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Eva Jané-Llopis, Director, World Economic Forum

The document discusses the role of the private sector in achieving universal health coverage and promoting healthy lives as part of the post-2015 development agenda. It notes that public-private partnerships during the MDG era helped increase access to medicines and vaccinations. Looking ahead, the private sector can help leverage its core competencies like innovation, management flexibility, and access to infrastructure. Examples highlighted include social enterprises that expand family planning access, mobile technologies that help train healthcare workers, and public-private collaborations on issues like non-communicable diseases. However, supportive policies are still needed to ensure the private sector's efforts also promote equity and public health priorities as part of achieving the Sustainable Development Goals.

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The role of the private sector in the post-2015 development agenda Dr Eva Jané-Llopis Director Health Programmes World Economic Forum Margarita Xydia-Charmanta Project Associate World Economic Forum
The World Economic Forum 2 Neutral platform to move the needle in different topics, from environment, to infrastructure, from gender parity to health
In the next 15 minutes 3 • 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
In the next 15 minutes 4 • 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
Progress towards the MDGs has been uneven Proportion of low and middle-income countries progressing or regressing on MDGs, 2010 5 Source: Overseas Development Institute “Millennium Development Goals Report Card”
Public-private collaboration in the MDGs have … 6 Sources: Development Cooperation, Ministry of Foreign Affairs of the Netherlands (2011) “Public-private partnerships. Ten ways to achieve the Millennium Development Goals”, GAVI Alliance, UNDP Europe and CIS, the UN Millenium Project, Lucci P. (2012) “Post-2015 MDGs. What role for business?”, Overseas Development Institute • Tripled investments in medication for HIV/AIDS, tuberculosis and malaria • More medicines available: eg. reach > 40 million people with African river blindness in > 30 countries • Vaccination: four in every five children worldwide protected by vaccines; 40% drop of number of children dying before their fifth birthday to fewer than 7 million Outside 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)
In the next 15 minutes 7 • 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
As with MDGs, we need all capacity we can for delivering the Sustainable Development Goals (SDGs) 8 Source: UNDP Europe and CIS Civil Society Public Sector Private Sector
Top 150 largest economies -Wal-Mart: revenues > GDPs of 174 countries employed > 2 million people. -Shell: > revenues than the combined GDPs 6th + 7th most populous nations in the world > 350 million Together, the 44 companies in top 100 have revenues over 9% of global GDP All businesses (micro-, smes) are: -drivers of our economic societies -create jobs, provide households -have large capital and present an opportunity to shift goods, services and revenue for health -an important resource of capacity 9 44% of the 100 top largest economies are not countries but corporations (2009)
10 Taskforces & progress: •water •gender equality •climate change
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 conditions 11Source: 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 • 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda How can we leverage the key competences of the private sector in the SDG agenda?
