The Role of Public-Private Partnerships in Health Systems Strengthening Workshop Summary (2016) / Chapter Skim
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Appendix A: A Review of PublicPrivate Partnership Activities in Health System Strengthening
Appendix A: A Review of PublicPrivate Partnership Activities in Health System Strengthening
Pages 67-86
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From page 67... ...
Authors of the Lancet's Global Convergence Series suggest a "diagonal" approach to health programming, which could support decreases in mortality in LMICs to the level of high-income countries (HICs)
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From page 68... ...
would coalesce into a basic multifunctional health service delivery platform that can provide lifelong care for people with chronic diseases and can establish a base to treat a range of health concerns. (Jamison et al., 2013)
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It is inclusive of personal health care delivery services, public or population health services, health research systems, and policies and programs within other sectors that address broader determinants of health. Additionally, a health system with robust public health services includes mechanisms for monitoring health status to identify and solve community health problems; diagnosing and investigating health problems and health hazards in the community; health promotion; community participation in health; developing policies and plans that support individual and community health efforts; enforcing laws and regulations that protect health and ensure safety; promotion of equitable access; human resources development and training in public health; quality assurance; public health research; and reduction of the impact of emergencies and disasters on health.
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This literature review was prepared to inform the workshop audience of lessons learned during previous iterations of PPPs involved in HSS, in order to inspire PPP Forum members and the public audience to share experiences that might fill gaps in the literature, and discuss alternative models of PPPs that address obstacles experienced in the past. This review is structured around four major themes that emerged from the literature -- service delivery, health workforce, medical technology, and laboratory systems -- demonstrating the tendency of PPPs to focus on components of the health system instead of the health system as a whole.
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From page 71... ...
with Malawi's leading faith-based provider, the Christian Health Association of Malawi (CHAM) , to operate rural health facilities; CHAM now operates 35 percent of all health facilities in the country (Chirwa et al., 2013)
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If the Central Medical Stores could not keep up with the demand, CHAM facilities resorted to purchasing more expensive drugs from private drug suppliers, leading to greater cost escalation. To make up for rising costs, some CHAM facilities unilaterally revised their service price lists; this list stated the price at which district health offices would reimburse CHAM facilities for services.
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Private academic and charitable institutions, including the African Medical and Research Foundation, Kenya Medical Training College, and Kenya Institute of Administration, supported health workforce training and exposure to best practices for HIV/AIDS care. The recruitment and training process took around 6 months; those who completed the process were given 3-year contracts, after which they were absorbed by
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. It is not certain how effective the new health care workers were overall, or to what extent the Emergency Hiring Program impacted HIV/AIDS-related deaths.
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. TDR has funded several PD PPPs, including the Global Forum for Health Research, the Multilateral Initiative for Malaria, the Medicines for Malaria Venture, the Strategic Initiative for Developing Capacity in Ethical Review, Drugs for Neglected Diseases Initiative, the Forum for African Medical Editors, and the Foundation for Innovative New Diagnostics (Zicker, 2007)
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. In fact, these issues are similarly experienced by PPPs involved in strengthening other components of the health system, leading one to believe that weak financial sustainability and inadequate definition of roles and responsibilities to be among the greatest challenges facing PPPs for HSS.
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With the goal of strengthening national laboratory systems in eight African countries severely impacted by HIV/AIDS and tuberculosis (TB) , the PPP focuses on training laboratory workers, improving the range and quality of services, developing tools and guidelines for quality control and quality assurance, strengthening TB reference laboratories to serve as training facilities, and improving access to diagnostics for TB.
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Additionally, extensive training in HIV-related services provides access to new information and professional growth opportunities for laboratory and health care workers, which may contribute to the retention of these workers in the future. It is critical, however, that donors, governments, and other partners enable the broader patient population to access newly established resources through national policies and funding support.
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The article by Doyin Oluwolea and John Kraemerb is mostly an optimistic account of PRRR activities, while the article on GAVI is a critical perspective that describes aspects of the partnership that did not function well. Pink Ribbon Red Ribbon PRRR is a PPP designed to support cancer control -- in particular, cervical cancer -- in Africa and Latin America; however, Oluwolea and Kraemerb use the term "diagonal approach" to describe the partnership's strategy of bringing together partners from across the health system and benefitting from existing vertical programs, such as those established for HIV/AIDS control, to strengthen the broader issue of chronic disease management.
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Governance structures at the country level varied with each iteration, but included government stakeholders, civil society representatives, and NGOs. In a thorough study on GAVI operations at the global and country lev
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Based on the literature contained in this review, future iterations of PPPs involved in HSS could take the following actions to address key challenges experienced in the past: 1. Consult with national, district, and community stakeholders, in particular local health authorities, to identify health priorities and needs at each level.
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13. Ensure adequate integration of national health programs and policies at privately operated health facilities, taking into account any additional resources or support necessary.
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CONCLUSION Diagonal approaches to global health programming will allow a convergence to happen within the next two decades; thus, PPPs that continue to address disease priorities and strengthen health systems will help LMICs reduce mortality to the level of HICs by 2035. As public and private organizations become more active in pursuing HSS strategies, the workshop serves as an opportunity to examine new models of partnerships that account for sustainability, incentives, measuring performance, and addressing the key challenges experienced in the past.
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2008. The health worker recruitment and deployment process in Kenya: An emergency hiring program.
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2009. Global Health partnerships in practice: Taking stock of the GAVI Alli ance's new investment in health systems strengthening.
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