Tanzania Private Health Sector Assessment

: Key Findings for Private Health Providers

James White R.N., MSc., Assessment Team Co-lead Towards Increased Public-Private Cooperation in Health February 26 th , 2013 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

PSA Approach

Key Focus Areas of the Assessment  Policy and Enabling Environment  Service Delivery in the Private Health Sector  Pharmaceutical and Medical Commodities Supply Chain  Health Financing  Key Focal Health Areas  HIV/AIDS   Reproductive, Maternal and Child Health Tuberculosis  Malaria

Defining the Private Health Sector

A diverse landscape of actors

The Private Health Sector is Diverse Health  Private-not-for-profit  Faith-based organizations  Not-for-profit entities  Non-governmental organizations Commercial / Private for-profit Non-health private sector  Private employers, corporations, commercial banks

A Holistic View of the Health Sector

Landscape of the Tanzanian Health Sector

Findings from the Private Health Sector Assessment

The Private Health Sector’s National Coverage

Public-Private Mix of Health Infrastructure  Public owns majority of health facilities  Distribution skewed by # of dispensaries   PNFP also owns significant # of hospitals PFP concentrated on dispensaries

Total Number of Health Facilities in Tanzania

Source: MOHSW (2012)

Facility Type Hospitals Health Centers Dispensaries TOTAL Percent of TOTAL Public

103 444 4,057 4,604 72.3%

PNFP

101 134 625 860 13.9%

PFP

36 55 787 878 13.8%

Total

240 633 5,469 6,342 100.0%

The Private Sector Contributes at all Health Service Levels

The Private Health Sector Serves all Tanzanians DHS, 2009/2010

Private Providers Make Vital Contributions to Priority Health Services To HIV/AIDS Services To PMTCT and Prevention

Private Providers Make Vital Contributions to Priority Health Services To Reproductive and Maternal Health To Child Health

Private Providers Make Vital Contributions to Priority Health Services To Malaria (Cough and Fever) Treatment

The Private Sector is an Important Source of Medical Commodities  The private sector is involved in all aspects of the drug supply chain in Tanzania  659 private health facilities with onsite pharmacies  155 PNFP health facilities with onsite pharmacies   661 private retailers 6,000+ ADDOs and Transitional DLDBs  375 wholesalers

The Enabling Environment Supporting Private Sector Engagement

Conducive Policy Environment in Tanzania  Progressive policy environment  Political commitment from different areas of gov’t and society  Key groups such as PPP-TWG spearheading change and collaboration  Donor commitment and investments in private sector  Policy framework and institutional structures largely in place  Relatively well organized private health sector at national level

Challenges in the Enabling Environment  Difficulties in moving from plans to action  Pockets of resistance and misinformation remain  No common understanding of health PPPs  Key institutions – PPP Unit – are under-resourced  At local (and national) level the private sector remains fragmented and disorganized  Disconnect between service leadership, service levels, and providers  Significant market barriers limit growth of private sector businesses (financing and services)  Few SLAs with the commercial private health sector, and limited understanding of SLA potential

Private Health Services

The importance of local engagement

Leveraging the Private Health Sector  Missed opportunities to maximize private health sector contributions at the local level  With exception of APHFTA, CSSC and MOHSW partnerships, no systematic effort to monitor and collect data on quality in the private health sector  Information does not flow freely between sectors  Limited access to continuing professional development (CPD) and donor training  No access to subsidized drugs and supplies which increases costs and affects affordability of services  Very limited involvement of P.S. in CCHP process

Recommendations to Increase Delivery of Private Sector Services  Simplify reporting mechanisms to improve information sharing  Increase access to continuing professional development (CPD) and donor training  Routinely include private sector members in LGA/ DHMT planning processes (i.e. CCHP)  Replicate APHFTA/MOHSW model for joint  supervision and use data to monitor quality Act on ‘quick wins’ to leverage P.S. contributions

“Quick Wins” for Private Sector Contributions  Coordination of diagnostic/equipment use  Contracting for non-clinical services  Scaling-up promising private sector programs  Create opportunities for CCHP and planning dialogue  Promote multi-disciplinary and multi-sectoral knowledge exchange. (i.e. maternal mortality audits, M&M dialogue at facility level)

Encouraging and Forging Partnership  Private providers can make contact and demonstrate value  Highlight contributions to essential health services  Seek ways to make P.S. contributions more visible  Organize, coordinate, collaborate What steps can APHFTA members take to improve local collaboration?

Private Sector Assessment

Conclusions

Pop Quiz • Health is financed mostly by the Tanzanian government True/False • The Tanzanian private health sector only serves the rich True/False • The Tanzanian private health sector only delivers specialty services True/False

Pop Quiz #1 False According to the most recent NHA, Development partners and households contribute 40% and 32% #2 False According to the 2009-2010 DHS, 20% of the poorest get their FP methods and 10% deliver in a private setting GoT subsidizes the wealthiest – 50% and 76% wealthiest income group get their FP and deliver in a public facility #3 False 25% diarrhea, 15% PMTCT, 34% FP methods, etc.

Thank you on behalf of the PSA Team:

James White R.N., SHOPS Barbara O’Hanlon, SHOPS Grace Chee, SHOPS Sean Callahan, SHOPS Dr. Malangalila, SHOPs consultant Dr. Kimambo, SHOPS consultant Jorge Coarasa, IFC Michelle Wu, USAID

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

www.shopsproject.org

Questions, Comments and Discussion