The post-2015 Development Agenda: Interconnection – we need a systems approach 13Source: United Nations (2013) “A renewed global partnership for development” They are all interconnected
14 Approaches go beyond CSR for a more inclusive green growth agenda : -Eliminating waste + more efficient use of resources (e.g walmart global supply chain carbon footprint) -Redesigning how make and deliver (sustainable production processes, e.g., cradle to cradle, limited use toxic chemicals) -All institutions for sustainability (e.g., innovative business schools developing a new generation of business leaders) The sustainability agenda is more advanced in leveraging the private sector Leading companies have: - 25% higher stock value - the fastest growing stock value - deliver superior financial performance - are better investment risks Sources: http://www.oecd.org/greengrowth/Rio+20%20brochure%20FINAL%20ENGLISH%20web%202.pdf Alignment of policies and incentives continue to be key
The post-2015 Development Agenda: need for supportive policies to advance action 15Source: United Nations (2013) “A renewed global partnership for development” Healthy Lives Universal Health Coverage Policies across all sectros that might have an influence to healthy lives Systems approach
Core competencies of the private sector that can be leveraged 16 Source: Lucci P. (2012) “Post-2015 MDGs. What role for business?”, Overseas Development Institute • Find different ways of raising funds using international capital markets and new financial products
Creating a system level change for healthy lives 17
Innovation from the private sector to healthy lives 18 Source: 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 Process and product reengineering
Innovation to leverage from the private sector to increase healthy lives 19 Source: 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
Greenstar, as an NGO, has used the private healthcare system to create an extensive network of family planning franchises DescriptionDescription • Social marketing organization for family planning and access to contraceptives • Leverages / uses the private healthcare system (70% of Pakistanis) to act as franchisees to: - Counseling and advice - Outlet for purchasing affordable contraceptives (26%) Cost advantage and qualityCost advantage and quality • Low income non-users, thru total market approach – different price points per segment • Cross subsidisation increases access • Funding from large international organizations and Governments • Per capita GNP is low, 70% accesses care in the private sector, • Affordability and access to quality health products are needs • 59% of family planning services delivered by public sector • Greenstar can grow (though it is fairly large) • Constant funding support shows replicability 27 38 35 ProductsProgram CostsOperations/Admin Moderately low operating and administrative costs 30 59 KeySocialMarketing CommercialSector Greenstar NGOSector Publicsector 30 70PublicPrivate Source: world economic forum 2010 Share of family planning services in Pakistan Within the private sector, there was • Significant need for family planning services • Underutilised capacity to provide these services • Low levels of knowledge and skills RelevanceRelevance ScalabilityScalability
21 Source: 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 Innovation to leverage from the private sector to increase healthy lives
22 Prevalence 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 less than 20 minutes of vigorous activity three times per week, or the equivalent Source:WHO2011
Sedentary time will continue to increase Source: Ng, Popkin. Obesity Reviews, 2012 USA P1: 2009 UK P1: 2005 Brazil P1: 2007 China P1: 2009 India P1: 2005 P1 23
24 Estimated gains in life expectancy with elimination of physical inactivity Source: I-Min Lee et al, Lancet, 2012
25 Creating a social movement Digital platforms have: •amplified the message for a healthier generation •engaged younger audiences •motivated healthier choices personalization and empowerment, enable that systemic approach, getting the right message to the right people From video games to social media challenges Supportive policies across sectors: -Environnent -Transport -City planning
Leapfrogging innovation from the private sector to increase healthy lives 26 Source: 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 Process and product reengineering. This reduces costs and offers and alternative to the traditional product Alignment of policies across relevant sectors continue to be key
Universal Health Coverage, 2010 27 Source: adapted from PNHP, WHO and SEARO
Health care expenditure increasing in emerging economies - with still significant catching up with developed economies 0% 5% 10% 15% + 1.6 pp +0.8 pp +0.9 pp +3.1 pp Low income 5.8% 4.0% Lower middle income 4.4%3.8% Upper middle income 6.1%5.3% High income / Developed economies 12.3% 9.5% 2011 1995 Upper 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 the Grenadines, Suriname, Thailand, Tunisia, Turkey, Turkmenistan, Tuvalu, Uruguay, Venezuela Lower middle income countries: Albania, Armenia, Belize, Bhutan, Bolivia, Cameroon, Cape Verde, Congo, Rep., Cote d'Ivoire, 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, Papua New 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, Zambia Low 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, Zimbabwe Source: World Bank, BCG analysis Total healthcare expenditure as % of GDP by country income group (2011 vs. 1995, %) Mostly driven by increase in donor funding Emerging economies
