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Opportunities and Models for
Increasing Impact by Collaborating
with the Private Sector in Health

Camille Saadé, Halima Mwenesi
and Christian Winger

January 26, 2011
Camille Saade

                Halima Mwenesi

                                 Christian Winger
Objectives
  • Familiarize audience with FHI 360 private
    sector skills, resources, capabilities and
    experience
  • Role of private sector in increasing scale
    and sustainability of health programs
  • How can we incorporate public-private
    partnerships (PPP) into existing and future
    projects


                                                  3
Importance of Private Sector in Health



              ‘The private             ‘…the role the private
              sector is the            sector plays in fighting
                                       poverty and improving
             primary driver            livelihoods is more
              of economic              critical and profound
                 growth’               than ever.’



Bill Gates, November 2011     Rajiv Shah, December 2011
Cannes G20 Summit             New Delhi, India
Bringing the Private Sector in …




“ …we can create a hospitable enabling environment and
  develop creative incentives to encourage the private
  sector to engage more deeply on development
  challenges.”              Bill Gates, November 2011
           Innovation With Impact: Financing 21st Century Development
                               A report to G20 leaders, Cannes Summit
An Enabling Environment - Examples
• Policy
  – Clear yet flexible to embrace private sector-i.e.
    flavored ORS, or zinc in any form (tablet or syrup)
• Regulations
  – Fast-track registration of conforming new product
  – Enforce labeling/ claims to reflect policy
  – Classification as OTC drug (beyond pharmacies,
    outreach distribution, public promotion)
• Taxes and Tariffs

                                                          8
PPP: Enabling Policies are Critical
• Taxes and Tariffs on essential health products
  – Major barrier to availability and affordability
     • Private sector imports less or not at all
     • Increase price mark-ups significantly
  – Double whammy for the bottom of the
    pyramid
• Non-tariff barriers (or measures)
  – Customs procedures
What is the Private Sector in Health?
• Commercial
  – health providers
  – producers
  – R&D
  – product and service providers
  – Distributors and marketers
• Non-commercial
  – NGO, CBO, civil society in general
  – professional associations
  – universities
                                         10
Forms of Private Sector Involvement in
             Public Health

1) Philanthropy: donations (cash, products)
2) CSR (Corporate Social Responsibility): P&G’s
   PuR water treatment, Exxon-Mobil vouchers for
   ITNs
3) Core Business: Unilever’s PureIt water filter,
   Vestergaard-Frandsen’s Permanet, Dr. Reddy’s
   Zinc, Nutriset’s Nutributter, etc.

Which one is sustainable for our target population?

                                                      11
What Public Health Benefits can be
 Delivered by the Private Sector?

• Supply of appropriate
  products and services
• Affordability
• At-scale coverage
• Marketing cost-
  efficiency
• Sustainability

                                      12
Existing Situation: Inefficient Coverage

   Rich    A
                   Commercial
           B       Sector



           C

               Public
               Sector
           D
                        NGO

           E

    Poor
Expanding Coverage Through PPP

Rich    A

            Commercial
        B
            Sector


        C



        D
            NGO

        E    Public
             Sector
 Poor
Supply

                               “Shall I produce for the public
                               sector or the private market?

Diversify sources and engaging multiple partners
   • Technology transfer for local production : ITNs in Ghana,
     Tanzania, Nigeria
   • Create competition - 31 local zinc producers in India, 8 in
     Indonesia
   • In Tanzania, initial public sector supply through UNICEF .
     Upgraded local GMP capabilities for government and
     private market supply
                                                                   15
Access


                “But there is no market out there!”

• POU water filter manufacturers targeted only upper-
  income urban consumers
• FHI 360 linked self-help groups, NGOs, micro-finance
  institutions and the private sector to create a market
  for urban and rural poor. (Hindustan Unilever)



                                                           16
Affordability

                     “How can I sell to the poor and
                     still make a profit?”
• In India FHI 360 provided different POU products
  (chlorine, filters) at different price points to meet
  demand. Expensive filters preferred by customers
  were accessible though micro-finance
• Across Africa, NetMark provided ITN vouchers via
  public sector targeting pregnant women. Vouchers
  collected via private sector kept leakage to a
  minimum
                                                          17
Demand: Health Providers - Formal
• Pharmaceutical marketing: symposium, detailing by
  medical reps, journal ads, other SBCC materials and
  use of the cascade approach for formal providers
    Opinion Leaders
    Pediatricians

    General Practitioners

    Drug Sellers
    Nurses/Midwives
    General Public

                                                        18
Demand: Health Providers - Informal
• Enlisting NGOs in
  pharmaceutical detailing to
  cover 65,000 Rural Medical
  Providers (RMPs) in Uttar
  Pradesh and Gujarat
• GIS database - tracking of
  coverage, purchase and use
  shared with pharma and NGO
  partners



                                       19
Demand: Caregivers
             “Yes, but this is costly!”
• If medical product direct marketing to caregivers after
  providers
• Message reflects and reinforces public policy




                                                            20
Demand: Caregivers (cont)

• Use of appropriate mix: IPC, community activities, in-
  store promotion (POS), mass media.
• Created demand from caregivers across Indonesia
  using mass media and PSAs resulting in over 7 million
  treatment courses sold in 2011 (IMS-Health data)
•   http://youtu.be/5xB58B2mpho




                                                           21
Next Steps
Strategic vision for FHI 360
• To be a leader in developing public-private
  partnerships for health (and beyond)
Our commitment for existing / future programs
• What can we do together using PPPs to
  increase health impact?




