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ROLE OF PRIVATE SECTOR INREACHING MARGINAL

POPULATIONS

Josef Tayag, USAID

January 29, 2017

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MARGINAL POPULATIONS AREDIVERSE

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PRIVATE PROVIDERS AREEQUALLY DIVERSE

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PRIVATE SECTOR IS ANIMPORTANT SOURCE

45%

44%

28%

55%

56%

72%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Asia

Latin America

Sub-Saharan Africa

Modern contraception users who obtained method from privatesector (%)

Private

Public

Source: SHOPS analysis of DHS data 2005-2012

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EVEN FOR THE POORUse of private providers for modern family planning methods bytwo lowest-income quintiles (%)

Source: SHOPS analysis of DHS data 2005-2012

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AND YOUTH

Source: SHOPS analysis of DHS data 2005-2012

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AND PEOPLE SEEKING HIVSERVICES

Source: SHOPS analysis of DHS data 2005-2011

0%

10%

20%

30%

40%

50%

60%

70%

Private Source of HIV Testing by Gender (2005-2011)

Women

Men

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AND CARE FOR CHILDHOODDIARRHEA AND PNEUMONIA

Source: Montagu, D and A Viconti. 2010. Analysis of multi-country DHS data. www.ps4h.org/globalhealthdata.html

79%

66%

51%

34%

21%

34%

49%

66%

0% 20% 40% 60% 80% 100%

South Asia

SE Asia

Sub-Saharan Africa

Latin America & Caribbean

Private

Public

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IMPROVE ACCESS TO CARE,BUT…

• Private providers are least likely toparticipate in national health financingschemes.

• Challenges:

– Donor crowding out

– Unorganized, limited voice, visibility

– Range of qualifications, quality

– Accreditation requirements

– Payment mechanisms and rates

– Administrative burden

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Crucial question:

HOW should health financingprograms engage the full range ofprivate providers?

INTEGRATINGPRIVATE PROVIDERSINTO UHC

VOUCHERS:A POWERFULDEMAND-SIDE SUBSIDY TOTARGETYOUTH

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• 2015 HIP Brief identifies several benefits from voucher programs:

– Improve targeting of subsidies

– Support movement toward UHC

– Increase access to and improve quality of services

– Increase accountability and reduce fraud

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BENEFITS OFVOUCHER PROGRAMS

Source: High-Impact Practices in Family Planning. Vouchers: addressing inequities in access to contraceptive services. 2015 Jan

HOWVOUCHER PROGRAMS WORK

Funding source(government or donor)

Voucher management agency

Distributor

Targeted client

Participating provider

Source: Adapted from World Bank “A Guide to CompetitiveVouchers” 2005.

Four key elements:

• Population

• Benefits

• Price

• Awareness

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GETTINGVOUCHERS RIGHT

• Marie Stopes International operates BlueStar social franchise inMadagascar

• 2011: New voucher program to increase access to voluntary FPcounseling and services

• Low use by youth development of youth-targeted voucher

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IMPLEMENTING AVOUCHER PROGRAM INMADAGASCAR

Source: MSI SIFPO project report “Increasing access to voluntary family planning and STI services for young people”

MARIE STOPES MADAGASCAR MODEL

USAID and UNFPA

Marie Stopes Madagascar

Youth community healtheducators

Youth (ages 15-19) in 6 projectregions

BlueStar clinics

Source: Adapted from World Bank “A Guide to CompetitiveVouchers” 2005.

PROGRAM SUCCESS IN REACHINGYOUTH

Implant removal1% IUD removal

0%

STI counseling33%

FP counseling1%

Short-term FP

13%

Implant insertion39%

IUDinsertion

13%

Services redeemed

July 2013 and December 2014:

• 58,417 vouchers distributed

• 43,352 redeemed (74% redemption rate)

YOUTH-FRIENDLY, USER-CENTERED1. Modules for communicating effectively with youth and better

understanding their SRH needs;

2. Targeted mobilization schools and youth associations

3. Trained BlueStar franchisees on youth-friendly services and workoutside of facility

4. Covered range of FP methods, including counseling, short-actingmethods, LARCs (insertion and removal), and STI screening/counseling

5. Included mobile and paper voucher options—mobile to appeal to youthand paper to reach 80% of target population who did not have mobilephone/limited connectivity