0 25 50 75 100 100 0255075 Out-of-pocket2 expenditure on health (2011, % of private expenditure on health) United States France Kazakhstan Brazil Vietnam Turkey Government expenditure on health (2011, % total expenditure on health) Tanzania South Africa Senegal Saudi Arabia Rwanda Russia Philippines Nigeria Mexico Indonesia India Ghana Ethiopia Colombia Angola Thailand Very high heterogeneity in source of financing among emerging economies: Several clusters are present Lower health coverage Higher health coverage 1. 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-pocket payments are strongly associated with catastrophic and impoverishing spending, according to the WHO Source: WHO; BCG analysis Size proportional to per capita health care expenditure1 Countries of focusReference Moderate public with limited private coverage High public with limited private coverage High public with high private coverage Moderate public with moderate private coverage Lower public with very limited 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 Source: 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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach patients through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs
31 Source: 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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach through telemedicine Lower operating costs through simplified medical services High volume and low unit costs Optimizing human resources. By shifting tasks to trained lay people, have reduced operating costs, increased availability of staff, and empowered the local community
In Kenya, eLearning has eased the healthcare HR crisis: have used mobile technology to support knowledge transfer and its application for scalability In Kenya, Enrolled Nurses (ENs) comprise 70% of nursing and 45% of the health workforce • First point of contact for communities • But inadequately skilled to manage diseases like HIV/AIDS Objective: upgrade 22,000 ENs • From ‘enrolled’ to ‘registered’ level w/in 5 years • Via eLearning methods Main achievements to date: • 7,000 nurses upgraded • 32 colleges and schools participating • Over 500 computer-equipped training centers (incl. in remote/marginalized districts) eLearning vs. traditional methods for upgrading ENs In Kenya, chronic shortage of highly skilled nurses In Kenya, chronic shortage of highly skilled nurses Intriguing progress since start of program in Sep. 2005 Intriguing progress since start of program in Sep. 2005 High potential of eLearning vs. traditional methods High potential of eLearning vs. traditional methods Source: WHO, AMREF website, Press search, BCG analysis 10 15 20 0 25 5 2017 2005 (K) 2016 2225 2015 2014 2013 2012 2011 2006 Traditional classroom method eLearning 22,000 ENs to upgrade ~1,000 ENs upgraded/yr., cost ~ $2.5M ~100 ENs upgraded/yr., cost > $50M
33 Source: 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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach to patients through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs the support and know-how of mobile and communications industry is instrumental for going to scale
35 Source: 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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs
RelevanceRelevance ScalabilityScalability Aravind Eye Care System has grown into the largest and most productive eye care facility in the world DescriptionDescription • Eye care to poor and wealthy in India through 5 owned hospitals, 4 managed hospitals, etc. • Mass marketing and industrial engineering to creat an eye care model combining: • high service volumes and quality • with low cost and innovation to meet needs • Conducts over 285,000 eye surgeries and provides 2.4M with outpatient eye care per year Cost advantage and affordabilityCost advantage and affordability • India has 12M blind people, more than any other country, 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 to pay for care - Held aye camps in rural villages using community workers - Local sponsor organizations also provide transportation and food for patients needing surgery at an Aravind hospital - Growth over 3 decades: - 1978–87: Seeing up and developing hospitals - 1988–97: Refining and scaling up internally by adding more hospitals, Aurolab, LAICO, education - 1998–2007: Foundation for scaling up externally establishing managed hospitals, growth in specialty care, R&D • LAICO now works with >250 hospitals across Central & South America, Africa and Asia to increase capability and capacity 0 200 400 Cost of intraocular lens (IOL) ($) 2,400% Average 100–150 Aurola b 4–6
37 Source: 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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs Alignment of policies across relevant sectors continue to be key
