Malaria in the Private Sector: The role of the Private Sector (Independent Private Health Subsector) in ensuring equity and access to services in Uganda
Malaria in the Private Sector: The role of the Private Sector (Independent Private Health Subsector) in
ensuring equity and access to services in Uganda
The term ‘private sector’ is used to include a diverse range of
health care providers: from formal groups of health professionals and
commercial companies of various sizes; large healthcare and workplace programs
run by major corporations; to civil society groups, associations and informal
providers such as unqualified medicine sellers and shopkeepers.
In Uganda, the private sector health market is large and vibrant.
Despite having to pay, many people choose to access malaria services through
the private sector. This is due to, for example, a greater variety of
providers, better availability of products, and a perception that goods and
services are of higher quality compared to the public sector.
Yet, while the private sector can improve access to services,
particularly where the public sector is weak, it is no magic bullet. Paying for
health care can impoverish households. Key populations at-risk of malaria may
remain neglected. Also, the quality of services, medicines and other
technologies provided in the private sector can be poor. To address these
issues, governments need to engage more strategically with the Independent Private Health Subsector.
The capacity and reach of the private sector is not uniform across
the country. It plays a particularly large role in providing services to the
general population in Uganda, but has a mixed or more limited role in other
countries. However, since private sector data is rarely included in official
statistics, there is limited evidence of the exact scale of its contribution.
A range of strategies for engaging the private sector have been
implemented in other countries, and successes have been documented. For
example, market-based incentives, such as subsidizing the costs of long lasting
insecticide treated nets, have been applied to keep the cost of essential
malaria commodities affordable, thereby stimulating demand. Formal provider
associations have been successfully encouraged to self-regulate. Public-private
partnerships have helped to bring innovations in malaria medicines and other
technologies to the market. Consumer empowerment initiatives and behavior
change communication campaigns have been implemented.
Key messages
1.
Strong and sustained engagement with the private sector is
essential to reach the target of the millennium development goals. The private
sector already makes a significant contribution to malaria prevention,
diagnosis and treatment in Uganda, and will continue to be an important partner
in malaria control efforts in the future.
2.
In Uganda, between 40 - 60
per cent of health care for poor people is provided by the private sector. Partnerships between the
public and private sectors can help reduce the cost of essential malaria
medicines. Companies engaged in forestry and mining often have direct access to
mobile and migrant populations at high-risk of contracting malaria, who are
often beyond the reach of the public sector.
3.
Engaging the private sector is not without its challenges. The
cost of private care may deter the poor from seeking treatment, or impoverish
them if they do. In circumstances where the capacity to regulate medicines
supply is poor, many private providers sell low-quality medicines, or
treatments which are sometimes banned on the markets. Prescribing practices may
also be poor. This contributes to emerging resistance to malaria medicines in
the country.
4.
More strategic engagement with the private sector is therefore
needed. This should aim to tap new resources and optimise private sector
strengths such are reaching remote ‘markets’. Increasing the affordability and
quality of services provided in the private sector is also important.
To achieve this, government
and development partners need to:
i) Support better regulation
of the private sector, more efficiently and consistently, to improve access to
quality malaria products and services.
ii) Build the evidence
base on where the private sector has been effective and delivered results in
malaria control. This will allow malaria programs to select the most appropriate
strategies for engaging the private sector in their context.
iii) Devise means for
private sector financing for malaria. It is crucial, however, that governments have the capacity to
regulate and manage these resources.
iv) Capitalise on
opportunities to establish public-private partnerships, to implement malaria
control programs. Such partnerships should engage and support local health
associations, and be carefully planned in order to remain sustainable.
v) Bring the private
sector into national and regional fora. This is key to increasing engagement
between public and private sectors and building trust. It should also help to
better define the role of the private sector in key areas, such as reaching
remote and mobile populations and combating the sale of sub-standard medicines.
Challenges
To harness the full potential of the private sector, a number of
crucial challenges must be addressed. A key issue is that governments have had
limited capacity (or will) to regulate private sector markets. This is urgently
needed to address, for example, the patchy availability of quality medicines
for malaria, the proliferation of substandard or fake medicines, poor
prescribing practices and high prices in the private sector.
National malaria control programs need
to better understand the nature, role and scale of the private sector’s
(potential) contribution. There are knowledge gaps on how private markets work,
which make decision-making difficult. For example, the cost-effectiveness of
interventions delivered by the private sector is under-researched, and malaria
treatment practices by informal providers are not fully understood. Little is
known about how supplier behavior affects prices for the consumer, despite the
evidence that retailers have an important influence on the availability,
quality and price of malaria products.
This will require collecting data
nationally, analyzing distribution chains in all sectors, as well as taking
into account consumer demand.
Sustainable financing is another important issue. There are a wide
range of non-state funding sources that can be better tapped for malaria
control in the country, including global funding mechanisms. But making these
work in a sustainable manner relies on sustained political engagement, as well
as the capacity of associations and institutions (nationally) to regulate and
manage financing partnerships effectively.
Opportunities
While these challenges are not unique to the country,
opportunities related to the potential contribution of the private sector are.;
Uganda, in particular, has a burgeoning private sector whose
resources remain largely untapped. The presence of natural and energy resources
in the region also presents an opportunity. Companies in these industries often
operate in remote locations, which are beyond the reach of public services.
They are therefore well placed – operationally, logistically and financially –
to extend the health care they provide to employees and their families, who
represent some of the most vulnerable groups at risk of malaria. This is
already happening in some countries with established natural resource
industries. Experience suggests that developing positive relationships with
communities and governments is key to success and sustainability.
Existing national malaria efforts and fora provide further
opportunities to pool resources for the procurement of medicines and
technologies, and share knowledge. New national efforts could focus
specifically on best practices for engaging the private sector in malaria
control.
In a climate of limited funding, strategic engagement with the private sector provides malaria control programs with both an opportunity and an obligation. There is an opportunity to widen access, improve quality and reduce costs of malaria interventions, through a variety of approaches. However, the private sector cannot be considered a panacea. There is also an obligation to actively engage with the private sector at sub-national and national level to plan and design programs which ensure equity for poor and marginalized communities across the country.
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