The Role of Non State Providers in Child

Health in East Asia and the Pacific

Dr Abby Bloom
Sydney Medical School & Menzies Health Policy Inst
Nossal Global Health Institute, Univ Melbourne
Dr Dominic Montagu
Univ California San Francisco, Global Health

The views expressed in this presentation are the views of the author(s) and do not necessarily reflect the views or policies of the Asian
Development Bank (ADB), or its Board of Directors or the governments they represent. ADB does not guarantee the source, originality,
accuracy, completeness or reliability of any statement, information, data, finding, interpretation, advice, opinion, or view presented, nor
does it make any representation concerning the same.
Out-of-pocket spending on health
as a percentage of national Total Health Expenditure

(plus China)
countries
Group 1

(plus Mongolia)
countries
Group 2

Source: WHO, 2006 National Health Accounts Data: http://www.who.int/nha/country/en/index.html

Out-of-pocket spending on health
as a percentage of national Total Health Expenditure

(plus China)
countries
Group 1

(plus Mongolia)
countries
Group 2

Source: WHO, 2006 National Health Accounts Data: http://www.who.int/nha/country/en/index.html

Source of Healthcare by Wealth Quintile

Source: DHS Data (Cambodia 2005; Indonesia 2007; Philippines 2003; Vietnam 2002)
A Wide Range of Models for NSP
Involvement in Child Health

Contracting (“PPPs”)

Purchasing

Social marketing

Social franchising

Social entrepreneurship

NGO and FBO direct provision of care

Vouchers

Insurance (including Social insurance)

Accreditation

Certification

Output Based Aid

Provider Training

Patient Education

Manufacturer-based supplements

Manufacturer-based product subsidies
Source of healthcare: Cambodia

83% of
healthcare
from private
providers

78% of
healthcare
from private
providers

Source: DHS Data Cambodia 2005

Cambodia - Current Situation

Poor health, but steady improvements

Private Out of Pocket (OOP) is main source of

financing

80% of population treated in private facilities

Good examples of government & private

collaboration to increase access & quality for
priority health services
Cambodia: Malaria Treatment

70% of fevers treated in the private sector

Aim: to assure widespread coverage of
ACTs.

Government & PSI are partners in
Affordable Medicines Facility-Malaria
(AMFm) initiative.

PSI co-packages ACT and rapid test kits

Comprehensive training provided

IEC and BCC create market demand

270,000 units sold in 2009

Will be available in both private and Govt
shops and clinics
Source of healthcare: Indonesia

83% of
healthcare
from private
providers

69% of
healthcare
from private
providers

Source: DHS Data Indonesia 2007

Indonesia – Current Situation

Private sector provides ¾ of all health services

½ of all financing for health is private

“Dual practice” by government clinical staff

Decentralization has led to financing challenges

within the national delivery system

Self-treatment for simple ailments is common
Indonesian Midwives Association

USAID-supported initiative to improve

quality standards among private midwives

BidanDelima program for training and

certification

7,800 members: 10% of all Indonesian

Midwives
Source of healthcare: Philippines

75% of
healthcare
from private
providers

46% of
healthcare
from private
providers

Source: DHS Data Philippines 2003

Philippines – Current Situation

Private health expenditure > than government
expenditure

Poor most often seek healthcare from informal

sector: shops, friends, and relatives

Pharmaceutical sales = 46.6% of THE

Strong national leadership + well-managed

national health insurance program = foundation
for collaboration
 Philippines:Drugstore Franchising

Philippines has highest retail drug costs
in EAP

Government response: BotikangBayan
franchise of private drug stores

Operated by PITC, governmental trade
company

Central procurement from India, China,
and local generic manufacturers

1,971 participating pharmacies across
the country

photo: www.pia.gov.ph/press/
 Key Message 1:
The private sector is pervasive and has been filling
the gap in EAP for some time

What’s wrong with the current situation?

 The private sector is often unqualified, usually unregulated,

overservices or provides ineffective care

 And… out-of pocket payment (OOPS) is regressive and

penalizes poor.
 Key Message 2:
Government engagement, let alone
"stewardship“, is very limited.

“Stewardship Lite”

But there is opportunity now to review and

strengthen.
Key Message 3:
There are already very impressive examples
of private sector initiatives contributing to
the health of children:

Cambodia

Indonesia

Philippines, Vietnam, Fiji, etc.
 Key Message 4:
There is a very broad menu of mechanisms from
which Government can choose.

Options are much greater than is generally considered –

and

Most are much easier, and less risky, than traditional
“PPPs”, and

Have much greater impact on the poor and on equity.
Key Message 5:
Government must answer 3 questions:

1. What are we trying to achieve?

Lower infant mortality? Build and equip new hospitals? Replace

inefficient work practices? Improve equity????

2. What options have been proven to achieve these

objectives?

Look at the long list of options available – and choose the ones that
are likely to have the outcomes Government wants for poor children.
3. What is our country’s capacity to support these
initiatives and mechanisms?

To engage and manage the private sector for the "public good"?

What is our capacity for stewardship?

Are we ready now? If not, what can we do to be ready to manage
technical, financial and economic risks?
Ex: Review & revise legislation, regulations and funding (Mongolia,
Vietnam, Indonesia)
Ex: This Workshop: bringing together stakeholders, including
Ministries of Finance and NSPs, not just MOH, to consider
strategies.
Contact details:
Dr Abby Bloom
healthinnovate@optusnet.com.au