Stop ignoring the private sector, urged Emeka Okafor, pharma health systems lead at Society for Family Health Nigeria — a local nonprofit organization working to provide health products, clinical services, and behavior change communications — and project manager of the IntegratE project.
Most government activities and policies around reproductive, maternal, newborn, child, and adolescent health, or RMNCAH, have thus far excluded the private sector, Okafor explained, and this is hindering the ability to achieve universal health coverage.
“Until governments begin to pay more attention to the private sector’s building [of] capacities and bring in data from the private sector, it will [take] us a long time to address RMNCAH issues.”
Over 800 women die each day due to complications related to pregnancy or childbirth. Nigeria is home to approximately 23% of those deaths.
Thankfully, the conversation around private sector engagement is shifting, Okafor said, and this could yield better RMNCAH outcomes in Nigeria and beyond.
“The conversation is gradually changing because governments have seen that without carrying the private sector along there’s little mileage we can achieve in both UHC and meeting the needs of the Sustainable Development Goals.”
Sitting down with Devex, Okafor explained how to advance the conversation, what barriers need to be broken down to encourage further local private sector engagement in RMNCAH, and how to do so.
This conversation has been edited for length and clarity.
Given the gaps in RMNCAH service delivery and funding, what do you see as the role of local private sector actors?
The major thing is that the private sector contributes to a huge chunk of service delivery especially for RMNCAH, in and across most countries in Africa. Specifically in Nigeria, almost 60% of patients access to RMNCAH care from the private sector. When you look at family planning, over 84% of clients access family planning services and commodities from the private sector, so the private sector plays a vital role in improving access to RMNCAH in Nigeria. But oftentimes it is not given pride of place. This is because the private sector is not fully integrated into the formal sector. Most government policies are public sector focused and currently private sector services data do not flow into the national data reporting system.
Until governments begin to shift that attention [roles of public health facilities] to also include the private sector, we may not be able to have that total view, especially as we move toward UHC.
— Emeka Okafor, pharma health systems lead, Society for Family Health NigeriaWhat can you tell us about your work with the private sector in RMNCAH?
In line with reducing maternal mortality and also the key role that family planning plays in improving maternal outcomes, SFH — with funding from the Bill & Melinda Gates Foundation and MSD for Mothers — decided to pilot the IntegratE project that tries to test a “proof of concept,” that community pharmacists and patents and proprietary medicine vendors — the category of providers that we all call drug or chemist stores — have the capacity to provide a wider spectrum of family planning and other key services than [they are] currently authorized by law to provide. And also to begin to show evidence that would make sure that these services become services that they can provide on a permanent or sustainable basis. The project is being piloted in two states, Lagos and Kaduna states. Essentially, in the process of implementation, the project also intends to strengthen the overall quality of services [provided] on a sustainable basis. Early results from the IntegratE project show that these services are consistently being provided at acceptable levels of quality.
Are there any actions Nigeria takes to encourage private sector engagement?
Very recently, the Federal Ministry of Health developed a strategic framework to engage the private sector in scaling family planning services. This is one of the laudable efforts of [the] government to ensure the involvement of the private sector, realizing that for sustainability of family planning services and commodities, the private sector needs to play a pivotal role. We would like to see this type of effort replicated not only in family planning but other RMNCAH areas.
What are some of the barriers that might prevent more local private sector actors from entering the RMNCAH space?
If you look at certain government policies — task shifting and task sharing policies, even national health acts — so many tend to be huge on the public sector. [They] tend to clearly define the roles and participation of public health facilities with little mention of private-sector health facilities. Until governments begin to shift that attention to also include the private sector, we may not be able to have that total view, especially as we move toward UHC.
Private sector engagement
As defined by the Organisation for Economic Co-operation and Development, this is an activity that aims to engage the private sector for development results, which involve the active participation of the private sector.
The definition is deliberately broad in order to capture all modalities for engaging the private sector in development cooperation, from informal collaborations to more formalized partnerships.
Read more about the definition and how Maternity Matters: Funding the Future is exploring the topic.
Specifically for RMNCAH — again because over the years the attention is focused more on the public sector — some of the areas involvement of the private sector have not been clearly defined. Most private sector practitioners don’t feel carried along because they don’t fully understand the role they are expected to play.
For family planning, for instance, for a very long time, it has been focused mainly on the public sector. Some years ago, the United States Agency for International Development decided to work with the Society for Family Health on a component that goes to the private sector through social marketing. Commodities for family planning would be available to be sold at highly subsidized rates through the private sector, while in the public sector the same commodities would be free.
With that in mind, what would your call to action be?
The call to action is simply for governments to be deliberate about policies that will involve or engage the private sector and clearly define the role the private sector will be expected to play. They can't be doing the same thing, the same way, over and over again and expect a different result each time. We have all fully paid attention to the public sector over the years and it has yielded very little results so this is time for governments to be deliberate about policies, deliberate about their actions to make sure that the private sector is deeply involved in both the planning, project estimation, data reporting, and service delivery. That is the only way we can move the needle if we want to make any change at all.
The Funding the Future series is supported by funding from MSD, through its MSD for Mothers program and is the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.
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