Price of open-heart surgery, ($) Narayana Hrudayalaya provides top quality open- heart surgery for ~50% the cost of private hospitals: government policy could support further DescriptionDescription • Narayana Hrydayalaya (NH) 2001 one largest provider of pediatric heart surgeries - provides affordable quality cardiac healthcare to the masses / poor • NH drives down unit costs (which it passes onto the patients) through a high-volume standardised strategy • The philanthropy wing helps those unable to afford the care Cost advantage and qualityCost advantage and quality • Comparable level of quality – half the cost: - High-volume by high capacity utilisation and staff productivity - High procurement of medical supplies - Constant technological innovation - Partnerships support subsidizing poor (farmers) - Good human capital management RelevanceRelevance • The number of cardiac diseases in India is higher than most countries - 45% of the world's incidence of coronary heart diseases with the figure due to rise • In 2004, 2.4M heart surgeries were needed, only 60,000 were performed • Lack of options for poorer segments of Indian population - Private hospitals are often too expensive for lower- income Indians, don't offer surgeries on compassionate grounds to those who are less well off - Government hospitals did not have adequate capacity to treat large numbers of patients ScalabilityScalability • A barrier to growth is the overly bureaucratic public sector. Media coverage and public awareness has increased the government supporting certain areas (e.g., low cost insurance) but no forthcoming - Large duties on consumables such as heart valves - Regulatory hurdles in the way of new colleges to train doctors and nurses $2.3K Private hospitals $1.5–6K Narayana Hrudayalaya
Presentation Outline 39 • 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 the SDGs • Leapfrogging innovation from the private sector to increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
40 Source: 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 Core competencies from private sector that can be leveraged – health in all policies can help Increasing outreach through telemedicine Optimizing human resources Lower operating costs by simplified medical services Franchising High volume and low unit costs Process and product reengineering Social marketing
Challenges in private sector involvement in health – lack of mechanism to address them 41 Source: Center for Global Development (2009) “Partnerships with the private sector in Health” Do we need HEALTH as a stronger workstream within the UN COMPACT work?
Bringing stakeholders together: What dialogues should we engage and what environment we need to create to overcome these issues? Conceptual issues? Strenthening policy? Geographic issues?
THANK YOU 43

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Eva Jané-Llopis, Director, World Economic Forum

  • 1.
    The role ofthe private sector in the post-2015 development agenda Dr Eva Jané-Llopis Director Health Programmes World Economic Forum Margarita Xydia-Charmanta Project Associate World Economic Forum
  • 2.
    The World EconomicForum 2 Neutral platform to move the needle in different topics, from environment, to infrastructure, from gender parity to health
  • 3.
    In the next15 minutes 3 • 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
  • 4.
    In the next15 minutes 4 • 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
  • 5.
    Progress towards theMDGs has been uneven Proportion of low and middle-income countries progressing or regressing on MDGs, 2010 5 Source: Overseas Development Institute “Millennium Development Goals Report Card”
  • 6.
    Public-private collaboration inthe MDGs have … 6 Sources: Development Cooperation, Ministry of Foreign Affairs of the Netherlands (2011) “Public-private partnerships. Ten ways to achieve the Millennium Development Goals”, GAVI Alliance, UNDP Europe and CIS, the UN Millenium Project, Lucci P. (2012) “Post-2015 MDGs. What role for business?”, Overseas Development Institute • Tripled investments in medication for HIV/AIDS, tuberculosis and malaria • More medicines available: eg. reach > 40 million people with African river blindness in > 30 countries • Vaccination: four in every five children worldwide protected by vaccines; 40% drop of number of children dying before their fifth birthday to fewer than 7 million Outside 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 next15 minutes 7 • 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
  • 8.
    As with MDGs,we need all capacity we can for delivering the Sustainable Development Goals (SDGs) 8 Source: UNDP Europe and CIS Civil Society Public Sector Private Sector
  • 9.
    Top 150 largest economies -Wal-Mart:revenues > GDPs of 174 countries employed > 2 million people. -Shell: > revenues than the combined GDPs 6th + 7th most populous nations in the world > 350 million Together, the 44 companies in top 100 have revenues over 9% of global GDP All businesses (micro-, smes) are: -drivers of our economic societies -create jobs, provide households -have large capital and present an opportunity to shift goods, services and revenue for health -an important resource of capacity 9 44% of the 100 top largest economies are not countries but corporations (2009)
  • 10.
  • 11.
