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These practical tools can help countries achieve universal health coverage

How to strengthen primary health care and engage the private sector

Despite the fact that there is widespread support among global health donors, implementers and governments for universal health coverage (UHC), achieving UHC has not been easy or straightforward.

One challenge policymakers and practitioners face is a lack of practical knowledge related to designing and implementing health system reforms. Put simply: there is a lot of information available about what should be done to achieve UHC, but very little information about how to do it.

At Results for Development (R4D), we set out to solve this problem guided by the core belief that people who have led or are leading health systems reforms are best positioned to help others in the same situation. The approach, also known as peer-learning or joint learning, is exactly what we had in mind when we helped launch the Joint Learning Network (JLN)—a member-driven community of global health policymakers who are all working together to collectively address barriers to achieving UHC—in 2010. Since then, the JLN has grown to include 179 members in 28 countries. It has led to 61 new knowledge products, 36 workshops and 17 country exchanges.

In July, JLN hosted its first global meeting, which attracted more than 150 participants. The meeting focused on two key challenges, among others, that policymakers and practitioners currently face in achieving UHC:

  1. Improving primary health care
  2. Engaging the private sector

To help implementers address these needs, the JLN launched two resources at the global meeting—JLN’s UHC Primary Health Care Self-Assessment Tool: Summary Report from Four Country Pilots and Engaging the Private Sector in Primary Health Care to Achieve Universal Health Coverage: Advice from Implementers, to Implementers.

Improving primary health care

The UHC Primary Health Care Self-Assessment Tool was developed to assess whether a country’s health financing approaches are well-aligned with their primary health care (PHC) service delivery goals. This Tool is not limited to JLN member countries, but can be adapted for any country working to achieve universal health coverage.

The Tool, which was collaboratively designed with input from 50 representatives from JLN member countries and global partners, is a rapid diagnostic instrument that captures the perspectives of various stakeholders, identifies misalignments between health financing and service delivery goals and creates the space to discuss changes that can lead to improved delivery of primary health care.

Country representatives from GhanaIndiaIndonesia, and Malaysia have successfully piloted the Tool and have documented their experience in a new report that can help others who are facing similar challenges.

The Ghana, India, Indonesia and Malaysia teams adapted the Tool to ensure its relevance to their local settings and stakeholders. While the teams from Ghana, India and Indonesia made only slight adjustments to the terminology of the Tool, the team from Malaysia made significant changes to the health financing sections to better reflect how the Malaysian public health system is organized. Overall, the pilots demonstrated that countries could adapt and rapidly implement the tool in a variety of settings, either at the national or sub-national level.

For example, Malaysia piloted the Tool with national-level stakeholders, including the Ministry of Health (MOH) that serves as the primary funder, provider and regulator of the health system. The MOH delivers health services through an extensive network of primary care clinics, and many Malaysians also rely on private clinics for primary care. While the utilization rates of public and private PHC facilities are nearly equal, the services provided differ; public sector PHC facilities treat more chronic illnesses, whereas private facilities treat acute illnesses and provide curative care. In addition, the pilot revealed that private PHC providers lack awareness of national health policies and priorities despite providing 51 percent of PHC services. and accounting for 60 percent of primary health care expenditure.

The JLN members also identified common challenges, including: creating the best payment or funding mechanisms mix to support PHC priorities; adjusting PHC benefits packages; managing PHC demand vs. secondary care; engaging private providers; and strategic communications in policy implementation. To respond to these challenges, the JLN PHC Technical Initiative have prioritized and delved into how to define and enable delivery of PHC benefits packages and engage private providers.

Engaging the private sector to achieve UHC

The private sector is a major provider of health care globally. Two reports from the World Bank Group’s International Finance Corporation found that more than half of health spending and health care provision in sub-Saharan Africa involves private provision.

Fortunately, there is growing evidence that it is beneficial for the public sector to work with the private sector to increase coverage and improve equity in accessibility, quality, efficiency and sustainability of primary health care services.

Like many countries around the world, JLN member countries have mixed (public and private) health delivery systems, but government officials lack the tools, ability, or know-how to create an effective partnership. The JLN’s report on the Self-Assessment Tool revealed that in some countries private providers are ineffectively organized and regulated, and potentially underutilized in terms of advancing national health priorities (though highly utilized by consumers). In other countries there has been some progress in connecting with private providers, but engagement challenges remain. Thus, there is a need to generate evidence and good practices that will help health system stewards develop better partnerships between the public and private sector for delivery of primary health care services.

Based on the lack of practical guidance for engaging with private providers around primary health care service delivery, JLN members collected country experiences and worked with leading experts in the field to jointly produce the manual, Engaging the Private Sector in Primary Health Care to Achieve Universal Health Coverage: Advice from Implementers, to Implementers. The first two modules of the manual provide practical guidance on: initial communications and partnership around primary health care and provider mapping. Future modules will cover provider and facility regulation, accreditation or empanelment; provider contracting and payment; and primary health care systems monitoring and evaluation.

Dr. Kamaliah, co-author of the private sector guide from Malaysia, notes “to optimise the available human resources for health in the country, we need to include [the private sector] in our efforts to strengthen primary care services to achieve our UHC goals—thus engagement is crucial….And what better way than to learn how other countries in the same boat have done it!”

With increased collaboration and coordination among practitioners, policymakers, donors and governments, the JLN is working to find collaborative learning approaches to tackle the tough challenges and unanswered questions on how to achieve UHC. Utilizing these tools and resources and building on the work of this peer-to-peer learning network, we hope to bridge theory with practical guidance on how to address challenges related to implementation of UHC in low and middle-income countries.

Comments 1 Response

  1. siewe paulline laure December 14, 2017 @ 4:59 am

    I have a question. How can an NGO help in achieving UHC? What can we do as an NGO to promote UHC?

    Reply

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