The best of both worlds: How PPPs can deliver 'choice' to women living in poverty

As support for universal health coverage continues to expand, tremendous opportunities for public-private partnerships are emerging from the Philippines to Ghana and beyond.

There’s ample evidence that the private sector is a key contributor to the supply of health care in much of the developing world. But private health care in these markets is not without its challenges. Services are often unregulated, leading to poor quality and a  focus on curative services at the expense of preventative health. Furthermore, women living in poverty by and large access private health care through out-of-pocket payments, discouraging them from spending their hard earned cash on “what ifs” like preventing unplanned pregnancies. This can then lead to “health shock”-induced poverty in the event of illness.

But a paradigm shift is happening in health markets across the world that is creating enormous opportunities to leverage the supply of private health care to meet the needs of the poor. This shift is the increasing use of public funds to purchase health care from both public and private suppliers of services. We are seeing this happen through state supporting health insurance programs like PhilHealth in the Philippines to government contracting of health services in a diverse range of developing world markets.

This is why we at Marie Stopes International continue to invest in social franchising in developing world health markets. Social franchising seeks to organise small private healthcare providers that serve poor communities. We develop the capacity of these providers to offer reproductive health services like family planning, provide a quality assurance framework for their services, and eventually accredit these health care businesses and promote their services under a common franchise brand. This has been a key strategy for scaling up access to long acting methods of contraception in markets as diverse as Uganda, Mali, Pakistan and Vietnam.

The newest benefit of social franchising is that the resulting quality-assured networks are much easier to accredit into emerging insurance schemes. In the Philippines, we’ve had tremendous success helping midwives establish clinics that can achieve accreditation with the national insurance system.  Linked with an ambitious strategy by the government of the Philippines to subsidize premiums for poor Filipinos, this creates an opportunity for our BlueStar Pilipinas network to deliver high quality health care to women irrespective of their ability to pay and creates an attractive business proposition for our midwife partners to serve the poor.

Of course, challenges remain. We need to ensure that family planning and other cost-effective preventative health services are being included in universal health coverage  planning by governments that have tended to focus on hospital level care for the sick. We also need to make sure that publicly subsidised schemes like national insurance include the poor and underserved. Finally, we need to make sure that these systems are willing to purchase health care services from the small, low-level providers that poor women often rely on.

Social franchise networks have begun to demonstrate the role that these small, low-level private providers can play in helping achieve national health goals, but we have a lot more work to do if are going to ensure that these networks become a sustainable source of essential health care for poor women and their families. Work is underway to create industry standard metrics to ensure the accountability of health care suppliers and allow governments and other purchasers of health care to make their decisions based on clinical quality and the ability to reach the poor.  

Work is also underway to test these ideas in complex and underserved health markets as part of the African Health Markets for Equity Partnership. Most importantly, we need to better understand the needs of poor families, their health seeking behaviours, and their barriers to access so that we can ensure that health care financing and the supply of health care services are designed to meet their needs.

Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.