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Findings from the Private Health
Sector in West Africa: A Six-country
Macro-level Assessment
Bettina Brunner
Regional Manager, Francophone Africa, SHOPS
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
West Africa Macro PSAs and mHealth Scan
• Macro-level private health
sector assessments in six
countries to explore
opportunities for USAID’s
flagship family planning
(AGIR-PF) and HIV and
AIDS (PACTE-VIH)
projects
• mHealth landscape of 17
countries to identify
regional opportunities for
public-private mhealth
partnerships
Benin, Burkina Faso, Cameroon, Cape Verde, Gambia, Ghana, Guinea, Guinea Bissau,
Cote d’Ivoire, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo
Macro-Level Private Sector Assessment
5 components
Legal and
regulatory review
Recommendations
for partnerships
Role of the private
sector
Public private
partnerships (PPP)
& CSR
Key NGOs and
FBOs
Timeline
Cameroon
Niger
Dec.
8-17,
2013
Jan.
11-19,
2014
Côte
d’Ivoire
Togo
Jan.
13-17
Mar.
17-21,
2014
Feb.
1-10,
2014
Country Visit
Mauritania
Mar.
1-10,
2014
Event
Burkina
Faso
Feb. 22 Mar. 2,
2014
Ghana
Implementing
Partners
Meeting
Mar.
19-20,
2014
Final report publication
Ghana
Dissemination
Event
May
20-21,
2014
May
2014
Methodology
1. Plan




Draft scope of work
Select assessment team
Engage stakeholders
Finalize scope of work
2. Learn
 Desk review
 Prepare field survey
instruments
 Fieldwork
 Debrief key stakeholders
3. Analyze
 Analyze data
 Formulate recommendations
 Draft report
4. Share
 Disseminate draft report
• Validate and prioritize
recommendations
• Finalize the report
Health Stakeholders Interviewed
Commercial private
sector

Health care providers
Nonprofit private
sector

(e.g., doctors, nurses,
midwives)

Health care facilities



Health insurance

Diagnostic services
(e.g., laboratories)

Multinational
companies (e.g.,
mining companies)
Professional and
medical associations

Civil society
organizations
companies

Faith-based
organizations
Pharmaceutical
distributors

health care delivery
(e.g., hospitals,
clinics, pharmacies)
NGOs engaged in
Public sector

Business coalitions

Corporate social

Ministries of Health,
International
donors (e.g.,
Works, Investment
foundations,
Promotion
foreign national
Departments,
governments)
Professional councils

Public hospitals

Central medical stores

Government
commissions on HIV
and AIDS


Finance, Public
and regulatory boards
responsibility NGOs
Development
partners
Government health
dialogue platforms