    Comparative advantages anddisadvantages: 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 conditions 11Source: 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: Lessonslearned 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 the SDGs • Harnessing innovation capacity to promote healthy lives and increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda How can we leverage the key competences of the private sector in the SDG agenda?
  • 13.
    The post-2015 DevelopmentAgenda: Interconnection – we need a systems approach 13Source: United Nations (2013) “A renewed global partnership for development” They are all interconnected
  • 14.
    14 Approaches go beyondCSR for a more inclusive green growth agenda : -Eliminating waste + more efficient use of resources (e.g walmart global supply chain carbon footprint) -Redesigning how make and deliver (sustainable production processes, e.g., cradle to cradle, limited use toxic chemicals) -All institutions for sustainability (e.g., innovative business schools developing a new generation of business leaders) The sustainability agenda is more advanced in leveraging the private sector Leading companies have: - 25% higher stock value - the fastest growing stock value - deliver superior financial performance - are better investment risks Sources: http://www.oecd.org/greengrowth/Rio+20%20brochure%20FINAL%20ENGLISH%20web%202.pdf Alignment of policies and incentives continue to be key
  • 15.
    The post-2015 DevelopmentAgenda: need for supportive policies to advance action 15Source: United Nations (2013) “A renewed global partnership for development” Healthy Lives Universal Health Coverage Policies across all sectros that might have an influence to healthy lives Systems approach
  • 16.
    Core competencies ofthe private sector that can be leveraged 16 Source: Lucci P. (2012) “Post-2015 MDGs. What role for business?”, Overseas Development Institute • Find different ways of raising funds using international capital markets and new financial products
  • 17.
    Creating a systemlevel change for healthy lives 17
  • 18.
    Innovation from theprivate sector to healthy lives 18 Source: 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 Process and product reengineering
  • 19.
    Innovation to leveragefrom the private sector to increase healthy lives 19 Source: 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 anNGO, has used the private healthcare system to create an extensive network of family planning franchises DescriptionDescription • Social marketing organization for family planning and access to contraceptives • Leverages / uses the private healthcare system (70% of Pakistanis) to act as franchisees to: - Counseling and advice - Outlet for purchasing affordable contraceptives (26%) Cost advantage and qualityCost advantage and quality • Low income non-users, thru total market approach – different price points per segment • Cross subsidisation increases access • Funding from large international organizations and Governments • Per capita GNP is low, 70% accesses care in the private sector, • Affordability and access to quality health products are needs • 59% of family planning services delivered by public sector • Greenstar can grow (though it is fairly large) • Constant funding support shows replicability 27 38 35 ProductsProgram CostsOperations/Admin Moderately low operating and administrative costs 30 59 KeySocialMarketing CommercialSector Greenstar NGOSector Publicsector 30 70PublicPrivate Source: world economic forum 2010 Share of family planning services in Pakistan Within the private sector, there was • Significant need for family planning services • Underutilised capacity to provide these services • Low levels of knowledge and skills RelevanceRelevance ScalabilityScalability
  • 21.
    21 Source: Bhattacharyya etal. (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 Innovation to leverage from the private sector to increase healthy lives
  • 22.
    22 Prevalence of physicalinactivity* • 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 less than 20 minutes of vigorous activity three times per week, or the equivalent Source:WHO2011
  • 23.
    Sedentary time willcontinue to increase Source: Ng, Popkin. Obesity Reviews, 2012 USA P1: 2009 UK P1: 2005 Brazil P1: 2007 China P1: 2009 India P1: 2005 P1 23
  • 24.
    24 Estimated gains inlife expectancy with elimination of physical inactivity Source: I-Min Lee et al, Lancet, 2012
  • 25.
    25 Creating a socialmovement Digital platforms have: •amplified the message for a healthier generation •engaged younger audiences •motivated healthier choices personalization and empowerment, enable that systemic approach, getting the right message to the right people From video games to social media challenges Supportive policies across sectors: -Environnent -Transport -City planning
  • 26.
