Role of Private Sector in Reaching Marginal Populations
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Transcript of Role of Private Sector in Reaching Marginal Populations
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ROLE OF PRIVATE SECTOR INREACHING MARGINAL
POPULATIONS
Josef Tayag, USAID
January 29, 2017
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MARGINAL POPULATIONS AREDIVERSE
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PRIVATE PROVIDERS AREEQUALLY DIVERSE
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PRIVATE SECTOR IS ANIMPORTANT SOURCE
45%
44%
28%
55%
56%
72%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Asia
Latin America
Sub-Saharan Africa
Modern contraception users who obtained method from privatesector (%)
Private
Public
Source: SHOPS analysis of DHS data 2005-2012
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EVEN FOR THE POORUse of private providers for modern family planning methods bytwo lowest-income quintiles (%)
Source: SHOPS analysis of DHS data 2005-2012
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AND YOUTH
Source: SHOPS analysis of DHS data 2005-2012
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AND PEOPLE SEEKING HIVSERVICES
Source: SHOPS analysis of DHS data 2005-2011
0%
10%
20%
30%
40%
50%
60%
70%
Private Source of HIV Testing by Gender (2005-2011)
Women
Men
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AND CARE FOR CHILDHOODDIARRHEA AND PNEUMONIA
Source: Montagu, D and A Viconti. 2010. Analysis of multi-country DHS data. www.ps4h.org/globalhealthdata.html
79%
66%
51%
34%
21%
34%
49%
66%
0% 20% 40% 60% 80% 100%
South Asia
SE Asia
Sub-Saharan Africa
Latin America & Caribbean
Private
Public
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IMPROVE ACCESS TO CARE,BUT…
• Private providers are least likely toparticipate in national health financingschemes.
• Challenges:
– Donor crowding out
– Unorganized, limited voice, visibility
– Range of qualifications, quality
– Accreditation requirements
– Payment mechanisms and rates
– Administrative burden
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Crucial question:
HOW should health financingprograms engage the full range ofprivate providers?
INTEGRATINGPRIVATE PROVIDERSINTO UHC
VOUCHERS:A POWERFULDEMAND-SIDE SUBSIDY TOTARGETYOUTH
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• 2015 HIP Brief identifies several benefits from voucher programs:
– Improve targeting of subsidies
– Support movement toward UHC
– Increase access to and improve quality of services
– Increase accountability and reduce fraud
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BENEFITS OFVOUCHER PROGRAMS
Source: High-Impact Practices in Family Planning. Vouchers: addressing inequities in access to contraceptive services. 2015 Jan
HOWVOUCHER PROGRAMS WORK
Funding source(government or donor)
Voucher management agency
Distributor
Targeted client
Participating provider
Source: Adapted from World Bank “A Guide to CompetitiveVouchers” 2005.
Four key elements:
• Population
• Benefits
• Price
• Awareness
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GETTINGVOUCHERS RIGHT
• Marie Stopes International operates BlueStar social franchise inMadagascar
• 2011: New voucher program to increase access to voluntary FPcounseling and services
• Low use by youth development of youth-targeted voucher
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IMPLEMENTING AVOUCHER PROGRAM INMADAGASCAR
Source: MSI SIFPO project report “Increasing access to voluntary family planning and STI services for young people”
MARIE STOPES MADAGASCAR MODEL
USAID and UNFPA
Marie Stopes Madagascar
Youth community healtheducators
Youth (ages 15-19) in 6 projectregions
BlueStar clinics
Source: Adapted from World Bank “A Guide to CompetitiveVouchers” 2005.
PROGRAM SUCCESS IN REACHINGYOUTH
Implant removal1% IUD removal
0%
STI counseling33%
FP counseling1%
Short-term FP
13%
Implant insertion39%
IUDinsertion
13%
Services redeemed
July 2013 and December 2014:
• 58,417 vouchers distributed
• 43,352 redeemed (74% redemption rate)
YOUTH-FRIENDLY, USER-CENTERED1. Modules for communicating effectively with youth and better
understanding their SRH needs;
2. Targeted mobilization schools and youth associations
3. Trained BlueStar franchisees on youth-friendly services and workoutside of facility
4. Covered range of FP methods, including counseling, short-actingmethods, LARCs (insertion and removal), and STI screening/counseling
5. Included mobile and paper voucher options—mobile to appeal to youthand paper to reach 80% of target population who did not have mobilephone/limited connectivity