Multilateral
organizations (e.g.,
UN, WHO, World
Bank)
Key Motors for Change in West Africa
• Regional program in RH & HIV •
with KfW
•
• Diagnostic survey of private
health sector
•
• eHealth Strategy underway
• Six local manufacturers identified •
for local production of ARVs
• Assistance to 5 laboratories to
provide quality control
1 million new FP users by 2015
“De-medicalize, de-centralize,
democratize”
Engagement of countries in
collaboration with donors
Relaunch of FP strategies in all
USAID West Africa focus
countries except Cameroon
FP and HIV in Six Focus Countries
• Extremely low contraceptive
prevalence rate coupled with high total
fertility rate
• Provision of FP & ART by private forprofit providers varies by country
• Pharmacies are major source of FP
products
• Strong stigma against PLHIV and
MSMs in most countries
• Service delivery highly concentrated in
urban areas
• Contraceptive security committees not
operationalized
Public Private Dialogue
• Strong public sector dialogue with
NGOs and FBOs in FP and HIV
service delivery
• Poor engagement with private for-profit
sector
• Dialogue mechanisms exist but not
operationalized
• Private sector not included in health
information systems
• Wide range of professional bodies but
poor interface with MOH
• Regulatory environment is weak
Corporate Social Responsibility
• Nascent local concept in West Africa
• Low presence of multinationals, except in
extractive industries, large-scale agriculture
• Company foundations active in HIV
• Main CSR actors: Private sector coalitions for
HIV, chambers of commerce, CSR associations,
patronat
Examples of CSR in West Africa
Potential Impact
Togo: Brasserie BB finances Espoir
Vie’s work with OVC
Mauritania: BMCI finances
STOPSIDA’s activities with fishermen
Community
Burkina & Cameroon: Total
Foundation finances activities of NGO
for HIV activities with truck drivers
Families
Regional: Training and outreach on
sexually transmitted diseases
Employees
PPPs and Partnerships
• Lots of contracting out with NGOs & FBOs, much
less with private for-profit sector
• Health PPP idea nascent in region
• No health PPP units among 6 focus countries
• No health PPP guidelines in health
• No private sector strategies in place (Burkina’s is
underway)
Burkina Faso
Private Health Structures, 2012
Type de Structure
Total
Clinic
40
Polyclinic
9
Medical Center
482
Hospital
0
Medical Office
17
Dental office
5
Nursing Facilities
179
Birthing Clinic
14
CPSP
36
Other
3
Total
361
Source: Burkina Faso
Ministry of Health 2013
Private Health Structures, 2012
Category
Total
Private for-profit
261
Association
37
Faith-based organization
54
NGO
9
Total
361
• Donor coordination committee and
coordinating meeting on contraceptives
meet irregularly
• APROCLIB is key private sector player
• WBG has strong public-private dialogue
program
Cote d’Ivoire
Health Facilities by Type, 2010
Type of Facility
Number Percent
Public sector health facilities, 2009–2010
Semi-public facilities and institutions
Public health sector administrative services, 2009–2010
Authorized private health facilities (2009)
Unauthorized private health facilities
1887
11
102
554
1482
Private faith- and community-based health facilities
Total
99
4135
45.63
0.27
2.47
13.40
35.84
2.39
100
Government of Cote d’Ivoire, 2013
Number of Sites Providing HIV and AIDS Services by Sector
(2010)
Type of Facility
Public
NGO
Communitybased
Private for-profit
Faith-based
Workplace
Total
CT
641
15
PMTCT
559
6
ART
387
5
Lab with CD4
106
10
63
4
25
19
767
31
2
20
11
629
33
4
27
12
468
8
2
7
5
138
Source: Barnes et al, 2013
• Private health facilities are
52% of total
• Of 2,036 private health
facilities, 73% were
unauthorized (2009)
• Growing manufacturing
sector (7), but only supply 4%
of market
• Over 800 pharmacies
• Strong professional
organizations: ACPCI,
SYNAMEPI
• Strong business coalitions
(CECI) COSCI
Cameroon
Cameroon Hospital Attendance, 2012
Public health
facilities
(District
hospitals, CMAs
& Health
centers)
Faith-Based
health facilities
(Hospitals &
health centers)
2,566,653
Private For Profit
health facilities
(Hospitals, clinics
& health centers)
1,755,109
5,003,710
681,948
Funding for HIV by Source, 2012
Source
Public funds
Private funds
International/donor
funds
Total
Amount (CFA)
6,837,745,597
4,215,189,546
19,435,236,055
Percent
22.4
13.8
63.7
30,488,171,198
100
• Of 4,351 health facilities
identified in 2011, 44% in
private sector
• 34% of health personnel active
in private sector
• PPP exists with Confederation
of Private Enterprises for
distribution of ARVs
• Coca Cola Africa Foundation
provides medical supplies to Ad
Luchem Foundation clinics
including malaria & HIV
medicines work over $15 million
• AFD has invested 22.8 Euros to
standardize and streamline the
contracting out process with the
MOH.
Mauritania
CPR, Any modern method,
by location
• Private for profit facilities in
Nouakchott & Nouadhibou
include:
•
•
•
•
•
15 medical & surgical facilities
47 medical consulting offices
15 primary health stations
118 pharmacies
280 shops selling pharma products
• Private sector Engagement
• No public private forum (FP Multisectoral working group doesn’t
include private for profit sector)
• Private for-profit poorly represented in
MCH and HIV, but private nonprofit
well integrated with public sector
Niger
Niger Private Health Sector
Number of private pharmacies in
Niamey
Number of private pharmacies
outside of Niamey
Total number of private
pharmacies in Niger
Number of private physicians,
pharmacists, and dental
surgeons registered with the
local regulatory body
85
17
Health PPPs in Niger
Private entity
AREVA
(commercial
corporation)
Public
entity
MOH/CILS
102
750
Estimated total number of private 900-1000
health providers in Niger
Estimated number of wholesalers 22
Private
providers
MOH
SIM (FBO)
MOH
Private
pharmacies
MOH
Major
commercial
businesses
MOH
Description
CILS provides support to AREVA to
procure ARVs and reactives for HIV
testing. AREVA provides all health services
to Arlit population for free. In Niamey,
AREVA subsidizes materials for several
laboratories.
Doctors at private clinics are contracted by
the government to test patients, after which
they are referred to CTAs.
SIM operates 2 hospitals in Maradi (Danja)
and Zinder (Galmi).
Through funding from the Global Fund, the
MOH heavily subsidizes malaria test kits in
public and private pharmacies across the
country.
Anecdotally, major private companies in
Niger have workplace health programs that
have PPPs with the MOH.
Togo
Togo Private Health Sector
Overview
Total number of private pharmacies in
Togo
Number of private pharmacies in
Lomé
180
Number of private pharmacies outside
of Lomé
18
Number of private physicians
registered with the local regulatory
body (in 2013)
Estimated total number of private
health providers in Togo
200
162
2000**
• 51% health-related spending
is out of pocket (2010 CARMMA)
• For profit private sector is
33% of total
• Platforms exist but not
functioning well: Comité de
Coordination du Secteur de
la Santé (CCSS), Groupe
Inter Bailleur Santé
Thank you
Bettina Brunner
[email protected]
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