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Sexual and Reproductive Health and HIV/AIDS Action Plan for the Independent Private Health Subsector



Sexual and Reproductive Health and HIV/AIDS Action Plan for the PFP Private Health Subsector (Independent Private Hospitals and Clinics)

Executive Summary

The need for an SRH and HIV/AIDs action plan has been signaled by the role of private health sector in the general health service delivery which triggers the need for an Action plan for SRH and HIV/AIDS in the PFP Private Health Subsector. This Sexual and Reproductive Health Action Plan has been developed by Uganda National Association of Private Hospitals (UNAPH) to provide overall guidance for implementing the Sexual and Reproductive Health Services and HIV/AIDS care and prevention in the PFP Private Health Subsector. The plan presents an operational basis for UNAPH to contribute to achieving the goals of the MDGs and provide a framework through which the government, Ministry of Health (MOH) and Development partners (HDPs) can collaborate and partner with the PFP private health subsector in Uganda.

A Ugandan Private-for-Profit  HIV/AIDS Care report carried out by USAID and a Policy Brief on the Role of Private Sector in Sexual and Reproductive Health services have been used extensively to design this Action Plan. Other countries’ reports and plans have also been used to support and analyze the strategies below. 
The Healthcare Environment in Uganda
                                                             

                                                                 Public Hospitals


    Non-Profit Private      Private-for-Profit (PFP)
                      Health Sector                 Health Sector



Why engage the Private Sector in Reproductive Health

(i)      Previous and current systems are falling short of meeting the Millennium Development Goals, including those related to improving maternal and child health and combating HIV/AIDS.

(ii)     A significant percentage of people already receive family planning and reproductive health services from the private sector. Two-thirds or more of married women receive family planning from the private sector in Uganda.

(iii)  Many consumers value private services because they perceive the quality of services to be higher. For example, a WHO survey of 18 sub- Saharan African countries found that patients consistently rank skills, equipment, and drug availability in for-profit hospitals higher than similar services in public-sector facilities (IFc 2008).

(iv) Many PFP private  clinics serve vulnerable people in remote areas that might not        otherwise be reached by the public health system.
(v)   Dual practice, by which salaried public sector providers operate private practices  at the
       same time, raises issues with respect to the poor; as such providers usually provide better
quality care with shorter waiting times at their private clinics.

Why have a PFP Health Sub-sector HIV/AIDS and SRH Action Plan?

  1. Unregulated private sector involvement in health care typically leads to serious quality and equity problems. As the private sector is to a large extent motivated by profit or the pursuit of individual earnings, an inherent feature of unregulated private provision is that providers will ration care to those whose willingness and ability to pay allows providers to make a profit.      

  1. Ensure guidelines for HIV treatment and care providers for the wide provision of, and
access to, voluntary HIV testing, counseling services and condoms.

  1. Reducing the proportion of infants infected with HIV and ensure that pregnant women access antenatal care, have information, counseling and other HIV prevention services available to them.

  1. Develop private health sector strategies to strengthen health care systems and address factors affecting the provision of HIV-related drugs, like affordability and pricing.

  1. Enact, strengthen or enforce, legislative and other measures to eliminate all forms of discrimination against, and ensuring the full enjoyment of human rights and fundamental freedoms by, people living with, and vulnerable to, HIV/AIDS.

  1. Sometimes discussion of the public/private mix in health care centers on the question, “How, when, and why should government intervene?” This phrasing presumes that, barring specific reasons to the contrary, the private sector should provide health care services. Policymakers must take this difference in goals into account if government and the private sector are to work together to achieve a common aim.

Priority Actions for Engaging the Private Sector
The health challenges facing Uganda are too great for one organization or sector to address on its own. Increasingly, MOH and development partners (HDPs) recognize the need to engage the private sector to increase the coverage of health services. In many cases, national and local governments will need to redefine their roles and broaden the scope of health planning.

Recommendations
·         Involvement and full integration of Private Health Care Providers in HCT services provision.
·         Support private health facilities to provide STI management services.
·         Collaborate with and support private  health facilities to  provide effective and comprehensive 
      STI management services using national treatment protocols.   
·         Implement and operationalize the UNAPH Hospital Accreditation and Survey Guide.
·         Accredit private health facilities offering syndromic management in line with the national   
      Protocols   and lobby for the Franchising mechanism / voucher system.
           
Another set of recommendations centers on strengthening UNAPH;

1.         Support UNAPH to better monitor the Public-Private Partnership 
  In close collaboration with the development partners, assist UNAPH with broadening its mandate and enhancing the diversity of its membership.
  Help UNAPH to become a dependable sustainable monitoring and evaluation mechanism.
   Assist UNAPH in defining a common vision on appropriate public-private partnership in
SRH and HIV/AIDS and in identifying a public-private partnership opportunities to further encourage cross-sector collaboration.
2.    Reposition UNAPH in the marketplace
• Assess client needs in the area of SRH and HIV/AIDS care services.
• Strengthen UNAPH institutional capacity to deliver quality sexual and reproductive health services; train PFP private health providers in clinical skills, including counseling, etc.

3.    Orient UNAPH on the path toward sustainability
    Diagnose the organization’s overall health through a variety of analyses focusing on its
placement in the market, internal operating capacity, and financial sustainability as a means of identifying key areas for improvement.
    Design concise and targeted positioning strategies based on competitive advantages and
other diagnostics.

                                           

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