THE PRIVATE HEALTH SECTOR IN WEST AFRICA: SIX MACRO-LEVEL ASSESSMENTS November 2014 This publication was produced for review by the United States Agency for International Development. It was prepared by Bettina Brunner, Andrew Carmona, Alphonse Kouakou, Ibrahima Dolo, Chloé Revuz, Thierry Uwamahoro, Leslie Miles, and Sessi Kotchofa for the Strengthening Health Outcomes through the Private Sector (SHOPS) project. Recommended Citation: Brunner, Bettina, Andrew Carmona, Alphonse Kouakou, Ibrahima Dolo, Chloé Revuz, Thierry Uwamahoro, Leslie Miles, and Sessi Kotchofa. 2014. The Private Health Sector in West Africa: Six Macro-Level Assessments. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates Inc. Download copies of SHOPS publications at: www.shopsproject.org Cooperative Agreement: GPO-A-00-09-00007-00 Submitted to: Daniele Nyirandutiye and Mbayi Kangudie Activity Managers West Africa Regional Health Office United States Agency for International Development Abt Associates Inc. 4550 Montgomery Avenue, Suite 800 North Bethesda, MD 20814 Tel: 301.347.5000 Fax: 301.913.9061 www.abtassociates.com In collaboration with: Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting THE PRIVATE HEALTH SECTOR IN WEST AFRICA: SIX MACRO-LEVEL ASSESSMENTS DISCLAIMER The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States government. TABLE OF CONTENTS Acronyms ............................................................................................................................ v Acknowledgments ............................................................................................................. ix Executive Summary ........................................................................................................... xi 1. Introduction and Methodology .................................................................................... 1 1.1 Background ............................................................................................................... 1 1.2 Development Partner Context ................................................................................... 2 1.3 Methodology .............................................................................................................. 3 1.4 Goals of Macro-Level Assessment Activity ................................................................ 5 1.5 Key Concepts ............................................................................................................ 6 2. Regional Overview ....................................................................................................... 7 2.1 A Regional Look at the Private Health Sector ............................................................ 7 2.2 Key Regional Themes ............................................................................................. 10 3. Country Snapshots .................................................................................................... 19 3.1 Burkina Faso ........................................................................................................... 19 3.1.1 Background .................................................................................................... 19 3.1.2 Overview of the Private Health Sector ............................................................ 20 3.1.3 Enabling Environment ..................................................................................... 25 3.1.4 Trends in Health Finance ................................................................................ 27 3.1.5 Delivery of FP and HIV Services through Public and Private Channels ........... 27 3.1.6 Public-Private Partnerships ............................................................................. 29 3.2 Cameroon ............................................................................................................... 30 3.2.1 Background .................................................................................................... 30 3.2.2 Overview of the Private Health Sector ............................................................ 30 3.2.3 Enabling Environment ..................................................................................... 35 3.2.4 Trends in Health Finance ................................................................................ 36 3.2.5 Delivery of FP and HIV Services through Public and Private Channels ........... 38 3.2.6 Public-Private Partnerships ............................................................................. 41 3.3 Côte d’Ivoire ............................................................................................................ 42 3.3.1 Background .................................................................................................... 42 3.3.2 Overview of the Private Health Sector ............................................................ 43 3.3.3 Enabling Environment ..................................................................................... 45 3.3.4 Trends in Health Finance ................................................................................ 46 3.3.5 Delivery of FP and HIV Services in Public and Private Channels .................... 48 3.3.6 Public-Private Partnerships ............................................................................. 50 3.4 Mauritania ............................................................................................................... 51 3.4.1 Background .................................................................................................... 51 3.4.2 Overview of the Private Health Sector ............................................................ 51 3.4.3 Enabling Environment ..................................................................................... 53 3.4.4 Trends in Health Finance ................................................................................ 54 3.4.5 Delivery of FP and HIV Services in Public and Private Channels .................... 55 3.4.6 Public-Private Partnerships ............................................................................. 57 3.5 Niger ............................................................................................................... 58 3.5.1 Background .................................................................................................... 58 3.5.2 Overview of the Private Health Sector ............................................................ 58 3.5.3 Enabling Environment ..................................................................................... 59 3.5.4 Trends in Health Finance ................................................................................ 61 3.5.5 Delivery of FP and HIV Services through Public and Private Channels ........... 61 3.5.6 Public-Private Partnerships ............................................................................. 65 3.6 Togo ............................................................................................................... 65 3.6.1 Background .................................................................................................... 65 3.6.2 Overview of the Private Health Sector ............................................................ 66 3.6.3 Enabling Environment ..................................................................................... 69 3.6.4 Trends in Health Finance ................................................................................ 70 3.6.5 Delivery of FP and HIV Services through Public and Private Channels ........... 70 3.6.6 Public-Private Partnerships ............................................................................. 72 4. Conclusion and Recommendations .......................................................................... 73 4.1 Conclusions ............................................................................................................. 73 4.2 Recommendations................................................................................................... 73 4.2.1 Regional Recommendations ........................................................................... 73 4.2.2 Country-Specific Recommendations ............................................................... 75 Annex A: Stakeholder Visits by Country ......................................................................... 79 Annex B: Government Policies toward the Private Health Sector ................................. 87 Annex C: Mining Companies Active in Focus Countries of the Report ........................ 93 Annex D: Regional and Country Snapshots ................................................................... 95 Annex E: Bibliography .................................................................................................... 103 ii LIST OF TABLES Table 1: Fertility Rates by Country .............................................................................................. 2 Table 2: Macro Assessment Field Visit Schedule ........................................................................ 4 Table 3: List of Key Stakeholders Interviewed ............................................................................. 6 Table 4: Status of Contraceptive Security Committees by Sector .............................................. 11 Table 5: Ease of Doing Business in Six Focus Countries