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Eva Jané-Llopis, Director, World Economic Forum

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  • Digital platforms have played a role in amplifying the message to raise a healthier generation of kids, engaging a younger audience, and motivating healthier choices.
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    • 1. The role of the private sector inthe post-2015 developmentagendaDr Eva Jané-LlopisDirector Health ProgrammesWorld Economic ForumMargarita Xydia-CharmantaProject AssociateWorld Economic Forum
    • 2. The World Economic Forum2Neutral platform to move the needle in different topics, fromenvironment, to infrastructure, from gender parity to health
    • 3. In the next 15 minutes3• MDGs: Lessons learned and the role of public-private partnerships• The post -2015 Development Agenda: the role of different stakeholders• Leveraging core competencies of the private sector to achieve theSDGs• Harnessing innovation capacity to promote healthy lives and increasehealthcare coverage• Challenges in involving the private sector in the post-2015 agenda
    • 4. In the next 15 minutes4• MDGs: Lessons learned and the role of public-private partnerships• The post -2015 Development Agenda: the role of different stakeholders• Leveraging core competencies of the private sector to achieve theSDGs• Harnessing innovation capacity to promote healthy lives and increasehealthcare coverage• Challenges in involving the private sector in the post-2015 agenda
    • 5. Progress towards the MDGs has been unevenProportion of low and middle-income countries progressing orregressing on MDGs, 20105Source: Overseas Development Institute “Millennium DevelopmentGoals Report Card”
    • 6. Public-private collaboration in the MDGs have …6Sources: Development Cooperation, Ministry of Foreign Affairs of the Netherlands (2011) “Public-private partnerships. Ten ways to achieve the MillenniumDevelopment Goals”, GAVI Alliance, UNDP Europe and CIS, the UN Millenium Project, Lucci P. (2012) “Post-2015 MDGs. What role for business?”, OverseasDevelopment Institute• Tripled investments in medication for HIV/AIDS, tuberculosis andmalaria• More medicines available: eg. reach > 40 million people withAfrican river blindness in > 30 countries• Vaccination: four in every five children worldwide protected byvaccines; 40% drop of number of children dying before their fifthbirthday to fewer than 7 millionOutside health:•Better market access (e.g., small farmers in Kenya floriculture sector)•Code of practice for a sustainable horticulture (Ethiopia)•Higher incomes for cocoa producers (Cote d’Ivoire)
    • 7. In the next 15 minutes7• MDGs: Lessons learned and the role of public-private partnerships• The post -2015 Development Agenda: the role of different stakeholders• Leveraging core competencies of the private sector to achieve theSDGs• Harnessing innovation capacity to promote healthy lives and increasehealthcare coverage• Challenges in involving the private sector in the post-2015 agenda
    • 8. As with MDGs, we need all capacity we can fordelivering the Sustainable Development Goals(SDGs)8Source: UNDP Europe and CISCivilSocietyPublicSectorPrivateSector
    • 9. Top 150 largesteconomies-Wal-Mart: revenues > GDPs of 174 countriesemployed > 2 million people.-Shell: > revenues than the combined GDPs 6th+ 7thmost populous nations in the world > 350 millionTogether, the 44 companies in top 100 have revenuesover 9% of global GDPAll businesses (micro-, smes) are:-drivers of our economic societies-create jobs, provide households-have large capital and present an opportunity to shiftgoods, services and revenue for health-an important resource of capacity944% of the 100 top largest economies are notcountries but corporations (2009)
    • 10. 10Taskforces& progress:•water•genderequality•climatechange
    • 11. Comparative advantages and disadvantages:the private sector• Greater management flexibility• More innovation• More attentive to consumer/patient convenience• Accountability for consumer/patient satisfaction• Adaptable access to infrastructure• Flexible employment• Quicker response to changing market conditions11Source: Harding, A and Preker, A (2003) Private Participation in Health Services, The World Bank• Equity issues (purchasing power)• Services concentrated in urban areas• Little attention to public health services• Emphasis only on curative care services• Focus on a narrow range of customer needs• Some private sector products, like tobacco,are harmful to public health+-
    • 12. 12• MDGs: Lessons learned and the role of public-private partnerships• The post -2015 Development Agenda: the role of different stakeholders• Leveraging core competencies of the private sector to achieve theSDGs• Harnessing innovation capacity to promote healthy lives and increasehealthcare coverage• Challenges in involving the private sector in the post-2015 agendaHow can we leverage the key competences ofthe private sector in the SDG agenda?
