STRIDES for Family Health: Opportunities for Partnering with the Private Sector Background In Uganda, there is strong potential for strengthening partnerships with the private sector to increase access and use of reproductive health (RH), family planning (FP), and child survival (CS) services through its multiple channels, products, and services. There is already wide use and acceptance among Ugandans of the private sector for a range of health products and services—even among the poorest groups. For example, just over half (52 percent) of women obtain their family planning methods from the private sector; approximately 19 percent receive their antenatal care from the private sector.1 Private sector distribution channels (shops, pharmacies, and open markets) account for sourcing of over 60% of mosquito nets; non-governmental and faith-based organizations represent another 14 percent.2 While public sector facilities are recognized by the general public for their management and diagnosis of malaria, the private sector is also the major source for anti-malarials.3 The Ugandan Ministry of Health (MOH) recognizes the importance of the private sector in meeting the country’s overall health goals, and its National Health Policy4 encourages making the private sector “a major partner in Uganda’s national health development by encouraging and supporting its participation in all aspects of the National Health Programme.” In the health sector, the private sector is defined as for-profit and non-profit, with the non- profit including faith-based organizations such as the Uganda Catholic Medical Bureau and the Protestant Medical Bureau, as well as a large number of non-governmental organizations (NGOs) and USAID- supported programs. Private Partnership Opportunities for the STRIDES project The STRIDES for Family Health project aims to improve the quality of and increased access to integrated RH/FP and CS services to the people who need them in collaboration with the Ugandan MOH and the private sector. To assist in identifying initial opportunities for partnering with the private sector, STRIDES conducted a rapid assessment of on-going private sector activities, including gaps, weaknesses, and opportunities for collaboration as outlined in its Year I workplan. This assessment was conducted by Meridian Group International Inc., the STRIDES partner supporting increased linkages with the private sector. The assessment included interviews with health officials from various STRIDES 1 Uganda Bureau of Statistics (UBOS) and Macro International Inc. 2007. Uganda Demographic and Health Survey 2006. Calverton, Maryland, USA: UBOS and Macro International Inc. 2 Ibid. 3 Understanding Malaria Health-Seeking Behavior in Selected Districts in Uganda: A Formative Survey. Ministry of Health Uganda, Medicines for Malaria Venture, Population Services International, January 2008. 4 Ministry of Health, The Republic of Uganda, National Health Policy, September 1999. 1 Collaboration with the Private Sector districts to better understand their perceptions of the private sector’s role in Kyenjojo District in their respective districts and their current coordination with the private sector. The assessment also included facility-level visits to a The Kyenjojo district serves an estimated population of 435,000 with approximately 40 limited number of private not-for-profit and for-profit facilities to health centers (HCs). There is no district understand some of the issues they face in the delivery of services, and hospital in Kyenjojo. Three of its health meetings with the major social marketing organizations and other centers are HC IVs, and the remaining are HC projects working on public-private partnerships in Uganda.5 These IIIs and IIs. The Kyenjojo district collaborates activities were conducted as a pre-cursor to the baseline/needs with private providers on a number of levels. assessment currently being implemented by STRIDES in each district, Firstly, approximately 10 (HC IIIs and IIs) of providing input into the design of the private sector component of the its 40 health centers are owned and operated directly by private not-for-profit baseline/needs assessment instrument. organizations. These 10 organizations are designated by the districts to receive Poverty Based on this initial rapid assessment, there are a variety of Alleviation Funding (PAF) funding from the opportunities for working with the private sector, including: Ministry of Finance to support provision of services. Seven of these are managed by the Building and strengthening existing linkages between service Catholic Dioses in specific sub-counties; two delivery systems in the public and private sectors. This type of public are located on tea plantations although they private partnership seeks to maximize and improve existing service also serve the general community; and the delivery systems and opportunities for better collaboration and other facility is owned and operated by the coordination between public and private sector initiatives at the district 7th Day Adventist Church. level. In addition, the district also collaborates with a number of NGOs on various services, Expanding access and coverage of services through new, including community mobilization, training, innovative partnerships/collaboration. This type of public private and capacity building activities. These NGOs partnership seeks to identify new linkages, initiatives to increase access include Bringing Hope to the Family, Kind to RH/FP/CS products and services in under-served areas. Uganda, FXB, Toil and Promote Agriculture, GTZ, International Medical Corp, BRAC Increasing corporate contributions to RH/FP/CS. This type of Uganda, PACE, Baylor College of Medicines, partnership seeks to increase participation by the commercial sector in and the UHMG/AFFORD project. The district key health activities through their corporate contributions or corporate has formal memorandum of understandings (MOUs) in place with most of these social responsibility initiatives. organizations, which are signed and executed by the District’s Chief Administrative Officer. Opportunities for building and strengthening linkages between the public and private sectors District-Level Initiatives 5 District level interviews were conducted with health district officials from Kamwenge, Kasese, and Kyenjojo during the STRIDES initial workplan meeting with these western districts. Facility level visits were conducted in Kasese district. 2 The Ministry of Health’s recognition of the importance of the private sector in meeting basic healthcare needs has led to increased collaboration with the private sector at the district level. Many districts have identified Collaboration with the Private privately-owned facilities that receive support from the government for Sector in Kamwenge District the provision of services. These organizations, which are primarily faith- based organizations, receive government support (called Poverty The Kamwenge district serves a population Alleviation Funds), or PAF, through the Ministry of Finance in of approximately 315,000, with 33 health coordination with the district. They receive a bi-monthly allowance that centers. There is no district hospital in covers a portion of medical staffing and supplies, and are considered to be Kamwenge; two of their facilities are health a part of the official district health network. center IVs, and the remainder are HC IIIs and IIs. Kamwenge also has a number of One example of this type of partnership is the Kilembe Mines Hospital in health centers that are owned and operated by not-for-profit organizations (primarily the Kasese district. This hospital was started by Kilembe Mines Ltd. to faith-based) that receive PAF support. provide healthcare services for its employees and the surrounding community. In 1993, when the company was no longer able to run the In addition, the districts maintains hospital on its own, the company established a tripartite agreement with memorandums of understanding with other the government and Catholic diocese.6 In this case, Kilembe Mines Ltd. NGOs such as the Adventist Development Relief Agency (ADRA), Samaritan Pulse, provides the physical infrastructure of the hospital, housing for healthcare Parents Concern, Marie Stopes personnel, and some utility expenses. Approximately 70% of the International, MildMay, Egpaf, CRS, UNICEF, hospital’s medical staff is funded by the government, and the hospital also PACE, Baylor College of Medicine. receives medical supplies from the government. The remaining costs are covered through patient fees and donations provided by the Catholic In terms of collaboration with these NGOs, there is often a sharing of medical diocese. In this case, the hospital functions as the sub-district infrastructure, supplies, and healthcare headquarters for Sungora South (serving a population of 174,000), and personnel. For example, Marie Stopes oversees approximately 20 health units—a well-established example of International often conducts outreach public-private collaboration at the district level. Other PAF-funded services for long-acting and permanent facilities, however, receive significantly less funding—for example, the methods—they provide the medical Bishop Masereka HCIII (also in Kasese) receives funding for only one personnel and supplies for these services at clinic officer out of its 26 total healthcare personnel. Several of the district health facilities. In general, Kamwenge district officials recognized a districts interviewed for