Panel Discussion - Understanding the emerging role of the private sector in medical education
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The document summarizes a presentation about the emerging role of the private sector in medical education in Africa. It discusses how the private sector is involved in health service delivery and financing. It also addresses common myths about the private sector, such as that it only benefits the wealthy. The presentation then focuses on the types of public-private partnerships that exist in medical education and some challenges facing private medical training institutions. It concludes that there is significant potential for growth in private medical education and partnerships, but also major challenges around financial, business, and regulatory issues that differ across Africa.
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Panel Discussion - Understanding the emerging role of the private sector in medical education
- 1. Understanding the Emerging Role of the Private Sector in Medical Education Ilana Ron Levey Africa Regional Manager, SHOPS 20 March 2013, HIV Capacity Building Partners Summit SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting
- 2. Overview of the Session • Setting the context about the role of the private sector in health service delivery • Understanding more about the emerging role of the private sector in medical education • Focusing on financial and business challenges • Personal reflections from private medical training institution proprietors
- 3. Three Common Myths about the Private Health Sector Myth #1: Health in Africa is financed primarily by the public sector
- 4. Health Financing in Africa Source: Marek T, et al. 2005
- 5. Private Sector Expenditures in Africa Where Health Funds Come From Where Private Funds Are Spent $16.7B $8.3 B $4.2B 100% Public Providers Public ~40% ~ 40% ~ 65% ~ 50% Private ~65% For profit Private Providers Out of pocket ~ 50% ~ 50% Social enterprise ~ 15% ~15% ~50% ~50% Non profit ~10% ~ 10% Other private Private prepaid Traditional healers ~10% ~ 10% Source of payment Providers Private sector providers Healthcare Expenditure by Healthcare Expenditure by Provider Financing Agent (%) Ownership (%) Source: IFC Report, 2007
- 6. Private Financing Trends • Over half of total health expenditures for households are in the private sector • Private sector health expenditure is generally in the form of direct payments at the point of service • Out-of-pocket health expenditures has increased in both absolute and relative terms • Some evidence that donor funding may be affecting private investment in HIV Source: AFD Diagnostic forthcoming
- 7. Three Common Myths about the Private Health Sector Myth #2: The private health sector mostly benefits the wealthy
- 8. All Population Segments, Including the Poor, Access the Private Health Sector % 74% Use of private sector among POOREST QUINTILE in Sub-Saharan Africa for curative child care 49% 7% Source: SARA Project 2004
- 9. The For-profit Private Sector Provides Care Across all Income Groups Urban and Rural Population Receiving Care from Private for-Profit Provider of Modern Medicine Lowest quintile Highest quintile *Percent: Most recent survey year available between 1995-2006 Source: WB Africa Development Indications 2006, team analysis
- 10. Three Common Myths about the Private Health Sector Myth #3: The private health sector is insignificant in Africa
- 11. Virtually Half of all Physicians Work in the Private Health Sector in Africa Geographic Region % of physicians Asia 60% working (6 countries) Sub-Saharan Africa (8 countries) 46% in Mali the private sector 50% Kenya 74% Latin American & Caribbean 46% (5 countries) North African & Middle East 35% (7 countries) Source: Marek, T. Presentation in South Africa 2005, WB 2005, IFC Country Assessments of the Private Health Sector
- 12. Private-for-profit Providers are a Sizable Source for HIV Testing in Africa Source: Most recent Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS)
- 13. Even Higher Reliance on Private Health Sector for STI Care Source: Most recent Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS)
- 14. Private Healthcare Market in Africa Expected to Double by 2016 40,000 Actual Projections $35B 35,000 30,000 25,000 Private 20,000 $13.5B Health expenditures 15,000 Total health expenditures 10,000 5,000 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 ($ million) Actual values for 1996 – 2005; projections for 2005 – onward Source: IFC Report, 2007
- 15. Moving from Service Delivery to HRH: The Private Sector Role in Medical Education
- 16. Private Sector Actors in Each Building Block of the Health System Source: Arur A. et al. 2010. Strengthening Health Systems by Engaging the Private Health Sector: Promising HIV/AIDS Partnerships. SHOPS Project, Abt Associates.
- 17. Setting the Stage • Globally, the share of total enrollment in private tertiary education in 30 percent • Asia is the region with the highest level of private tertiary enrollment (e.g., Philippines at 75 percent) • Growth in private medical tertiary education in Africa in the context of stronger emphasis for pre- service education
- 18. Greater Linkages with the Public Sector in the Education Sphere • Partnerships between the public and private sectors are more of a norm in medical education than in service delivery • Few purely private models of private education→ high interdependence • Public-private partnership (PPP) in medical education is a formal collaboration with any level of government and the private sector to jointly regulate, finance or deliver medical education
- 19. Public and Private Actors in Medical Education PUBLIC PRIVATE • Ministries of Health and • For-profit or not-for-profit Education Universities, Teaching • Professional Councils Hospitals, and Training • Public Universities and Institutes (PMTI) Training Institutes • Associations of Private • Public Teaching Hospitals Training Institutes • Research Organizations • Management Consultancies
- 20. The Public/Private Mix in Medical Education Ownership / Delivery PUBLIC PRIVATE Traditional Private institutions that receive public government support PUBLIC institutions - Contracting out - Subsidized or - Targeted vouchers no tuition - Tax incentives fees - Transfer payments or subsidized loans Financing Public Independent private institutions (for- institutions profit and not-for profit) with private - Tuition fees PRIVATE cost-sharing - Student loans - Tuition fees - Private contributions, equity or debt - Student loans - Private contributions
- 21. Types of PPPs in Medical Education • Contractual or “contracting out” • Legal requirements or tax incentives • Supply-side subsidies • Demand-side subsidies • Sale of public assets • Voluntary or philanthropic partnerships • Medical education franchising
- 22. Some Emerging Lessons • PPPs in medical education are nascent compared to service delivery • Growth of PMTI is a precursor to PPPs→ many barriers to the growth of PMTI in Africa still exist • Effective student loan initiatives require the sharing of risk between public and private stakeholders and can benefit from innovative PPPs • Major gaps in the adequate flow of information from the private education market to consumers
- 23. Ilana Ron Levey ilana_ron@abtassoc.com www.shopsproject.org SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting
- 24. Wrapping It All Up • There is significant potential for the growth of private medical education and PPPs • However, there are major challenges- particularly around financial and business issues- facing private medical education • Other issues around private medical education including quality of instruction; accreditation systems; and regulatory environment differ across Africa→ hard to generalize • Often need to dig deep to the institution-level to truly understand the landscape
- 25. Eager to Hear from the Audience • What are the main challenges in private medical education in your country? • Do you think the private sector has been adequately incorporated into human resources for health efforts? Why or why not?
Editor's Notes
- Important observations:Most important source of health finances in Africa are individuals who pay out of pocketMOH funds are heavily dependent on donor funds to meet their budgetsIt is interesting to note that in OECD countries, public sector is the most important source of health finance NOT the private insurance or out of pocket spending by individuals
- Let’s turn our attention to the different components of a health system and the range of private sector actors. This is diagram – which is on the wall as a reference as well as a handout in your packet – is based on the WHO six building blocks. The six building blocks are in the middle green circle. They include governance; information; financing; human resources and medicine and technology.The outer blue ring illustrates the breadth and scope of private sector providers. Private sector is a cross–cutting theme in each of health system building blocksLIST A FEW BY BUILDING BLOCKAs you can note, there are a diverse range of private sector actors beyond private healthcare providers. As mentioned before, the diversity presents a challenge for public sector because the private health sector is often fragmented and not “organized”. The breadth of private sector actors also presents an opportunity, offering a greater range of PPP possibilities that can strengthen the health system. Another important observation is that many of the same private health sector actors are present in multiple building blocks. This signifies that when the public sector can effectively work with the private sector partners it not only helps strengthen one building block but in most cases, several health systems.
- ContractualGovernments contract with private operators to manage public training institutionsLegal requirements or tax incentives Governments require private educational institutions to provide scholarships to low income students, or provide tax breaks to encourage greater public benefit Supply-side subsidies Governments subsidize the establishment or operations of private educational institutionsDemand-side subsidies Governments finance vouchers, scholarships or loans for students to enroll in private institutions Sale of public assets Governments allow the private sector to purchase part or all of a public university’s assets and manage its operationsVoluntary or philanthropic partnershipsThe private sector makes financial, intellectual or in-kind contributions to build capacity and support operations of public medical training institutions