Policy

1. Restructuring incentives to induce greater private sector participation.

The private sector, especially the commercial sector, responds to market conditions, profit opportunities, and perceived risk and losses. PSP-One identifies incentives that encourage both commercial and nongovernmental organizations (NGOs) to enter the marketplace, work toward implementing health policy changes that minimize risk, and generate new prospects for profits. PSP-One works with the public sector to encourage reforms that influence pricing and market size and demonstrate to the private sector that favorable market conditions exist.

PSP-One analyzed how Indonesia successfully shifted market share from predominant reliance on the public sector to the private sector. The Indonesian case study examined the policies and programs implemented by the BKKBN to incentivize the private sector to enter the RH/FP marketplace and provided lessons learned for other countries exploring strategies to stimulate greater private sector provision of RH/FP services and products. In addition, PSP-One is exploring creative market mechanisms--such as contracting out and vouchers—to expand private sector market share and increase access to private sector services among lower-income groups in FP/RH and HIV/AIDS services.

Creative market mechanisms--such as contracting out, insurance schemes and vouchers--help expand private sector market share and increase access to private sector services among lower-income groups in FP/RH and HIV/AIDS services. In the area of vouchers, PSP-One, along with the Government of India/Ministry of Health Family Welfare (MOHFW), the German Development Bank (KfW), USAID/India, Packard Foundation, sponsored a two-day workshop that provided a forum to share experiences with voucher programs in health. The working addressed lessons learned and gaps in knowledge to provide policy makers and program managers with the tools to assess the need for feasibility of voucher schemes as well as their design and implementation.

In Nigeria, PSP-One's work focuses on addressing two needs pf private under the new National Health Insurance Scheme: (1) learning how to manage their practices differently with more clients under a fixed monthly capitation fee and (2) providing them technical updates in key preventive care areas of family wellness-FP, malaria, nutrition and routine immunization. PSP-One is partnering with one of Nigeria's leading HMOs, Total Health Trust (THT). With financial and technical support from PSP-One, THT is conducting a series of workshops for their providers to teach managed care and Society for Family Health (SFH), a local social marketing NGO, is responsible for teaching the family wellness health modules.

2. Facilitating a shared vision between the public and private sectors on common goals and respective roles in RH/FP markets.

It is not enough simply to invite the private sector to the table. Experience demonstrates that it is essential to incorporate the concerns of both the public and private sectors into the dialogue and analytic process in order to inform decisions and prompt action and commitment from both sides. Although much has been written about successful strategies to foster effective collaboration between the public and private sectors, PSP-One focuses on the private sector. The commercial sector requires a different approach for involving the private sector that reflects that sector’s mentality, language, and business approach.

PSP-One has successfully launched to country programs to facilitate dialogue and collaboration between the public and private sector. In Ethiopia, PSP-One is assisting the Minister of Health in activities that will create greater interaction between key stakeholders in health. The resident PSP-One policy adviser is assisting the Minister of Health and his staff to establish a working group with representatives from all sectors – NGO, commercial for-profit and faith based non-profits, to explore private sector opportunities in HIV/AIDS. Additionally, PSP-One is helping build capacity of the newly formed Public-Private Partnership Unit created within the Ministry of Health to guide the MOH’s efforts with the private sector. Technical assistance has focused on drafting the PPP Unit’s terms of reference and creating the policy framework for private sector provision of HIV/AIDS services.

In Guatemala, the PSP-One Policy Adviser has brokered an MOU between the Medical Association of Private Physicians and the PSP-One project to create awareness on the growing HIV/AIDS problem in Guatemala and to train private physicians to offer quality counseling and testing services. Also, PSP-One has created the National Commission on HIV/AIDS with active leadership from 8 professional associations representing private health sector and the Ministry of Health’s HIV/AIDS Unit. Together, they are tackling such challenging issues as how to improve private sector knowledge and use of MOH norms in VCT, how to create non-burdensome systems for private providers to report HIV/AIDS cases, and strengthen referral system between private and public systems.

Using these and other country examples, PSP-One will document several examples of public/private dialogue to determine what activities, approaches, factors, and conditions contributed to a successful collaboration, resulting in guiding principles to help structure future program design in public/private interactions.

3. Removing legal and regulatory barriers to private sector entry and sustained presence in the RH/FP marketplace.

A host of legal, regulatory, and other policy barriers encourage and/or discourage private sector participation in the RH/FP marketplace. The private sector is primarily concerned about two issues: getting the public sector out of the way and getting the price right. PSP-One offers a comprehensive approach that not only looks at legal and regulatory barriers but also assesses attitudes and practices that influence private sector involvement. This approach strives for better appreciation of market conditions from a private sector perspective while maintaining full appreciation of the public sector’s role.

PSP-One's legal and regulatory work has focuses on three areas:

1. Articulating the legal and regulatory issues that can impede private sector participation in health. PSP-One developed an comprehensive manual on legal/regulatory barriers entitled Navigating Unchartered Waters: A Guide to the Legal and Regulatory Environment for Family Planning Services in the Private Sector, and a policy brief explaining the importance of policy assessment called Why Policy Matters: Regulatory Barriers to Better Primary Care in Africa - Two Private Sector Examples in Africa.

2. Identifying policy issues in country program design to identify potential pitfalls to implementation. PSP-One has carried out several private sector assessments in different country settings that include discussions on the policy barriers and opportunities for the private health sector (please refer to the resources center for the country assessments in Azerbaijan, Ethiopia, Guatemala, Kazakhstan, Kyrgyzstan, Nigeria, Romania, Ukraine, Zambia). The policy sections in these assessments identify opportunities as well as constraints to any private sector programming and make recommendations how to address these challenges.

3. Supporting public sector capacity to “steward” the private health sector. PSP-One has conducted several evaluations of the policy conditions and legal/regulatory frameworks in multiple countries and to complement this knowledge, will review the experience of countries with vibrant private health sectors to develop a standard and “model” policy environment to create an enabling environment. In addition, the PSP-One project has formed a network of 8 African Ministry of Health Public-Private Partnership Units to help strengthen their stewardship role of the private health sector. PSP-One is conducting several workshops in different policy instruments available to MOHs and is providing targeted assistance to each of the PPP Units to help them create a policy framework and implement some of these policy mechanisms.

PSP-One Technical Area Leader: