private health sector role and potential for partnership medhealth 2014 cairo, 12 – 13 march 1
TRANSCRIPT
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Private Health Sector
Role and Potential for Partnership
Private Health Sector
Role and Potential for Partnership
MEDHEALTH 2014
Cairo, 12 – 13 March
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• Why assessment of private sector?
• Analysis of private health sector.
• Current status in EMR countries.
• Conclusion and next steps.
AGENDAAGENDA
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Analysis of Private Health Sector: MethodologyAnalysis of Private Health Sector: Methodology
Analysis follows health systems approach – financing, delivery, workforce, technology, governance
Data collected in two phases:– Phase One [2007-10]:
• Assessment of private health sector in 12 counties
– Phase Two [2012 - 13]:
• Review of published reports, ministry of health records and grey literature from EMR countries
• Studies on private sector regulations
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Private Health Sector: DefinitionPrivate Health Sector: Definition
Private sector includes all actors outside of government including for-profit, non-profit, formal and non-formal entities
[World Bank, 2008]
All formal service providers working for profit and/or not-for-profit (e.g. nongovernmental organization). Focus on for-profit sector
[Definition used for the study]
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Free market ideology driven generally towards privatization;
Growth of private sector driven by market demands leading to a public private mix;
Traditional role of state wherein public sector has control and limited interaction with private sector.
Trends in Privatization Policies
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Group1Group 2Group 3
Djibouti
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Private Health Sector in EMR Countries: Preliminary Results
Private Health Sector in EMR Countries: Preliminary Results
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(I) Service Provision: Primary care facilities and hospital beds(I) Service Provision: Primary care facilities and hospital beds
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Countries Primary care facilities [includes GP clinics]
Hospital Beds
Estimated number[range]
Percent in private sector
(%)
Estimated number[range]
Percent in private sector
(%)
Group 1203 – 2401
15 - 892086 – 61,036
6 - 26
Group 2880 –
56,4215 - 82
6357 – 131,555
7 - 83
Group 369 –
79,59119 - 92
469 – 128,137
8 - 22
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(I) Service Provision: Pharmacies, laboratories and diagnostic facilities (I) Service Provision: Pharmacies, laboratories and diagnostic facilities
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Countries Pharmacies Laboratories and diagnostic Facilities
Estimated number[range]
Percent in private sector (%)
Estimated number[range]
Percent in private sector
(%)
Group 1 111 – 6,022
27 – 93 51 - 246 43- 89
Group 2 821 – 63,374
58 – 99 1204 – 8,083
52 - 92
Group 3 59 – 55,000
22 - 98 23 – 4,000 22 - 60
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(I) Service Provision: Use of primary care services, private and public providers(I) Service Provision: Use of primary care services, private and public providers
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Public Private Public Private Public Private Public PrivatePakistan Egypt Morocco Jordan
0
10
20
30
40
50
60
70
80
90
100
Poorest Middle Richest
Per
cent
Source: Demographic and Health Surveys
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(II) Workforce: Private and Public Health Workforce (II) Workforce: Private and Public Health Workforce
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Country Groups*
Private sector workforce
[Per 10,000 population]
Public sector workforce [per 10,000 population]
Physicians Nurses Physicians Nurses
Group 1 4 – 16 5 – 38 2 – 20 5 – 44
Group 2 3 –33 9 –20 4 – 20 6 – 33
Group 3 0.1 – 19 0.3 – 6 0.1 – 8 0.4 –7
* Private sector workforce data not available for Group 1 – Qatar; Group 2 – Egypt, Iran, Iraq, Libya, Syria, Tunisia; Group 3 – Afghanistan; Sudan, South Sudan;
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Duality of practice between public and private sectors
Concentration of private workforce in urban areas
Unregulated expansion, lack of accreditation programs for health professionals’ education
Limited data on workforce distribution, salary structure and multiple job holding
Inadequate coordination between MOH and MOHE to plan for public and private sectors
(II) Workforce: Private Health Workforce – Issues and Challenges
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(III) Health Finance: Private Health Sector Expenditure in EMR Countries, 2011(III) Health Finance: Private Health Sector Expenditure in EMR Countries, 2011
Group THE per Capita
US$
PHE[% of THE]
OOP [% of THE]
OOP [% of PHE]
Group 1 991 27.0% 16.7% 61.9%
Group 2 245 52.0% 49.1% 94.4%
Group 3 49 74.3% 69.0% 92.8%
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THE – Total Health Expenditure; PHE – Private Heath Expenditure; OOP – Out of Pocket Payment
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Huge investments in high-tech imaging technology, motived by medical tourism
Irrational use of biomedical devices and technologies leading to high OOP payment
Weak medicine regulatory system and poor enforcement
Availability of core medicines lower in public compared to private facilities
Non prescription sale of antibiotics in private pharmacies (antimicrobial resistance)
(IV) Essential Medicine and Technology
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(V) Governance
Regulations governing PHS need
updating
Policies for engagement between public and private sectors are evolving in most
countries
Limited MOH technical capacity
to formulate policies and fulfill
regulatory responsibility
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Conclusion and Next Steps
Preliminary review of private health sector based on systems approach
Significant gaps in information that need to be plugged
Priority areas that need particular attention are:o MOH regulatory capacityo Partnership with private health sectoro Reduce OOP payment incurred in private sectoro Improve the quality of care
Develop regional strategy that supports countries to engage with private sector for public health goals
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Thank you