    • 13. The post-2015 Development Agenda:Interconnection – we need a systems approach13Source: United Nations (2013) “A renewed global partnership for development”They are allinterconnected
    • 14. 14Approaches go beyond CSR for a moreinclusive green growth agenda :-Eliminating waste + more efficient useof resources(e.g walmart global supply chain carbon footprint)-Redesigning how make and deliver(sustainable production processes, e.g., cradle tocradle, limited use toxic chemicals)-All institutions for sustainability (e.g.,innovative business schools developing a newgeneration of business leaders)The sustainability agenda is more advanced inleveraging the private sectorLeading companies have:- 25% higher stock value - the fastest growing stock value- deliver superior financial performance - are better investment risksSources: http://www.oecd.org/greengrowth/Rio+20%20brochure%20FINAL%20ENGLISH%20web%202.pdfAlignment of policies and incentives continue to be key
    • 15. The post-2015 Development Agenda:need for supportive policies to advance action15Source: United Nations (2013) “A renewed global partnership for development”Healthy LivesUniversal HealthCoveragePolicies acrossall sectros thatmight have aninfluence tohealthy livesSystems approach
    • 16. Core competencies of the private sector that canbe leveraged16Source: Lucci P. (2012) “Post-2015 MDGs. What role for business?”, Overseas Development Institute• Find different ways of raising funds using international capitalmarkets and new financial products
    • 17. Creating a system level change forhealthy lives17
    • 18. Innovation from the private sector to healthylives18Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsProcess and product reengineering
    • 19. Innovation to leverage from the private sector toincrease healthy lives19Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and Systems
    • 20. Greenstar, as an NGO, has used the private healthcaresystem to create an extensive network of familyplanning franchisesDescriptionDescription• Social marketing organization for family planningand access to contraceptives• Leverages / uses the private healthcare system(70% of Pakistanis) to act as franchisees to:- Counseling and advice- Outlet for purchasingaffordable contraceptives (26%)Cost advantage and qualityCost advantage and quality• Low income non-users, thru total marketapproach – different price points persegment• Cross subsidisation increases access• Funding from large internationalorganizations and Governments• Per capita GNP is low, 70%accesses care in the private sector,• Affordability and access to quality healthproducts are needs• 59% of family planningservices delivered by publicsector• Greenstar can grow (thoughit is fairly large)• Constant funding supportshows replicability273835ProductsProgram CostsOperations/AdminModerately lowoperating andadministrative costs3059KeySocialMarketingCommercialSector GreenstarNGOSectorPublicsector3070PublicPrivateSource: world economic forum 2010Share of familyplanning services inPakistanWithin the private sector,there was• Significant need for familyplanning services• Underutilised capacity toprovide these services• Low levels of knowledgeand skillsRelevanceRelevance ScalabilityScalability
    • 21. 21Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsInnovation to leverage from the private sector toincrease healthy lives
    • 22. 22Prevalence of physical inactivity*• High rates of physical inactivity across countries independent of income level• Except India and China, over 40% of the population (>14 yrs) is physically inactive• Saudi Arabia and the UK have the highest rates of physical inactivity• In these countries, women are less active than men* Physical inactivity - the percentage of the population aged 15 or older engaging in less than 30 minutes of moderate activity five times per week or lessthan 20 minutes of vigorous activity three times per week, or the equivalentSource:WHO2011
