Theme: “Committed leadership for accelerated Universal Access to HIV and AIDS services”
The dinner was on Friday 4th July 2014, Protea Hotel kampala
Demand for HIV prevention, treatment, and care services in developing countries continues to increase, putting additional stress on an already overburdened public health sector. To meet the need for these services within communities and ensure service quality and sustainability, it is useful to consider a renewed focus on identifying new models that incorporate capacity and resources from other parts of the health sector. The private health sector, including private providers and insurance schemes, is often overlooked in health systems strengthening (HSS) initiatives, yet has the potential to ease the increasing burden on public health resources and strengthen the health sector in developing countries. Health systems strengthening initiatives can engage the private sector to expand access to quality care to underserved populations and create linkages between the public and private sectors to build an integrated, sustainable health system.
Better integration of the commercial health sector into the health system improves the efficiency of resources and may be preferable to some clients. Private facilities can alleviate the patient load on public facilities, have shorter wait times, reduce stigmatization, and provide more flexible scheduling. Some patients also perceive private facilities as having more respect for confidentiality and sensitivity toward patient needs (Sandiford, Gor ter, and Salvetto 2002). Patients may be geographically closer to a private provider, enabling them to access services closer to their homes or work. According to data collected by the World Health Organization (WHO) in 2006, approximately 21 percent of patients receiving antiretroviral therapy (ART) in six African nations (Botswana, Kenya, Namibia, Nigeria, South Africa, and Uganda) were receiving treatment in the private sector (Feeley, Connelly, and Rosen 2007).
Despite these potential benefits, including private sector involvement in the national strategy for meeting HIV needs has been overlooked in some regions due to quality concerns about provider training, prescribing standards, regular testing and monitoring of HIV patients, adequate counseling on prevention, and appropriate management of oppor tunistic infections, among other things (Over 2009). In some countries where the private sector is heavily involved in HIV treatment but also largely unregulated, clinical mismanagement may exacerbate the epidemic’s impact and cost. Donor and government concerns about quality and affordability may have limited the role the private sector currently plays in HIV care and treatment but there are successful models that attempt to address these concerns. This brief presents a sampling of those models.
This technical brief will describe effective or promising practices that leverage the private health care sector in developing countries, taking advantage of existing infrastructure, financial resources, and expertise to better integrate HIV services and reduce the burden on public health facilities. The authors undertook a review of published literature describing existing models of private health sector integration into HIV service delivery in developing countries, as well as interviews with program managers. It is intended to be a tool for program planners and implementers of HSS initiatives. The introductory table and section titled “Implementation Considerations” should prove universally valuable, while the details of different programmatic examples will be useful to individual program planners, depending on their needs.