The Role of Non State Providers in Child Health in East Asia and the Pacific
Dr Abby BloomSydney Medical School & Menzies Health Policy
Inst
Nossal Global Health Institute, Univ Melbourne
Dr Dominic MontaguUniv California San Francisco, Global Health
Out-of-pocket spending on healthas 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 healthas 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)
A Wide Range of Models for NSP Involvement in Child Health 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
Source of healthcare: Cambodia
83% of healthcare from private providers
78% of healthcare from private providers
Source: DHS Data Cambodia 2005
Cambodia - Current Situation 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
Cambodia: Malaria Treatment
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
Source of healthcare: Indonesia
83% of healthcare from private providers
69% of healthcare from private providers
Source: DHS Data Indonesia 2007
Indonesia – Current Situation
Private sector provides ¾ of all health services
½ of all financing for health is private
“Dual practice” by government clinical staff
Decentralization has led to financing challenges within the national delivery system
Self-treatment for simple ailments is common
Indonesian Midwives Association
USAID-supported initiative to improve quality standards among private midwives
BidanDelima program for training and certification
7,800 members: 10% of all Indonesian Midwives
Source of healthcare: Philippines
75% of healthcare from private providers
46% of healthcare from private providers
Source: DHS Data Philippines 2003
Philippines – Current Situation 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
Philippines:Drugstore Franchising
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.
“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.
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?
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.