    • 23. Sedentary time will continue to increaseSource: Ng, Popkin. Obesity Reviews, 2012USAP1: 2009UKP1: 2005BrazilP1: 2007ChinaP1: 2009IndiaP1: 2005P123
    • 24. 24Estimated gains in life expectancy with elimination of physical inactivitySource: I-Min Lee et al, Lancet, 2012
    • 25. 25Creating a social movementDigital platforms have:•amplified the message for a healthier generation•engaged younger audiences•motivated healthier choicespersonalization andempowerment,enable that systemicapproach, gettingthe right messageto the right peopleFrom video games to socialmedia challengesSupportivepoliciesacrosssectors:-Environnent-Transport-City planning
    • 26. Leapfrogging innovation from the private sectorto increase healthy lives26Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsProcess and product reengineering. This reduces costs andoffers and alternative to the traditional productAlignment of policies across relevant sectorscontinue to be key
    • 27. Universal Health Coverage, 201027Source: adapted from PNHP, WHO and SEARO
    • 28. Health care expenditure increasing in emerging economies -with still significant catching up with developed economies0%5%10%15%+ 1.6 pp+0.8 pp+0.9 pp+3.1 ppLow income5.8%4.0%Lower middle income4.4%3.8%Upper middle income6.1%5.3%High income /Developed economies12.3%9.5%20111995Upper middle income countries: Algeria, American Samoa, Angola, Antigua and Barbuda, Argentina, Azerbaijan, Belarus, Bosnia and Herzegovina, Botswana, Brazil, Bulgaria, Chile, China,Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Gabon, Grenada, Iran, Islamic Rep., Jamaica, Jordan, Kazakhstan, Latvia, Lebanon, Libya, Lithuania, Macedonia,Malaysia, Maldives, Mauritius, Mexico, Montenegro, Namibia, Palau, Panama, Peru, Romania, Russian Federation, Serbia, Seychelles, South Africa, St. Lucia, St. Vincent and theGrenadines, Suriname, Thailand, Tunisia, Turkey, Turkmenistan, Tuvalu, Uruguay, VenezuelaLower middle income countries: Albania, Armenia, Belize, Bhutan, Bolivia, Cameroon, Cape Verde, Congo, Rep., Cote dIvoire, Djibouti, Egypt, El Salvador, Fiji, Georgia, Ghana,Guatemala, Guyana, Honduras, India, Indonesia, Iraq, Kiribati, Kosovo, Lao PDR, Lesotho, Marshall Islands, Micronesia, Moldova, Mongolia, Morocco, Nicaragua, Nigeria, Pakistan, PapuaNew Guinea, Paraguay, Philippines, Samoa, Sao Tome and Principe, Senegal, Solomon Islands, South Sudan, Sri Lanka, Sudan, Swaziland, Syrian Arab Republic, Timor-Leste, Tonga,Ukraine, Uzbekistan, Vanuatu, Vietnam, West Bank and Gaza, Yemen, ZambiaLow income countries: Afghanistan, Bangladesh, Benin, Burkina Faso, Burundi, Cambodia, Central African Rep., Chad, Comoros, Congo, Dem. Rep., Eritrea, Ethiopia, Gambia, Guinea,Guinea-Bissau, Haiti, Kenya, Korea, Dem. Rep., Kyrgyz Republic, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Myanmar, Nepal, Niger, Rwanda, Sierra Leone, Somalia,Tajikistan, Tanzania, Togo, Uganda, ZimbabweSource: World Bank, BCG analysisTotal healthcare expenditure as % of GDP by country income group (2011 vs. 1995, %)Mostly driven by increasein donor fundingEmerging economies
    • 29. 0255075100100 0255075Out-of-pocket2expenditure on health (2011, % of private expenditure on health)United StatesFranceKazakhstanBrazilVietnamTurkeyGovernment expenditure on health (2011, % total expenditure on health)TanzaniaSouth AfricaSenegalSaudi ArabiaRwandaRussiaPhilippinesNigeriaMexicoIndonesiaIndiaGhanaEthiopiaColombiaAngolaThailandVery high heterogeneity in source of financing amongemerging economies: Several clusters are presentLower health coverageHigher health coverage1. 2011, PPP int.$ 2. Out-of-pocket is a core indicator of health financing systems capturing the relative weight of direct payments by households in health expenditures; high out-of-pocketpayments are strongly associated with catastrophic and impoverishing spending, according to the WHOSource: WHO; BCG analysisSize proportional to per capitahealth care expenditure1Countries of focusReferenceModerate public withlimited private coverageHigh public with limitedprivate coverageHigh public with highprivate coverageModerate public withmoderate private coverageLower public with verylimited private coverage High private coverage• Out-of-pocket = Relative weight of direct payments by households in health expenditures• Low government expenditure associated with high out-of-pocket spend suggests low healthcare coverage• High out-of-pocket payments are strongly associated with catastrophic and impoverishing spending, according to the WHO
