
p s p
ss, df -spf
pps p
s, d p PPPs
ff s
ss w hiv/
aiDS js.
PivaeSecoAcos
Pubic-PivaeEngageenoSenghenHeahSyses
IneediaeHeahSysesOucoes
Who Wha Why
Pfsssss
P d ps
P fs d psss (.., s d pdws, s p) d s
p s ps
o ssp d d s sdd p p ss
ss p s p
Pfsssss
S d, s d/ ds, dfsps f pfss sps f p, p-s
d d sdds, d f sip quaiyandsafey df d
f q sdds d spd kwdP pdd f sss df
spp f f d
P d ps
S d d ss, sf ddss s ps, d d w
p s psip quaiyandsafey s
d d pss d d fsddsP fdd ( p-p -fdd) ps
f ss s k
Table 6: Private sector engagement that strengthens the health system: Governance and leadership
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12
reFerenceS
bs, J, o’h, b, F, F,g, n, mK, K & Dk,c. 2009. Kenya Private Health Sector
Assessment . bsd, mD: PS Psps-One pj,a asss i.
bs, J. 2010 (df). Designing Public
Private Partnerships in Health.bsd, mD: Sh os P S pj, aasss i.
bdr h. 2008.Requirements for a Successful Treatment Model: The Down-Referral
Model as a Case Study . p://www.ds-./ss/df/fs/3p_ds/70/d-W-Wks---t-P.pdf
i F cp.2007. The Business of Health in
Africa: Partnering with the PrivateSector to Improve People’s Lives.
n, P. 2010. Implementation of aNovel Model to Enhance Routine HIV Care and Treatment Capacity in South
Africa: Outcomes, Costs, and Cost-effectiveness. PD tss, us
f cp tw.o’h, b d S, a. 2009. African
Public-Private Partnership Units inHealth: What Are They and What DoThey Do? bsd, mD: PS Psps-One pj,a asss i.
PePFar rz. 2008. h.r.rp. n. 5501, 110 c., 2dSss.
DiSclaimert s’ ws pssd s p d ss f ws f ud Ss a f i
Dp (uSaiD) ud Ss g.
AbouSHOPSt S h os P S pj (ShoPS) s
fdd u.S. a f i Dp (uSaiD) d c n.gPo-a-00-09-00007.ShoPS s d a asss i. d pd w f ps:b g i Jp i m Sps i i m gp i o’h hcs
F f ShoPS, ps :S h os P Se-: f@spspj.p://www.spspj.
F f h Sss 20/20, ps :h Sss 20/20
e-: f@sss2020.www.sss2020.
a asss i.4550 m a,S 800 nbsd, mD 20814 uSa
t: (301) 347-5000F: (301) 913-6019www.sss.
n 2010
ts f ws ppd as a, S Sz, Jff bs, b o’h, d D a. i s j p f S h os P S (ShoPS) pj d h Sss 20/20 pj.
Pass Fd his Fd. p://www.fd./
t g h gp. 2009. Public-Private Investment Partnerships: Aninnovative approach for improving access, quality and equity inhealthcare in developing countries. S Fs: t g h
gp, g h Ss,us f cf, SFs.
unaiDS (J ud nsP hiv/aiDS).2009. HIV-related Public-PrivatePartnerships and Health SystemsStrengthening . p://d.ds./p/rp/2009/j1721_ pppsps_.pdf.
AbouHeahSyses20/20
h Sss 20/20 s f- (2006-2011) p (n. ghS-
a-00-06-00010-00) fdd u.S. a f i Dp (uSaiD). t
pj ss d pp ddss f, , p, dp ss ss pd ss d s f f-s p
ss.a asss i. ds f ps ds:
a K Fd i bá asds i brac us i bd b asss
D cs, llP i F o cs i rti i i t r-ss gp i t us S f P h