    Leapfrogging innovation fromthe private sector to increase healthy lives 26 Source: 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 Process and product reengineering. This reduces costs and offers and alternative to the traditional product Alignment of policies across relevant sectors continue to be key
  • 27.
    Universal Health Coverage,2010 27 Source: adapted from PNHP, WHO and SEARO
  • 28.
    Health care expenditureincreasing in emerging economies - with still significant catching up with developed economies 0% 5% 10% 15% + 1.6 pp +0.8 pp +0.9 pp +3.1 pp Low income 5.8% 4.0% Lower middle income 4.4%3.8% Upper middle income 6.1%5.3% High income / Developed economies 12.3% 9.5% 2011 1995 Upper 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 the Grenadines, Suriname, Thailand, Tunisia, Turkey, Turkmenistan, Tuvalu, Uruguay, Venezuela Lower middle income countries: Albania, Armenia, Belize, Bhutan, Bolivia, Cameroon, Cape Verde, Congo, Rep., Cote d'Ivoire, 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, Papua New 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, Zambia Low 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, Zimbabwe Source: World Bank, BCG analysis Total healthcare expenditure as % of GDP by country income group (2011 vs. 1995, %) Mostly driven by increase in donor funding Emerging economies
  • 29.
    0 25 50 75 100 100 0255075 Out-of-pocket2 expenditure onhealth (2011, % of private expenditure on health) United States France Kazakhstan Brazil Vietnam Turkey Government expenditure on health (2011, % total expenditure on health) Tanzania South Africa Senegal Saudi Arabia Rwanda Russia Philippines Nigeria Mexico Indonesia India Ghana Ethiopia Colombia Angola Thailand Very high heterogeneity in source of financing among emerging economies: Several clusters are present Lower health coverage Higher health coverage 1. 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-pocket payments are strongly associated with catastrophic and impoverishing spending, according to the WHO Source: WHO; BCG analysis Size proportional to per capita health care expenditure1 Countries of focusReference Moderate public with limited private coverage High public with limited private coverage High public with high private coverage Moderate public with moderate private coverage Lower public with very limited 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.
    30 Source: Bhattacharyya etal. (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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach patients through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs
  • 31.
    31 Source: Bhattacharyya etal. (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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach through telemedicine Lower operating costs through simplified medical services High volume and low unit costs Optimizing human resources. By shifting tasks to trained lay people, have reduced operating costs, increased availability of staff, and empowered the local community
  • 32.
    In Kenya, eLearninghas eased the healthcare HR crisis: have used mobile technology to support knowledge transfer and its application for scalability In Kenya, Enrolled Nurses (ENs) comprise 70% of nursing and 45% of the health workforce • First point of contact for communities • But inadequately skilled to manage diseases like HIV/AIDS Objective: upgrade 22,000 ENs • From ‘enrolled’ to ‘registered’ level w/in 5 years • Via eLearning methods Main achievements to date: • 7,000 nurses upgraded • 32 colleges and schools participating • Over 500 computer-equipped training centers (incl. in remote/marginalized districts) eLearning vs. traditional methods for upgrading ENs In Kenya, chronic shortage of highly skilled nurses In Kenya, chronic shortage of highly skilled nurses Intriguing progress since start of program in Sep. 2005 Intriguing progress since start of program in Sep. 2005 High potential of eLearning vs. traditional methods High potential of eLearning vs. traditional methods Source: WHO, AMREF website, Press search, BCG analysis 10 15 20 0 25 5 2017 2005 (K) 2016 2225 2015 2014 2013 2012 2011 2006 Traditional classroom method eLearning 22,000 ENs to upgrade ~1,000 ENs upgraded/yr., cost ~ $2.5M ~100 ENs upgraded/yr., cost > $50M
  • 33.
    33 Source: Bhattacharyya etal. (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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach to patients through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs the support and know-how of mobile and communications industry is instrumental for going to scale
  • 34.
    35 Source: Bhattacharyya etal. (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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs
  • 35.
