Global Public Private Mix Recommendation
- 1. Global Strategies, Guidelines and Recommendation for Public Private Mix/Partnership PPM guideline development, 24 August 2023 1
- 2. The Private Sectors Engagement and Universal Health Coverage 2
- 3. Private Sectors The private health sector is the individuals and organizations that are neither owned nor directly controlled by governments and are involved in provision of health services. It can be classified into subcategories as for profit and not for profit, formal and informal, domestic and international. Characteristics of the private health sector. The private health sector has different characteristics. Common characteristics include: • Ownership. The private health sector works outside the public health sector and outside the direct control of the state. They are nonstate actors who are not owned or controlled by governments but instead owned by individuals, families, or corporations. • Motive. The aim of the private health sector may be philanthropic or commercial and comprises of for profit and not-for-profit entities. The not-for profit organizations further include faith-based organizations (FBOs), non- governmental organizations (NGOs) as well as civil society organizations (CSOs). • Training. Based on the training that the service providers receive, the private health sector may include formally trained providers (pharmacists, doctors, nurses, and midwives) or informally trained providers (traditional healers, ayurvedic medicine, etc.). Many countries rely heavily on informal providers, and they tend to constitute a large group. For health interventions to be successful, it is important to understand and acknowledge their role within the health system. • Geography. The scope of a private organization can either be domestic or international based on the extent of population that it covers.
- 4. Private Sectors • Defining private health sector necessitates a clear understanding of the concept of service delivery, types of private health actors and characteristics of the private health sector. • As one of the WHO health-system building blocks, service delivery involves provision of effective, safe, good quality personal and non-personal care to those that need it, when needed, with minimum waste. These services may include prevention, treatment, or rehabilitation. • More ‘traditional’ forms of service delivery involving physical interaction between a patient/client and healthcare provider may now be accompanied by ‘virtual’ health services such as digital health and telemedicine. • In many LMIC contexts, there are a diverse range of service delivery actors. The range of health actors that may exist and fall within the private health sector (they also have public • sector forms) is broader than we expected before.
- 5. The landscape of the work has changed. UHC cannot be achieved without the private sector. It is essential to re-frame public and private sector engagement as a partnership in health for shared health outcomes Peter Salama, former Executive Director of Universal Health Coverage, World Health Organization Universal health coverage means that all people are able to receive needed health services of sufficient quality to be effective, without fear that the use of those services will expose them to financial hardship. Universal health coverage comprises a set of objectives – equity in access to health services, quality and financial protection.
- 7. Six governance behaviors critical to private sector health service delivery governance: 1. Build understanding: Collection and analysis of data to align priorities for action. 2. Foster relations: Working together to achieve shared objectives in a new way of doing business. 3. Enable stakeholders: Institutional framework that empowers actors. 4. Align structures: Organizational structures to align with policy objectives. 5. Nurture trust: Mutual trust amongst all actors as reliable participants. 6. Deliver strategy: Agreed sense of direction and articulation of roles and responsibilities. WHO recommendation for a new way of doing business for health system governance
- 8. Theory of change for new ways of doing governance envisions a system that aligns the heterogeneous private sector service delivery to public sector service delivery. The governance behaviors operate with traditional tools of government: 1. Economic regulations such as business licensing, market entry, price floors/ceiling, import restrictions, capital rates, tax relief, certificate of need, subsidized credit/loan, and guarantees; 2. Social regulations such as facility and human resource licensing and quality assurance / accreditation; 3. Patient information such as raising awareness on quality, informing patients of their rights, publishing permitted prices; 4. Supply-side financing such as clinical/support service contracts, non-clinical service contracts, outsourcing contracts, direct grants and/or subsidized inputs for specific services, transactional PPPs; 5. Demand-side financing such as health insurance, vouchers/insurance combined with service contracts.
- 9. Private sectors engagement • Private sector engagement in global heath started with private sector participation in large vertical health programs. These later evolved into broader based “market shaping” interventions. • Private sector engagement is the meaningful inclusion of private providers for service delivery in mixed health systems. • It requires that governments focus on governance of the whole health system – both private and public – to ensure quality of care and financial protection for patients, irrespective of where they seek care. • It requires that the private sector aligns with public sector health goals and commits to working to support the government agenda. This strategy report focuses on private health sector service delivery.
