The lessons we’ve learned in the 12 months since launching the USAID-funded MOMENTUM Private Healthcare Delivery Project
By Rajat Chabba, Senior Technical Advisor-Private Sector and Frontier Solutions, MPHD/Jhpiego; Erin Dumas, Senior Program Manager, MPHD/PSI and Coley Gray, Senior Advisor, MPHD/PSI
With more than 40 percent of health services delivered through the private sector in the low- to middle-income country (LMIC) context, it is imperative that the sector is engaged as an important decision maker, implementer and partner in global health programs and interventions.
However, in a mixed health system environment with active public and private sector actors, national efforts to strengthen the capacity of people and systems to deliver health care often leave out the private sector. When it comes to strengthening pathways to maternal, newborn and child health, voluntary family planning and reproductive health (MNCH/FP/RH) care, the private sector’s contributions cannot be overlooked.
The USAID-funded and PSI-led MOMENTUM Private Healthcare Delivery (MPHD) project harnesses the private sector’s potential to deliver high-quality, evidence-based health care for women, men, adolescents, and children. Tapping four key principles from USAID’s Private Sector Engagement (PSE) Policy, we’re testing models for how to work hand-in-hand with the private sector to design and deliver effective and sustainable MNCH/FP/RH solutions across contexts as diverse as Burundi, Indonesia, and Mali.
What does that look like in practice? As we approach MPHD’s first anniversary, we share our experiences applying these principles, which illustrate the value of an intentional, tailored approach to collaborating with key private sector actors.
Principle 1: Engage early and often.
The design stage of any project lays the groundwork for strong working relationships and for generating the insights needed to develop successful interventions. Using a problem-driven and solution-oriented approach to private sector engagement, MPHD identifies key private sector individual champions, local provider networks, and professional organizations to be part of initial co-creation and validation processes.
In Mali, this meant involving private sector actors in the process of analyzing the many distinct private health points-of-service, typical services offered, and clientele reached. This exercise highlighted, for instance, that the more flexible operating hours of a private clinic may be a better option for the schedules of in-school youth to access services. Private midwives’ practices, or cabinets de sage femme, are especially well suited to antenatal and family planning services.
Fostering communication and linkages between these facilities, therefore, is important to providing an effective continuum of care that builds on each piece in the ecosystem. Getting nuanced feedback from the providers themselves early on will help MPHD to target the training, distribution and coverage of health products, and supportive supervision that helps them deliver high-quality FP/RH/MNCH services to the various client groups.
Principle 2: Incentivize and value PSE throughout planning and programming.
PSE is not a stand-alone activity but rather should be present throughout each stage of a project’s lifecycle. MPHD in Burundi’s approach is structured around strengthening two non-governmental local organizations, the National Association of Social Franchise and the Network of Regional Confessions for the Promotion of Health and the Integral Well-being of Families, so they can continue to support the clinical and business management skills of individual private providers long after the project is over.
In Indonesia, MPHD will work closely with faith-based health networks to provide clinical governance and mentoring support to private health facilities and clinics in a sustainable manner. To further ensure the health system’s responsive to the needs and interest of the private sector, MPHD will work with the Ministry of Health to integrate private sector activities into national, provincial, and district-level annual action plans, data collection, and monitoring over the project’s next several years of implementation.
Principle 3: Expand the use of approaches — like USAID’s Principles — and tools that unlock the private sector’s potential.
One of USAID’s greatest resources is its ability to leverage its convening power to bring diverse private sector partners into joint conversation with national and local authorities and civil society organizations. The USAID Mission in Indonesia and MPHD carried out extensive consultations and co-creation and validation workshops that brought together the perspectives of relevant Ministry of Health directorates with those of private sector actors like networks of hospitals, individual midwife clinics, and professional associations.
As a result, MPHD will establish sustainable service delivery and quality assurance/improvement systems and develop continuous professional development marketplace through strategic engagement with the private sector stakeholders in the country.
Principle 4: Build and act upon the evidence of what works, and what does not, in PSE.
Working with private providers often requires examining their incentives and preferences as small business owners, which differ from providers in the public sector. In Indonesia, over 60 percent of all deliveries occur in the private sector, mostly private practices run by midwives, and half of modern contraception methods are provided by the private sector. Discussions with these midwives revealed that their ability to participate in continuing medical education courses that would improve the quality of services they could offer was limited because these courses were inconveniently timed and took them away from their place of business. This insight led to formulating a new potential solution of virtual, on-demand trainings that a midwife can access according to her own schedule and without leaving her workplace—and potentially losing valuable income from seeing patients.
Listening closely to the unique needs of private providers is the foundation of understanding what works in PSE to bring the best health care to all who need it. Applying PSE principles in MPHD’s first year has already yielded rich learnings that will inform how we implement the solutions generated through these collaborative co-creation processes. We will continue to keep our ears open for feedback and insights to ensure that the voices and experiences of the private sector guide us—every step of the way.
Banner photo credit: Trevor Snapp