    RelevanceRelevance ScalabilityScalability Aravind EyeCare System has grown into the largest and most productive eye care facility in the world DescriptionDescription • Eye care to poor and wealthy in India through 5 owned hospitals, 4 managed hospitals, etc. • Mass marketing and industrial engineering to creat an eye care model combining: • high service volumes and quality • with low cost and innovation to meet needs • Conducts over 285,000 eye surgeries and provides 2.4M with outpatient eye care per year Cost advantage and affordabilityCost advantage and affordability • India has 12M blind people, more than any other country, 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 to pay for care - Held aye camps in rural villages using community workers - Local sponsor organizations also provide transportation and food for patients needing surgery at an Aravind hospital - Growth over 3 decades: - 1978–87: Seeing up and developing hospitals - 1988–97: Refining and scaling up internally by adding more hospitals, Aurolab, LAICO, education - 1998–2007: Foundation for scaling up externally establishing managed hospitals, growth in specialty care, R&D • LAICO now works with >250 hospitals across Central & South America, Africa and Asia to increase capability and capacity 0 200 400 Cost of intraocular lens (IOL) ($) 2,400% Average 100–150 Aurola b 4–6
  • 36.
    37 Source: Bhattacharyya etal. (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 Provision of affordable high quality care services - Leveraging private sector innovations Increasing outreach through telemedicine Optimizing human resources Lower operating costs through simplified medical services High volume and low unit costs Alignment of policies across relevant sectors continue to be key
  • 37.
    Price of open-heartsurgery, ($) Narayana Hrudayalaya provides top quality open- heart surgery for ~50% the cost of private hospitals: government policy could support further DescriptionDescription • Narayana Hrydayalaya (NH) 2001 one largest provider of pediatric heart surgeries - provides affordable quality cardiac healthcare to the masses / poor • NH drives down unit costs (which it passes onto the patients) through a high-volume standardised strategy • The philanthropy wing helps those unable to afford the care Cost advantage and qualityCost advantage and quality • Comparable level of quality – half the cost: - High-volume by high capacity utilisation and staff productivity - High procurement of medical supplies - Constant technological innovation - Partnerships support subsidizing poor (farmers) - Good human capital management RelevanceRelevance • The number of cardiac diseases in India is higher than most countries - 45% of the world's incidence of coronary heart diseases with the figure due to rise • In 2004, 2.4M heart surgeries were needed, only 60,000 were performed • Lack of options for poorer segments of Indian population - Private hospitals are often too expensive for lower- income Indians, don't offer surgeries on compassionate grounds to those who are less well off - Government hospitals did not have adequate capacity to treat large numbers of patients ScalabilityScalability • A barrier to growth is the overly bureaucratic public sector. Media coverage and public awareness has increased the government supporting certain areas (e.g., low cost insurance) but no forthcoming - Large duties on consumables such as heart valves - Regulatory hurdles in the way of new colleges to train doctors and nurses $2.3K Private hospitals $1.5–6K Narayana Hrudayalaya
  • 38.
    Presentation Outline 39 • 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 the SDGs • Leapfrogging innovation from the private sector to increase healthcare coverage • Challenges in involving the private sector in the post-2015 agenda
  • 39.
    40 Source: Bhattacharyya etal. (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 Core competencies from private sector that can be leveraged – health in all policies can help Increasing outreach through telemedicine Optimizing human resources Lower operating costs by simplified medical services Franchising High volume and low unit costs Process and product reengineering Social marketing
  • 40.
    Challenges in privatesector involvement in health – lack of mechanism to address them 41 Source: Center for Global Development (2009) “Partnerships with the private sector in Health” Do we need HEALTH as a stronger workstream within the UN COMPACT work?
  • 41.
    Bringing stakeholders together: Whatdialogues should we engage and what environment we need to create to overcome these issues? Conceptual issues? Strenthening policy? Geographic issues?
  • 42.

Editor's Notes

  • #10 .
  • #25 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.