As the importance of the private sector in achieving family planning goals becomes increasingly apparent, public stewards are looking to engage with the private sector. But, they often lack the skills, information and resources to do so. A new SHOPS Plus primer addresses this gap.
“Governments and ministries of health are starting to understand the role of the private sector in family planning, but the question is always, how? How do you steward the private sector so their activities and services are aligned with the country’s family planning priorities? What are the mechanisms for engaging and partnering?” explains Nelson Gitonga, Public-Private Partnerships Advisor for SHOPS Plus and co-author of "Stewarding the Private Sector for Family Planning."
The new primer features successful examples of public stewards engaging with the private sector for family planning and provides recommended approaches to help governments design better stewardship models by focusing on three key aspects of stewardship—policy and strategy development, regulations, and supervision.
Policies and Strategies
The presence and role of the private sector is an important, but often incomplete step. Policies and strategies should define a clear framework and process for public-private engagement for family planning. For example, in Afghanistan—where social marketing organizations provide a significant source of contraceptive commodities—the national reproductive health strategy helps the government and donors work with private providers by outlining the types of outlets to engage, the services and products to target, and the mechanisms for that engagement.
It is important to strike a balance between private providers’ financial incentives and the need to achieve public health goals. Regulations designed to increase access to family planning in the private sector, like price controls, can actually be counterproductive. If price controls are set too low, private providers may not be able to earn enough to cover the costs of their commodities and staff time, and therefore, decide not to offer the service.
Jordan offers an interesting example of how government stewards can alter regulations to align market incentives with family planning goals. Because the private sector holds a major share of the family planning market, government stakeholders were concerned about the financial burden women might face. To bring down prices and make private family planning options more affordable, the National Population Commission successfully lobbied the Minister of Finance, Minister of Industry and Commerce, and General Director of Customs, as well as the Council of Ministers, to ease specific regulations for the family planning market. As a result of this lobbying, the Jordanian government removed all taxes, duties, and tariffs on imported contraceptive commodities. Not only did this make family planning options more affordable, it allowed the private sector to introduce newer generations of oral contraceptive pills at more affordable and cost-competitive prices than they previously would have.
“Jordan is important as a case,” Gitonga notes, “They needed a third party to help ensure the Ministry of Finance and the Ministry of Health were working together. But, every country is very different in terms of its regulation framework. In some cases we are asking the government to tighten their regulation framework and in some cases we are asking them to loosen their regulative framework.”
Supervising private providers requires a very different approach from supervising public providers. Within the public sector, supervision is relatively straightforward since both supervisors and providers are employed by government agencies that often are under the purview of the ministry of health. For private providers, government stewards lack that same direct access. And, they often lack basic information to know who private providers are and where they are located to plan supervisory visits. Effective supervision in the private sector, therefore, may require significantly more resources in terms of staff time, technical capacity, and data systems. In Malaysia, where the government lacks sufficient human resources to directly oversee all facilities, the Ministry of Health has partnered with a private association to develops standards, plan and implement accreditation programs, and promote safety and quality improvement in health care facilities. This has relieved the ministry of health of some of the direct, regular supervision burden.
Read more about how public stewards can engage with the private sector in these three areas and explore additional country examples in the full primer.