Some brief context: The majority of people seek health care in the private sector in developing countries (DHS data). Pharmacies, retail outlets, for-profit clinics and hospitals, NGOS (though smallest percentage). We generally think of the wealthy as using the private sector, but its across income levels. While this is referring to service delivery, and includes informal providers, its still important to recognize what a big role the private sector already plays in healthcare and think about how these existing private sector actors can be utilized in Integrated prevention campaigns. The question is what are the specific opportunities for the private sector in IPCs?
Investments in large-scale production, novartis with malaria treatment, pharma companies have brought down ART costs similarly, VF with bednetsGSK has used pharma detailers to provide IEC materials while selling drugsTechnology: Cell phone reminders and other outreach/educational toolsIndependent drug shops are often the “first point of care” and very rooted and trusted in communities. We’re starting to look to these outlets for distribution of diagnostic and preventative tools, such as RDTs for malaria (Uganda, Nigeria, Myanmar), so again there is potential here to serve as an operational base / distribution point for IPCs. Living goods – door to door social commodity sales.
Variety of contractual and financing models adapted to different contexts, different levels of sustainability
This is a quickly growing model52 programs around the world reported in 2011The number has doubled since 2006Number of countries more than doubled since 2003
While this graph refers mostly to clinical services, we’re also seeing more and more programs that are introducing preventative services: child nutrition, cervical cancer screening, diagnostic testing for HIV and malaria, and a large part of their business relies on selling subsidized preventative commodities (condoms, bednets, water purification tabs, etc). In addition, many programs involve networks of not just doctors, but community health/outreach workers, for example a second tier of rural outreach workers to feed referrals into the clinics but also to provide counseling, testing and prevention services and reach very rural areas. This is a potential point for collaboration/ value add to IPCs, because these networks of trained health workers already exist and could be utilized and adapted to help on the implementation side IPCs.The challenge is financingChallengesEasier to provide fee for service through private providers – motivation is profit, people don’t pay for prevention. What’s hard is finding a way to subsidize preventative services. Need a third party payer. Ways to do it through government partnerships, demand-side financing, vouchersLarge experiments going on to make it happen, but it’s a challengeDSF / voucher systems could work for IPCs if the campaign is government or privately-funded, and there is potential for innovative funding mechanisms because the providers are receiving additional perks such as branding and increased clientele, etc.
The critical role of NGOs, FBOs, and for profits in IPCs that we see is to provide large scale networks of providers, retailers, clinics, or hospitals, that can be leveraged for large-scale standardized replication of services and operations such as IPCIf everyone goes to private sector for care, those actors must be part of prevention campaigns as well – in fact they are already participating in many ways that can beThe challenge is working with lots of private outlets (you need to) I gave one example, this is an achievable, realistic goal, and if we want to reach the majority, this has to be one of the delivery systems for IPCThe challenge here is that the funding models are less applicable – private providers still make a profit on consultations and commodities, which
The Role of the Private Sector in Integrated Prevention Campaigns
The Role of the Private Sector inIntegrated Prevention CampaignsAnna York De La CruzUCSF Global Health Group
Presentation Objectives Why focus on the private sector in Integrated Prevention Campaigns? Private sector actors and potential roles The Social Franchising model Key Lessons
The Majority of People in DevelopingCountries are Treated in the Private Sector 58% 65% 78% Kenya Nigeria India Source: DHS & www.ps4h.org/globalhealthdata
Potential Private Sector RolesInputs and Commodities Private companies can produce high quality and inexpensive commodities NGO partnerships like Nets for LifeSupport, Data collection and information dissemination Pharmacy, drug outlets/chains, drug detailers Technology companiesImplementation Corporate-run networks and campaigns For-profit clinic, hospital, pharmacy chains NGO-run social franchises
One Model: Social Franchising Branding Franchisee Training Clinic Standards Commoditie Franchisee Franchisor s Clinic Membership fee Requirements/ Franchisee Standards Clinic GoalsQuality * Equity * Cost-effectiveness * Health Impact
Lessons Many innovative ways to engage the private sector in IPCs Provider networks of retailers, clinics, hospitals, NGOs, can be leveraged for large-scale delivery operations in IPCs Private companies can contribute to inputs and communications Funding for prevention is the biggest challenge, but one that can be overcome Need to work with the private sector to reach everyone