- 11. The Global PPM Guidance Documents
- 12. Implementing PPM for TB control involves the following main steps: • National situation assessment • Creating national resources • Developing operational guidelines • Local implementation • Scaling up
- 13. • Stewardship and key functions of NTP include provision of funds, supply of drugs and other materials and quality assurance. The NTP should constitute a local task force, coalition or coordination committee. It should have representatives of relevant stakeholders. • This body can act as an interface between NTP and other providers. It may also advise NTP in carrying out various tasks such as advocacy, sensitization, training, supervision, quality control, monitoring and evaluation. • In some settings, the issue of diagnosis of smear- and culture- negative forms of TB has been effectively addressed by establishing diagnostic committees comprising relevant local experts. PPM Stewardships and PPM Task Mix
- 14. The Global PPM Guidance Documents • Step 0. Preparing Documents and Gap Analysis • Step 1. Sensitization - Socialization Meeting • Step 2. Meeting with the Board of Directors of the Institution • Step 3. Workshop for Selecting Improvement Opportunities • Step 4. Signing the Collaborative Agreement • Step 5. Formulating the Monitoring Plan • Step 6. Evaluating Results • Step 7. Recognizing Performance
- 15. The Global PPM Guidance Documents 14 Tools of PPM Interventions: 1. Rationale and generic approach 2. National situation assessment 3. Operational guidelines 4. Advocacy, communication and social mobilization 5. Monitoring and evaluation 6. International Standards for Tuberculosis care 7. Resources and budgeting 8. Engaging private practitioners 9. Engaging hospitals 10. Engaging nongovernmental organizations 11. Engaging workplaces 12. Engaging social security organizations 13. Engagement for TB/HIV collaboration 14. Engagement for programmatic management of drug-resistant TB
- 16. • Enhanced quality of diagnosis, treatment and patient support PPM can reduce malpractice by fostering evidence-based TB diagnosis and treatment in line with the ISTC. This improves cure rates and reduces risks of drug resistance. It also limits misdiagnosis of TB and, unnecessary and often costly treatment. • Increased case detection and reduced diagnostic delays PPM can help increase TB case detection and reduce diagnostic delays by involving all health care providers in timely referral and diagnosis of TB. This also helps cut the chain of transmission at an early stage. • Improved and equitable access PPM can improve access to treatment and help overcome barriers such as stigma, by involving health care providers from whom the poor, marginalized and most vulnerable seek care. • Reduced cost of care and financial protection for the poor PPM reduces costs to patients by ensuring that treatment for TB is free of charge and all other costs are kept to a minimum. PPM can also reduce indirect costs for patients by providing services closer to their homes or workplace. • Ensured gathering of essential epidemiological data PPM contributes towards completeness of epidemiological surveillance on TB when all care providers who diagnose and treat TB follow proper TB recording and reporting routines linked to national information systems. • Improved management capacity PPM improves management capacity of both the public and the private sector, and can contribute to health systems strengthening in general. PPM contribution to public health
- 17. Generic PPM Model and Approach Main Steps: 1. A national situation assessment 2. Creating national resources for PPM 3. Developing national operational guidelines on PPM 4. Local implementation 5. Supervision and monitoring
- 18. ACSM of PPM
- 20. The Global PPM Guidance Documents 10 key actions are required to scale up the engagement of all care providers towards universal access to care. NTPs and their partners, in collaboration with the private sector
- 23. The Global PPM Guidance Documents Summary: 1. Private sector engagement needs to be urgently expanded to reach End TB targets. 2. Moving from Policy to Practice: We know how to do it 3. Strengthening private provider engagement: What more is needed 4. Emerging opportunities for increased engagement 5. A call to action: taking engagement of private providers to scale As countries move towards Universal Health Coverage (UHC) and towards reaching the TB-related targets in the Sustainable Development Goals and End TB Strategy, they need to harness the full potential of private providers. TB programmes can be pioneers in this area by accelerating the strategic engagement of private health care providers. Access to essential TB services across both the public and private sectors should be ensured especially in emergencies such as the COVID-19 pandemic.
- 26. Non-NTP drugs in private sales
- 27. Constraints to private provider engagement for TB
- 28. INTERVENTIONS TO ENCOURAGE PRIVATE PROVIDER ENGAGEMENT AT THE SYSTEM LEVEL
- 30. Potential Performance Indicators for Private Provider Engagement
- 31. Potential Performance Indicators for Private Provider Engagement
- 32. The Global PPM Guidance Documents
- 33. The Global PPM Guidance Documents
- 34. The Global PPM Guidance Documents
- 35. Another PPM Guidance documents available
- 36. Thank you More information on TB: https://www.who.int/health- topics/tuberculosis#tab=tab_1