November Updates from the Primary Health Care Initiative Nov 30, 2017

November Updates from the Primary Health Care Initiative

The Private Sector Engagement and Health Benefits Policy collaboratives under the JLN’s Primary Health Care initiative both convened this past month to reflect on the progress made toward their respective joint learning objectives. The two collaboratives ultimately aim to strengthen countries’ primary health care sectors, resulting in greater access to health care, higher patient satisfaction, and increased financial sustainability of health systems.

In most health systems, effectively engaging the private sector to provide health services is a vital approach to strengthening primary health care. The Private Sector Engagement collaborative provides guidance for implementers on best practices for engagement with the private sector to deliver primary health care services to achieve universal health coverage.

The Health Benefits Policy collaborative aims to develop a framework for analyzing available resources, policies, practices, and stakeholders to align primary health care policies and service delivery with a defined benefits package, a key element in providing access to primary care services.

Private Sector Engagement Collaborative

On November 2, 2017, the Private Sector Engagement (PSE) collaborative hosted a webinar for countries to share their experiences with implementing country regulatory system assessments, specifically on the regulation of private sector primary health care, with attendees from Ghana, Indonesia, Kenya, Malaysia, and Mongolia.

During the webinar, the group reviewed the work completed at this stage of the collaborative; participants from Indonesia and Malaysia presented their experiences implementing country regulatory system assessments; and participants discussed overall experiences, lessons learned, and next steps.

In 2016, the Private Sector Engagement collaborative completed the first two modules of a five-part practical guide titled, “Engaging the Private Sector in Primary Health Care to Achieve Universal Health Coverage: Advice from Implementers to Implementers” (available here). The practical manual contains step-by-step guidance along with real-world case studies to facilitate public-private sector engagement around primary health care, serving as a resource for public sector policymakers and practitioners interested in engaging and partnering with private sector actors.

The first two modules focus on initial communications and partnership between the public-private sector around PHC while the second module addresses provider mapping. The collaborative is currently developing the third module on provider and facility regulation, accreditation, or empanelment.  

To inform Module 3 of the practical guide and bridge the information gap regarding private sector regulation of PHC in low- and middle-income countries (LMICs), collaborative members plan to co-develop a series of case studies to document:

  • The type of regulations that govern the private health sector in LMICs
  • How private health sector regulations have been implemented in LMICs
  • The resources available for developing and implementing regulations in LMICs
  • The outcomes of regulations implemented in LMICs

Country Discussions
Following an introduction of the meeting norms, objectives, and the status of the collaborative’s work, Malaysia and Indonesia kickstarted the discussion with presentations on their data collection experiences.

Malaysia described their data collection process, which included secondary data collection completed by reviewing existing laws and regulations, as well as primary data collection from interviews with relevant stakeholders such as ministries of health, licensing bodies, and health insurance agencies. Like Malaysia, Indonesia utilized a mixed-methods approach to data collection, conducting key-informant interviews, holding focus group discussions, and compiling secondary data.

Country members engaged in a robust discussion on their experiences conducting data collection and analysis for the country assessments of the regulatory system. For example, Ghana and Kenya have experienced recent changes in government that have influenced their data collection timelines, whereas Indonesia and Malaysia highlighted the challenges they faced interviewing a wide variety of stakeholders. Through this discussion, country members had the opportunity to share recommendations and advice with their colleagues facing similar challenges.

Health Benefits Policy Collaborative

The Health Benefits Policy (HBP) collaborative also hosted a webinar this past month with participation from Ghana, Indonesia, Kenya, Malaysia, Mali, and Vietnam to discuss the status of the group’s work. Currently, the collaborative is completing data collection for the health benefits package implementation assessments.

The aim of these health benefits package implementation assessments is to evaluate and uncover complementary policies enacted by decision makers based on a series of prioritized health objectives.  Countries often have limited resources, and therefore must prioritize only a few objectives during different stages of reform. These implementation assessments will help countries determine their prioritized health objectives, and then evaluate how effectively complimentary policies achieved original health goals. Through the process of completing each implementation assessment, the collaborative will also surface best practices and create a menu of policy options that countries can choose depending on their health priorities, and evaluate the efficacy of their efforts.

All countries participating in the collaborative are in the process of defining, or have recently defined, health benefit packages and enacted supportive policies to promote access to the services in the package. The assessments apply the health benefits policy analytical framework co-developed by the collaborative to ultimately inform the development of resources for practitioners. More information on the health benefits policy analytical framework can be found in the collaborative’s recent health benefits policy brief.

With the collaborative nearing completion of the data collection phase, members convened to reflect on their overall experiences, lessons learned, successes, challenges, preliminary findings, and the framework.

Country Discussions
Following this overview, the Indonesia and Malaysia teams presented their data collection experiences and preliminary findings. The Indonesia and Malaysia assessments provide complementary perspectives of data findings and challenges; while Indonesia focused primarily on primary data collection through key informant interviews and focus group discussions, Malaysia relied entirely on secondary data.

Following the presentations, countries shared their own experiences with data collection and early findings, focusing much of the discussion on the prioritization of health objectives which include, health outcomes, financial protection, quality, efficiency, equity, and sustainability. Countries prioritize each of these health objectives differently based on context and, depending on their priorities, a country will use diverse policies within each of the six domains to accomplish their objectives.

Next Steps for the PSE and HBP Collaboratives

The Private Sector Engagement and Health Benefits Policy collaboratives will meet during a cross-collaborative JLN meeting held in Seoul, South Korea. The JLN’s Steering Group and four JLN collaboratives will meet for a week of strategic decision-making and joint learning, including the Health Benefits Policy, Primary Health Care Measurement for Improvement, Private Sector Engagement and Domestic Resource Mobilization collaboratives.

Participants will have an opportunity to discuss cross-technical topics at the intersection of health financing and primary health care. The meeting will also include a soft launch of the upcoming Toolkit for Medical Audit Systems, as well as a preview of new UHC tools developed by JLN members. 

During the Seoul meeting, PSE collaborative participants will share experiences and findings from country assessments of the regulatory system that governs private PHC; identify lessons learned across countries to inform Module 3 of the private sector practical guide; and discuss an outline for Module 4 on contract management for the private sector practical guide. Similarly, the HBP collaborative participants will also share experiences and review findings from the health benefits package implementation assessment and synthesize cross country lessons for health benefits policies.

Following the meeting in Seoul, countries that are part of both collaboratives will complete their respective assessments and work on a cross-country synthesis report. The PSE collaborative will also use findings from the case studies to inform Module 3 on private sector regulation.