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Private Health Sector:Role and Potential Partnership for Moving towards
Universal Health Coverage
Hassan Salah, Medical OfficerDepartment of Health System Development
The 14th Arab Conference Public-Private Partnerships for
Sustainable Health Care Services
Presentation Outline
Why assessment of
PHS?
Analysis of PHS
Current statues in
EMR
Challenges&
opportunities
Conclusion & next steps
III
IIIIV
V
Analysis of Private Health Sector: Methodology
• Analysis follows health systems approach:
– Financing, delivery, workforce, technology and governance
• Data collected in two phases:
– Phase One [2007-10]:
• Assessment of private health sector in 12 counties
– Phase Two [2012 - 14]:
• Review of published reports, ministry of health records and grey literature from EMR countries
• Studies on private sector regulations
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Private Health Sector: Definition
• Private sector includes all actors outside of government including for-profit, non-profit, formaland non-formal entities
[World Bank, 2008]
• All formal service providers working for profit and/or not-for-profit (e.g. nongovernmental organization). Focus on for-profit sector
[Definition used for the study]
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Growth of private sector driven by market demands leading to a public private mix;
Trends in Privatization Policies
Free market ideology driven generally towards privatization;
Traditional role of state wherein public sector has control and limited interaction with private sector.
Private Health Sector in EMR
Countries: Preliminary Results
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Towards universal health coverage in countries of the Eastern
Mediterranean: challenges, opportunities and roadmap7
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(I) Service Provision: Primary Care Facilities
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Countries Primary care facilities [includes GP clinics]
Estimated number[range]
Percent in private sector
(%)
Group 1 203 – 2401 15 - 89
Group 2 880 – 56,421 5 - 82
Group 3 69 – 79,591 19 - 92
Towards universal health coverage in countries of the Eastern
Mediterranean: challenges, opportunities and roadmap10
0
20
40
60
80
100
120
Public
Private
(I) Percentage of Public and Private PHC facilities
(I) Service Provision: Hospital Beds
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Countries Hospital Beds
Estimated number[range]
Percent in private sector
(%)
Group 1 2086 – 61,036 6 - 26
Group 2 6357 – 131,555 7 - 83
Group 3 469 – 128,137 8 - 22
12
0
20
40
60
80
100
120
Public
Private
(I) Percentage of Public and Private Hospital beds
37
5.3
(I) Service Provision: Pharmacies, laboratories
and diagnostic facilities
14
Countries Pharmacies Laboratories and diagnostic Facilities
Estimated number[range]
Percent in private sector
(%)
Estimated number[range]
Percent in private sector
(%)
Group 1 111 – 6,022 27 – 93 51 - 246 43- 89
Group 2 821 –63,374
58 – 99 1204 – 8,083 52 - 92
Group 3 59 – 55,000 22 - 98 23 – 4,000 22 - 60
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0
20
40
60
80
100
120
Public
Private
(I) Percentage of Public and Private Pharmacies
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Perc
ent
Source: Demographic and Health Surveys
85.1
62.8 63.6
0
10
20
30
40
50
60
70
80
90
100
Public Private Public Private Public Private Public Private
Pakistan Egypt Morocco Jordan
Poorest Middle Richest
(I) Service Provision: Use of primary care services,
private and public providers
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Quality of public services
OOP spending
Regulation & enforcement
Community perception
High revenue
Main Factors Contributed to PHS Growth
(II) Workforce: Private and Public Health Workforce
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Country Groups*
Private sector workforce [Per 10,000 population]
Public sector workforce [per 10,000 population]
Physicians Nurses Physicians Nurses
Group 1 4 – 16 5 – 38 2 – 20 5 – 44
Group 2 3 –33 9 –20 4 – 20 6 – 33
Group 3 0.1 – 19 0.3 – 6 0.1 – 8 0.4 –7
* Private sector workforce data not available for Group 1 – Qatar; Group 2 – Egypt, Iran, Iraq, Libya, Syria, Tunisia; Group 3 – Afghanistan; Sudan, South Sudan;
Duality of practice between public and private sectors
(II) Workforce: Private Health Workforce – Issues and Challenges
Concentration of private workforce in urban areas
Unregulated expansion, lack of accreditation programs for health professionals’ education
Limited data on workforce distribution, salary structure and multiple job holding
Inadequate coordination between MOH and MOHE to plan for public and private sectors
(III) Health Finance: Private Health Sector
Expenditure in EMR Countries, 2011
Group THE per CapitaUS$
PHE[% of THE]
OOP [% of THE]
OOP [% of PHE]
Group 1 991 27.0% 16.7% 61.9%
Group 2 245 52.0% 49.1% 94.4%
Group 3 49 74.3% 69.0% 92.8%
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THE – Total Health Expenditure; PHE – Private Heath Expenditure; OOP – Out of Pocket Payment
(III) Health Finance: Public Sector versus Out of
Pocket Private Sector Expenditure, 2013
Source: WHO Global Health Expenditure Online Database, 2013
Huge investments in high-tech imaging technology, motived by medical tourism
(IV) Essential Medicine and Technology
Irrational use of biomedical devices and technologies leading to high OOP payment
Weak medicine regulatory system and poor enforcement
Availability of core medicines lower in public compared to private facilities
Non prescription sale of antibiotics in private pharmacies (antimicrobial resistance)
Regulations governing PHS need updating
Policies for engagement between public and private sectors are evolving in most
countries
Limited MOH technical capacity to
formulate policies and fulfill regulatory
responsibility
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Whey Governments are not ready for develop
PPP?
Lack of Competence
First Demand
Prime Responsibility
Official Recognition
Conclusion and Next Steps
Preliminary review of private health sector based on systems approach
Significant gaps in information that need to be plugged
Priority areas that need particular attention are:
o MOH regulatory capacityo Partnership with private health sectoro Reduce OOP payment incurred in private sectoro Improve the quality of care
Develop regional strategy that supports countries to engage with private sector for public health goals
1990 2000 2010 2020
40%
55%
70%
Private
Public
100%