    • 30. 30Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsProvision of affordable high quality care services -Leveraging private sector innovationsIncreasing outreach patients through telemedicineOptimizing human resourcesLower operating costs through simplified medicalservicesHigh volume and low unit costs
    • 31. 31Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsProvision of affordable high quality care services -Leveraging private sector innovationsIncreasing outreach through telemedicineLower operating costs through simplified medicalservicesHigh volume and low unit costsOptimizing human resources. By shifting tasks totrained lay people, have reduced operating costs,increased availability of staff, and empowered the localcommunity
    • 32. In Kenya, eLearning has eased the healthcare HR crisis:have used mobile technology to support knowledge transferand its application for scalabilityIn Kenya, Enrolled Nurses (ENs)comprise 70% of nursing and45% of the health workforce• First point of contact forcommunities• But inadequately skilled tomanage diseases likeHIV/AIDSObjective: upgrade 22,000 ENs• From ‘enrolled’ to ‘registered’level w/in 5 years• Via eLearning methodsMain achievements to date:• 7,000 nurses upgraded• 32 colleges and schoolsparticipating• Over 500 computer-equippedtraining centers (incl. inremote/marginalized districts)eLearning vs. traditional methodsfor upgrading ENsIn Kenya, chronic shortage ofhighly skilled nursesIn Kenya, chronic shortage ofhighly skilled nursesIntriguing progress sincestart of program in Sep. 2005Intriguing progress sincestart of program in Sep. 2005High potential of eLearningvs. traditional methodsHigh potential of eLearningvs. traditional methodsSource: WHO, AMREF website, Press search, BCG analysis101520025520172005(K)20162225201520142013201220112006Traditional classroom method eLearning22,000 ENs to upgrade~1,000 ENsupgraded/yr.,cost ~ $2.5M~100 ENsupgraded/yr.,cost > $50M
    • 33. 33Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsProvision of affordable high quality care services -Leveraging private sector innovationsIncreasing outreach to patients throughtelemedicineOptimizing human resourcesLower operating costs through simplified medicalservicesHigh volume and low unit coststhe support and know-how ofmobile and communications industryis instrumental for going to scale
    • 34. 35Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsProvision of affordable high quality care services -Leveraging private sector innovationsIncreasing outreach through telemedicineOptimizing human resourcesLower operating costs through simplified medicalservicesHigh volume and low unit costs
    • 35. RelevanceRelevance ScalabilityScalabilityAravind Eye Care System has grown into the largestand most productive eye care facility in the worldDescriptionDescription• Eye care to poor and wealthy in India through5 owned hospitals, 4 managed hospitals, etc.• Mass marketing and industrial engineering tocreat an eye care model combining:• high service volumes and quality• with low cost and innovation to meetneeds• Conducts over 285,000 eyesurgeries and provides 2.4Mwith outpatient eye care per yearCost advantage and affordabilityCost advantage and affordability• India has 12M blind people, more than any othercountry, and 200M people in need of eye care• Restore vision:• 7.5 M through cataract surgery• 2.4M through refraction and spectacles• Aravind pioneered reach the poor and rural blind- Provided care free of charge to patients unable topay for care- Held aye camps in rural villages using communityworkers- Local sponsor organizations also providetransportation and food for patients needingsurgery at an Aravind hospital- Growth over 3 decades:- 1978–87: Seeing up and developinghospitals- 1988–97: Refining and scaling up internally byadding more hospitals, Aurolab, LAICO, education- 1998–2007: Foundation for scaling up externallyestablishing managed hospitals, growth in specialtycare, R&D• LAICO now works with >250 hospitals across Central& South America, Africa and Asia to increasecapability and capacity0200400Cost of intraocularlens (IOL) ($)2,400%Average100–150Aurolab4–6
    • 36. 37Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsProvision of affordable high quality care services -Leveraging private sector innovationsIncreasing outreach through telemedicineOptimizing human resourcesLower operating costs through simplified medicalservicesHigh volume and low unit costsAlignment of policies across relevant sectorscontinue to be key
    • 37. Price of open-heart surgery, ($)Narayana Hrudayalaya provides top quality open-heart surgery for ~50% the cost of private hospitals:government policy could support furtherDescriptionDescription• Narayana Hrydayalaya (NH) 2001 onelargest provider of pediatric heart surgeries- provides affordable quality cardiachealthcare to the masses / poor• NH drives down unit costs (which it passesonto the patients) through a high-volumestandardised strategy• The philanthropy wing helpsthose unable to afford the careCost advantage and qualityCost advantage and quality• Comparable level of quality – half the cost:- High-volume by high capacity utilisation andstaff productivity- High procurement of medical supplies- Constant technological innovation- Partnerships support subsidizing poor (farmers)- Good human capital managementRelevanceRelevance• The number of cardiac diseases in India is higher thanmost countries - 45% of the worlds incidence ofcoronary heart diseases with the figure due to rise• In 2004, 2.4M heart surgeries were needed, only 60,000were performed• Lack of options for poorer segments of Indian population- Private hospitals are often too expensive for lower-income Indians, dont offer surgeries oncompassionate grounds to those who are less well off- Government hospitals did not have adequate capacityto treat large numbers of patientsScalabilityScalability• A barrier to growth is the overly bureaucraticpublic sector. Media coverage and publicawareness has increased the governmentsupporting certain areas (e.g., low costinsurance) but no forthcoming- Large duties on consumables such as heartvalves- Regulatory hurdles in the way of newcolleges to train doctors and nurses$2.3KPrivate hospitals$1.5–6KNarayana Hrudayalaya
    • 38. Presentation Outline39• MDGs: Lessons learned and the role of public-private partnerships• The post -2015 Development Agenda: What to expect from the SDGs?• The role of various stakeholders in achieving the SDGs• Leveraging core competencies of the private sector to achieve theSDGs• Leapfrogging innovation from the private sector to increase healthcarecoverage• Challenges in involving the private sector in the post-2015 agenda
    • 39. 40Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -what can we learn from the private sector?” Health Research Policy and SystemsCore competencies from private sector that can beleveraged – health in all policies can helpIncreasing outreach through telemedicineOptimizing human resourcesLower operating costs by simplified medical servicesFranchisingHigh volume and low unit costsProcess and product reengineeringSocial marketing
    • 40. Challenges in private sector involvement in health–lack of mechanism to address them41Source: Center for Global Development (2009) “Partnerships with the private sector in Health”Do we needHEALTH as a strongerworkstream within theUN COMPACT work?
    • 41. Bringing stakeholders together:What dialogues should we engage and what environment we need tocreate to overcome these issues?Conceptual issues? Strenthening policy? Geographic issues?
    • 42. THANK YOU43

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