May 11th 2006 Meeting Summary
PSP-One's third Network Exchange explored various partnerships between private provider networks and professional associations. Eleven private sector professionals participated in the event. Two health networks, the Biruh Tesfa social franchise in Ethiopia and the Sun Quality franchise in Myanmar, presented their experiences in partnering with local professional associations as a way to transfer responsibility and ensure the sustainability of the network (Ethiopia), and to improve the quality of service delivery among private practitioners (Myanmar).
Representatives from professional associations in both countries also shared their rationale and objectives in partnering with a private health network. Network implementers and health care practitioners from Nigeria, Kenya, and the United States joined the phone conference for a discussion on the different objectives of these partnerships, taking into consideration the country environment and development of the private sector.
Main highlights of presentations
(Detailed summaries of both countries are also available)
In Ethiopia, the Biruh Tesfa social franchise entered into a partnership with the Medical Association of Physicians in the Private Practice in Ethiopia (MAPPP-E) with the objective to transition the role of franchisor from Pathfinder International to the association. MAPPP-E was established in 2003, and currently has 80 members. The association began partnering with Pathfinder/Biruh Tesfa in 2005, playing an increasing role in ensuring that franchised providers maintain quality standards, leading advocacy efforts and improving public trust and perception of private health providers. Although the long-term goal is for MAPPP-E to become financially sustainable and take over the Biruh Tesfa network, the association is currently supported by a grant from SIDA. Next steps for MAPPP-E include developing a strategic plan and positioning the association to legally act as the parent organization for the Biruh Tesfa network.
The partnership between the Sun Quality Health network in Myanmar and the Myanmar Medical Association was initiated to support the clinical capacity of providers in the network. It primary objective is to improve the quality of services and upgrade the skills of private providers towards institutionalizing better health practices among participating providers. Unlike the Ethiopian partnership, while Sun Quality and MMA have agreed to work together on common objectives, they have no immediate objective of transferring the management role of franchisor to the association.
Summary of questions and responses
1) What mechanisms are in place to assure quality? Are there specific protocols used? Is there data to support improvements in quality?
The Sun Quality network monitors its providers on a monthly basis and PSI is responsible for collecting data on health outcomes and quality of care. Providers sign a contract to enter the network and agree to adhere to specific quality guidelines. The network expels providers who do not comply. Approximately 5% of franchised providers have been dismissed for lack of compliance. The network has demonstrated improvement in key indicators of quality of care amongst participating providers.
The providers in the Biruh Tesfa network are monitored jointly by Pathfinder/MAPPP-E through regular site visits and training sessions. The network uses its own quality assurance protocol/checklist that is adapted from a Pathfinder tool and tailored to the providers in the network.
2) Because the Biruh Tesfa network includes lower level (i.e. non-physician) providers, has there been any opposition to physician association taking over as franchisor?
So far this has not been a problem, but it may be something MAPPP-E will have to be sensitive to as their role increases.
3) How does MAPPP-E sustain itself?
MAPPP-E currently operates with 7 physician volunteers and 3 paid support staff, supported by a grant from SIDA. Although members pays dues, the amount of funding this generates is not substantial. The association plans to go through a strategic planning process to identify ways to generate more income and increase their financial sustainability. Potential activities to accomplish this include: increasing membership and therefore revenues generated from dues, hosting an annual conference, leveraging partnerships with both private (e.g. pharmaceutical companies) and public sector, and potentially procuring products and supplies for franchisees.
4) Is financial sustainability an objective of the Sun Quality network, or of their partnership with the MMA?
Sun Quality focuses on improving and ensuring the quality of services provided by its franchised providers. Quality is monitored through monthly site visits, which is costly, and affects the cost recovery rate of the franchisor. The network has diversified its donor funding, expanding its package of franchised services in response to donor interests (e.g. TB, malaria). MMA views itself as primarily an academic organization, with a mission to improve the capacity and service quality of private doctors. The partnership between Sun Quality and MMA specifically addresses improving access to high quality services for low income clients, which is at odds with attaining financial sustainability.
Looking forward and next steps
While the respective private health sectors in Myanmar and Ethiopia are developing and the policy environments are increasingly favorable for such growth, there are still challenges to network sustainability, particularly if the objectives are to serve the poor. It was suggested that partnering with professional associations may be one way for private health networks to garner support from government Ministries of Health, perhaps through accreditation and contracting.
Network implementers expressed continuing interest in learning from each other about effective approaches to achieve sustainability and health objectives (as well as learning what has not worked). PSP-One will support this by continuing to hold Network Exchanges on topics of interest to network and franchise implementers. Please let us know what topics you would like more information on, and tell us about any innovative practices you come across.
List of Participants
Case Studies
Case Study of Biruh Tefsa and MAPPP-EthiopiaCase Study of Sun Quality Network and Myanmar Medical Association
