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Private Health Sector Platform: Influencing the National Health Strategy in Benin
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The private health sector in Benin has grown significantly over the past 20 years and is recognized as an important player in service delivery in Benin’s health sector national development plan (2009-2018). In 2013, USAID’s Strengthening Health Outcomes through the Private Sector (SHOPS) project conducted an assessment of Benin’s private health sector, highlighting both the strengths and the weaknesses inherent in this sector.1 Per the assessment findings, the sector has (i) a regulatory framework that’s not conducive to growth, (ii) weaknesses in the general administration of health institutions (iii) limited capacity or lack of conformity with clinical standards, (iv) weak ties to the public sector and (v) high costs. This situation limits equal access to health services despite the operational capacity for the private health sector to cover 66% of health services (compared to 65% for the public health sector).2 The SHOPS project also conducted a census on Benin’s private sector in 2014, which describes the size, scope, and geographic distribution of private health care facilities and providers in the country.3 The census estimated that the private health sector has more than 2,000 practices, including approximately 1,500 unregistered facilities, and identified over 10,000 providers working in private facilities and nearly 2,900 in non-pharmacy facilities. The census also showed that 55% of the facilities are located in rural areas; 77% offer one or more component of the maternal, neonatal, and child health (MNCH) set of services; and 16% are affiliated to an NGO or other organizations.
In search of a structural solution to the identified challenges and a way to increase private health sector participation in the strengthening of Benin’s health sector, the Private Health Sector Platform (PHSP) was established on May 16, 2014, with assistance from USAID’s Health Financing and Governance project. As a coalition of professional health care providers, the PHSP aims to be a platform that is (i) solely private (ii) representative of all segments of the private health sector (ii) inclusive, regardless of the health-related activity and (iv) apolitical, dynamic and open minded. PHSP has been identified as “a champion” among its peers to serve as an interface between the Ministry of Health (MOH) and all private health sector stakeholders in Benin.
USAID/ANCRE’s Strategic Approach
PHSP’s vision requires a solid institutional organization to progressively provide technical, managerial and material assistance. To support its growth and sustainability, USAID’s Advancing Newborn, Child and Reproductive Health (ANCRE) program works closely with PHSP to improve the institutional environment of private health providers and improve their service quality.
Key Activities and Interventions
Building a partnership: To better position the Platform on the national front as a significant partner for the public health sector and to serve as a formal platform for interaction amongst participants, USAID/ANCRE assisted the Platform gain official recognition from the MOH. A Memorandum of Understanding was established with the MOH and was signed in July 2017.
Development and implementation of a roadmap for PHSP: In June 2015, USAID/ANCRE supported PHSP draft a roadmap that would lead to better regulation of the private health sector. The roadmap includes four major strategies: strengthening the partnership with the MOH,streamlining registration and licensing processes for private providers and private facilities, strengthening institutional capacity of PHSP, and improving the policy environment for the private health sector.
Institutional strengthening of PHSP: USAID/ANCRE supported PHSP create an executive committee that would oversee strategic orientation, coordination, and implementation of its activities. To ensure that critically-needed staff were in place, the program helped recruit an executive secretariat and an administrative assistant. USAID/ANCRE also guided PHSP in the identification and establishment of an office that now serves as the Platform’s headquarters.
In May 2017, USAID/ANCRE supported a capacity building workshop that brought together 27 participants, including members of PHSP and representatives from the MOH and USAID. Participants learned how to mobilize technical, material, and financial resources that align potential contributors’ interests with PHSP organizational needs. In addition, participants learned to assess and leverage their own resources to facilitate the engagement and mobilization of potential contributors to provide complementary support.
Providing support to health sector reforms: USAID/ ANCRE assisted PHSP in the preparation of private sector proposals that were submitted to the National Commission, the government structure in charge of these reforms. These proposals addressed aspects relating to: (i) regulation, (ii) structure of Benin’s health sector (iii) improving access to quality care for the population, (iv) quality assurance for medicines given out in private institutions (v) professional health training and (vi) improving the private health sector’s contribution to Benin’s health information and management systems (SNIGS).
Assistance in establishing a technical committee for program accreditation: USAID/ANCRE supported PHSP develop accreditation guidelines, which were approved by the MOH in April 2016. Following a recommendation of the approval committee, the program assisted the Platform set up a technical committee to manage the accreditation program. Support consisted of:
- Recruitment of an executive secretary for the technical committee and defining a scope of work
- Producing a bi-annual brochure on regulation and accreditation to inform and educate private health providers. This brochure, published in two issues, succinctly explains the legal requirements for running or setting up a private practice.
- Joint organization (PHSP/ANCRE) of workshops for 468 private health clinics on licensing and registration procedures
Key Achievements and Progress To-date
Improved functionality of PHSP
As a result of USAID/ANCRE support, the Platform’s executive secretary is functional and actively participates in Benin’s health sector activities, including strategic discussions with the MOH and implementing partners. PHSP’s recommendations to the commission in charge of private health sector reforms were commended for their pertinence and importance and considered in the reforms submitted to MOH officials.
Provided essential support to position PHSP as an important partner in Benin’s health sector
With USAID/ANCRE’s support, PHSP has progressively positioned itself as a reliable interlocutor of the private health sector with the MOH. The Platform is increasingly becoming the structure for interaction between the private health sector and the public health sector in Benin. This is reflected in the Platform's invitation to strategic MOH meetings, such as the national dialogue on health financing and renewal of the Global Fund grant for HIV/AIDS and malaria in Benin. MOH is also soliciting PHSP’s contribution to the drafting of the private health sector portion of the report from the Health Reform Commission.
Increased interest in accreditation
At the end of May 2017, 64 clinics and five (05) pharmacies expressed interest in obtaining accreditation by registering with the Platform for support in improving the quality of their health services (see Figure 1). Further, other private health facilities have registered with the MOH's technical services for licensing, which is a prerequisite for enrollment in the accreditation program. To date, 15 of the 64 clinics in the program are supported by USAID/ANCRE’s technical team.
USAID/ANCRE’s technical support to the institutional and organizational strengthening of the private health sector through the PHSP has contributed to the strengthening of the national health system. Support of this kind is a first in Benin. This experience shows that better attention to the private health sector is a necessary component for a strengthened health system in Benin.
A pool of strong technical personnel is necessary for the sustainability and capitalization of Benin’s PHSP. USAID/ANCRE has assisted PHSP in setting up a team of qualified personnel and has built their capacity to support the accreditation program. Engagement of these seasoned professionals reveals their eagerness to develop the private health sector in Benin. As qualified staff, they can provide tailored coaching to private health providers that are registered in the accreditation program.
1 SHOPS Project (2013). Benin Private Health Sector Assessment. Brief. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates Inc.
2 Benin. Ministry of Health (2015). Availability and operational capacity of health services: SARA survey 2015, Cotonou.
3 SHOPS Project (2014). Benin Private Health Sector Census. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates Inc.
This document was prepared by the USAID/Benin Advancing Newborn, Child and Reproductive Health (ANCRE) program. The ANCRE program is funded by the United States Agency for International Development (USAID)/Benin under Agreement Number AID-680-A-14-00001. The program is implemented by University Research Co., LLC (URC), and sub-recipients Dimagi, Inc. and the Results for Development Institute (R4D).