Private Sector Participation in Development Cooperation – experiences and potential East Africa Healthcare Federation Conference 2012: „Partnerships: Harnessing opportunities and Innovation“ Julia Fimpel (Program Manager, KfW) Presenting on behalf of the Health Program of German Development Cooperation, Kenya May 2012
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Private Sector Participation in Development Cooperation – experiences and potential East Africa Healthcare Federation Conference 2012: „Partnerships: Harnessing opportunities and Innovation“
Julia Fimpel (Program Manager, KfW)Presenting on behalf of the Health Program ofGerman Development Cooperation, Kenya
May 2012
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1. The role of the private sector in the present GDC portfolio
● Germany‘s strategy on Public Private Partnership in Development Cooperation
Objectives:● Mobilizing private capital and know how to drive development● Increase efficiency in the delivery of public services● Complement government regulations by voluntary commitment by private companies● Enhancement of development programs by private contributions● Supporting small and medium enterprises in tapping a new market
„…a dynamic and innovative private sector is the ultimate engine for growth, creating new, productive jobs, generating tax revenues and thus making a major contribution to the funding of social security systems. An effective strategy for boosting the private sector can result in lasting increases in employment and income levels, also for the poor and disadvantaged. In a context of sound public policy and in close cooperation with the public sector, these can be used to boost a country‘s development prospects.“
Dirk Niebel, Minister for Economic Cooperation and Development, April 2012
shift purchasing power to consumers
address demand-side barriers aimed at stimulating demand for health services
To clients, introduce the concept of a pre-payment, which is unrelated to risk
Pay providers for outputs (e.g. no of deliveries), rather than inputs (like salaries and supplies)
To providers, introduce a competitive environment, where providers need to advertise their services and adopt a client oriented and quality conscious perspective
Guarantee payment to providers
Provide services without additional payment
Integrate private and public provision of health care
Develop systems for long-term health financing (e.g. claims processing, accreditation systems)
Example 1: Demand side financing systems in Kenya and Uganda …
Photo: Dirk Mueller
Choice!
Sustainability!
Complementarity!
Confidence!
Quality/service orientation!
Efficiency!
Solidarity!
Targeting
Successful targeting of poor and at risk populations. Uganda: fewer women reported lack of money as barrier to care after
program began.
Knowledge
Uganda: Knowledge of the program spread significantly in the population and more people were able to identify STI symptoms.
Impact of voucher programs
Utilisation
Uganda contracted clinics: 200% increase in STI visits; 15% increase of STI treatment among those with STI symptoms
Cost-effectiveness
Uganda: Safe motherhood programme is most likely cost-effective when comparing existing public services with the added voucher scheme:
Incremental cost-effectiveness ratio: < $ 200 per DALY averted More detailed cost-effectiveness analyses needed
Impact of voucher programs
Health impact
Uganda: marked reduction of syphilis prevalence in just one year from 7.3% (2006) to 2.9% (2007) in areas near to contracted facilities (<11 km) – a reduction of 57%!
Utilisation of STI treatment went up in the same timespan from 30% to 39%
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Example 2: Social Franchising Network „AMUA“
The AMUA-network● Franchisor and Franchisees pursuing a social
objective● By end of 2012 there will be 270 franchisees in
5 regions in Kenya
Results● Over 700.000 clients served and over 230.000
CYP generated between July 2010 and January 2012
● Cervical Cancer Screening introduced (effective and highly demanded)
● Effective linking HIV/AIDS and FP (over 30.000 PMTCT, over 100.000 VCT/PICT)
● Community health workers are essential for sensitizing and mobilizing target groups
● Cost-efficient approach (counselling, choice of FP method)
Public-Private-Cooperation● Use of national guidelines for medical
interventions ● Strengthening cooperation with DHMTs,
especially in reporting and contraceptive supplies
● Private providers receive FP commodities through public system
● Steering committee with the Ministry of Health
Example 3: Promising practiceViable Solutions for Health Care Waste Managment (HCWM)
HCWM Package
Target ClientsSmall and medium sized private clinics and hospitals for which formal HCWM set up is not cost-effective
Results till date Affordable HCWM services
NWH runs its waste mgt facility at margin with 10 regular customers
NEMA licensed transportation companies and NWH
Clarified mandate of regulatory bodies (NEMA, MoPHS and MoMS)
PartnersNWH (Nairobi Women’s Hospital)
GIZ (German Technical Cooperation)
Regulation
National Environmental Authority (NEMA)Rules, Inspection and Licensing
Transportation
Contracted Transportation Companies
Treatment of Waste
NWHagainst service fee/ kg waste
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Collection Transport Storage Treatment Disposal
GIZ: Facilitation, Training, MIS development
Regulation by NEMA, MoPHS, MoMs
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2. Mutual benefits of cooperation for donors/government and private stakeholders
Donor Agencies and Government
Private Sector
Advantages from cooperation
- More support in addressing the Health Care Challenge- Mobilising private ressources for health - Direct and cost-effective achievement of outputs (MDGs)- Outsourcing of services can yield efficiency gains- Innovative solutions - Well trained staff and expertise- Better access to information on private sector activities and quality monitoring
- Strategic partnerships, e.g. through Joint Ventures- Long-term business relationships- Market entry / extension of coverage- Risk mitigation through subsidies (e.g. Funds with first loss tranches, subsidies to cover the poorest etc.)- Reputational advantages- Dialogue with government