Financing Quality Improvement in Private Healthcare Providers The East Africa Healthcare Federation Conference

Dar es Salaam, Tanzania February 27-28, 2013 1

What is PharmAccess?

Mission

“Improve access to quality basic health care including HIV/AIDS treatment and care in sub-Saharan Africa, through building sustainable health systems”

• • • •

Office and staff

Working in 10 African core countries PharmAccess is employing a multi-disciplinary team of 100+ experts, including medical specialists, laboratory technologists, public health specialists, (health) economists, anthropologists and entrepreneurs Head Office in Amsterdam, The Netherlands Branches offices in Namibia (Windhoek), Nigeria (Lagos), Tanzania (Dar es Salaam, Moshi), Kenya (Nairobi) and Ghana (Accra) 2

PharmAccess: a Group of Organizations Sharing a Common Goal

•

Healthcare Quality

•

Health Insurance

•

Health Provider Financing Loan provision Technical assistance

•

PPPs Program development Capacity building Technical Assistance Workplace Programs Consulting (PPP)

•

Operational Research Basic upgrading Capacity building Monitoring & evaluation Data collection Impact analysis Learning

3

Health Care in Africa Stuck in a Vicious Circle

• • •

African healthcare systems stuck in a vicious circle of low demand and supply Shortage of resources is the major impediment to quality of healthcare services Access to quality basic health care among the poor is low

Demand ↓

Solidarity

↑

Out-of-pocket expenses

↓

Access to health care

↓

Ownership

Financing Delivery

Low Low

Patient ↑

Catastrophic spending

↓

Utilization

Supply ↓

Quality and capacity

↓

Efficiency

↓

Availability data

↑

Risk for owners and investors

4

Breaking the Vicious Circle: Building Trust

-Premium subsidies -Education and

marketing Health Insurance Fund

-

Introducing health insurance Donors / governments (tax)

Demand ↑

Solidarity

↓

Out-of-pocket expenses

↑

Access to health care

↑

Ownership Prepayment (contribution) by users

Financing

Higher SafeCare

Delivery

Higher

Patient ↑

Increased willingness to pre-pay

↓

Decreased financial risk

- Upgrading and capacity

building

- Quality assurance - Certification and

accreditation Government (public)

Supply ↑ ↑ ↑ ↓ ↑

Quality Efficiency Availability of data Risk Investment opportunities Medical Credit Fund

5

“Financing Health Care Quality Improvement in Africa”

6

Investment Strategy: MCF works with local partners

MCF Access to Finance Program Quality (SafeCare) & Business TA Program Partnership local banks Partnership local TA partners Sub Sahara Private Healthcare providers

Access to Finance Program:

Business planning improvement, making healthcare providers bankable

    Business planning training Preparation of financial statements and business plan (local partner) Support with filing of loan application Track record building through local banks Entry loan Around EUR 2,500 Second Loan Around EUR 20,000 Third loan Around EUR 50,000 Over time, the local commercial bank relative exposure on the client increases 8

MCF – Results (December 2012)

Portfolio Performance • 232 loans disbursed since inception: USD 1,600,000 • Outstanding Loans USD 900,000 • PAR > 90 days: 1.7% TA Performance 274 173 146 197 Clinics formally entered the MCF Program Clinics completed business training Clinics completed quality training SafeCare assessments performed Partners • Tanzania: APHFTA, BancABC and NMB Bank • Ghana: SPMDP/GRMA and MBG Bank • Kenya: KMET and PSI Kenya, KREP Bank • Nigeria: Hygeia Foundation and FCMB Bank

SafeCare: International Standards and Stepwise Certification for Healthcare Facilities in Resource Restricted Settings

International Standards, Local Solutions

“Quality is not necessarily high-tech or high cost”

SafeCare allows for realistic, practical and achievable solutions in resource restricted settings

SafeCare - Quality Standards

SafeCare started in 2011, as a collaboration of:     Comprises of innovative and realistic standards for healthcare providers in resource-restricted settings, ISQua approved Linked to a step-wise improvement process recognized by certification that can be used by governments, donors, health insurers, (social) investors and loan providers for benchmarking and performance-based financing These certificates of recognition will eventually improve the reputation of these healthcare facilities Clients are expected to have increased trust provided in services

SafeCare - Activities & Results

      With PAI and partners: 35 local surveyors and facilitators trained With MOHSW Tanzania: MoU for TA to certify facilities With MCF: 59 APHFTA facilities surveyed, 4 certified in Tanzania With MCF: 112 facilities surveyed, 18 certified elsewhere With APHIA Kenya: 360 facilities to be surveyed (PSI, KMET, FHI) With NHIFL: TA to NHIF Kenya to develop certification of facilities for the new outpatient scheme  With MOH Kenya: mapping of patient safety using SafeCare as basis for a new licensing structure for healthcare facilities   With AHME:using safe care for network in Kenya, Nigeria and Ghana With Shell Oil: certify healthcare facilities in Nigeria 14

The Partnership of MCF, SafeCare and APHFTA: Recognizing Achievements

Synergy of Programs: a Multiplyer Effect

Increased trust and utilization of care Transparancy of quality of care Insurance creates demand for quality care Access to finance to allow for investments

Discussion: Topics

1. Access to Capital:

• • What are the barriers for banks to lend to providers?

What are the barriers for provides to access bank loans?

2 . Role of Insurance:

• What is the role of insurance in accessing finance?

• What is the role of insurance in quality improvement?

3. Rural Outreach:

• How to stimulate private provider investments in remote areas?

• Or should these be entirely left to the public sector?

4. Regulation:

• What about the channel for self-regulation of private providers?

• Should self-regulation through certification be self-financing? • • What is the role of the public sector in private sector regulation?

5. Regional Cooperation

• • • • Can providers networks/associations an active role in regulation?

Can they design incentive systems for regulation?

Can they play a role in enforcement of self-regulation?

Is there perspective for a common regional self-regulation format?