                                                22

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Opportunities and Models for Increasing Impact by Collaborating with the Private Sector in Health

  • 1. Opportunities and Models for Increasing Impact by Collaborating with the Private Sector in Health Camille Saadé, Halima Mwenesi and Christian Winger January 26, 2011
  • 2. Camille Saade Halima Mwenesi Christian Winger
  • 3. Objectives • Familiarize audience with FHI 360 private sector skills, resources, capabilities and experience • Role of private sector in increasing scale and sustainability of health programs • How can we incorporate public-private partnerships (PPP) into existing and future projects 3
  • 4.
  • 5.
  • 6. Importance of Private Sector in Health ‘The private ‘…the role the private sector is the sector plays in fighting poverty and improving primary driver livelihoods is more of economic critical and profound growth’ than ever.’ Bill Gates, November 2011 Rajiv Shah, December 2011 Cannes G20 Summit New Delhi, India
  • 7. Bringing the Private Sector in … “ …we can create a hospitable enabling environment and develop creative incentives to encourage the private sector to engage more deeply on development challenges.” Bill Gates, November 2011 Innovation With Impact: Financing 21st Century Development A report to G20 leaders, Cannes Summit
  • 8. An Enabling Environment - Examples • Policy – Clear yet flexible to embrace private sector-i.e. flavored ORS, or zinc in any form (tablet or syrup) • Regulations – Fast-track registration of conforming new product – Enforce labeling/ claims to reflect policy – Classification as OTC drug (beyond pharmacies, outreach distribution, public promotion) • Taxes and Tariffs 8
  • 9. PPP: Enabling Policies are Critical • Taxes and Tariffs on essential health products – Major barrier to availability and affordability • Private sector imports less or not at all • Increase price mark-ups significantly – Double whammy for the bottom of the pyramid • Non-tariff barriers (or measures) – Customs procedures
  • 10. What is the Private Sector in Health? • Commercial – health providers – producers – R&D – product and service providers – Distributors and marketers • Non-commercial – NGO, CBO, civil society in general – professional associations – universities 10
  • 11. Forms of Private Sector Involvement in Public Health 1) Philanthropy: donations (cash, products) 2) CSR (Corporate Social Responsibility): P&G’s PuR water treatment, Exxon-Mobil vouchers for ITNs 3) Core Business: Unilever’s PureIt water filter, Vestergaard-Frandsen’s Permanet, Dr. Reddy’s Zinc, Nutriset’s Nutributter, etc. Which one is sustainable for our target population? 11
  • 12. What Public Health Benefits can be Delivered by the Private Sector? • Supply of appropriate products and services • Affordability • At-scale coverage • Marketing cost- efficiency • Sustainability 12
  • 13. Existing Situation: Inefficient Coverage Rich A Commercial B Sector C Public Sector D NGO E Poor
  • 14. Expanding Coverage Through PPP Rich A Commercial B Sector C D NGO E Public Sector Poor
  • 15. Supply “Shall I produce for the public sector or the private market? Diversify sources and engaging multiple partners • Technology transfer for local production : ITNs in Ghana, Tanzania, Nigeria • Create competition - 31 local zinc producers in India, 8 in Indonesia • In Tanzania, initial public sector supply through UNICEF . Upgraded local GMP capabilities for government and private market supply 15
  • 16. Access “But there is no market out there!” • POU water filter manufacturers targeted only upper- income urban consumers • FHI 360 linked self-help groups, NGOs, micro-finance institutions and the private sector to create a market for urban and rural poor. (Hindustan Unilever) 16
  • 17. Affordability “How can I sell to the poor and still make a profit?” • In India FHI 360 provided different POU products (chlorine, filters) at different price points to meet demand. Expensive filters preferred by customers were accessible though micro-finance • Across Africa, NetMark provided ITN vouchers via public sector targeting pregnant women. Vouchers collected via private sector kept leakage to a minimum 17
  • 18. Demand: Health Providers - Formal • Pharmaceutical marketing: symposium, detailing by medical reps, journal ads, other SBCC materials and use of the cascade approach for formal providers Opinion Leaders Pediatricians General Practitioners Drug Sellers Nurses/Midwives General Public 18
  • 19. Demand: Health Providers - Informal • Enlisting NGOs in pharmaceutical detailing to cover 65,000 Rural Medical Providers (RMPs) in Uttar Pradesh and Gujarat • GIS database - tracking of coverage, purchase and use shared with pharma and NGO partners 19
  • 20. Demand: Caregivers “Yes, but this is costly!” • If medical product direct marketing to caregivers after providers • Message reflects and reinforces public policy 20
  • 21. Demand: Caregivers (cont) • Use of appropriate mix: IPC, community activities, in- store promotion (POS), mass media. • Created demand from caregivers across Indonesia using mass media and PSAs resulting in over 7 million treatment courses sold in 2011 (IMS-Health data) • http://youtu.be/5xB58B2mpho 21
  • 22. Next Steps Strategic vision for FHI 360 • To be a leader in developing public-private partnerships for health (and beyond) Our commitment for existing / future programs • What can we do together using PPPs to increase health impact? 22