Private Providers Important to Maternal Health Care

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By: Amy Boldosser, Director, Global Advocacy Program, Family Care International

Family Care International was proud to partner with Merck for Mothers and Women Deliver to host a stimulating and provocative discussion on The Role of Private Providers in Expanding Access to Affordable, Quality Maternal Healthcare. At this side event to the 2012 UN General Assembly, held in New York on September 25, 2012, a distinguished panel of speakers highlighted the crucial role that private providers play in ensuring access to quality maternal health care, especially for the most marginalized populations, and the important contribution they can make in accelerating progress towards achieving Millennium Development Goal (MDG) 5, which aims to reduce maternal mortality by 75% and achieve universal access to reproductive health.

While there has been notable progress in reducing maternal mortality globally over the past decade, only 10 countries are currently on track to reach the 75% reduction target, and more than a quarter-million women continue to die each year from complications of pregnancy and childbirth. Approximately 99% of maternal deaths occur in the developing world, most of them in sub-Saharan Africa and South Asia, and almost all of these deaths could be prevented with better access to skilled care before, during, and after childbirth. In many countries, the private health sector — including independent physicians, nurses, and midwives; traditional practitioners; private clinics and hospitals; pharmacies, health shops, and drug outlets; and health insurers — plays a central role in helping governments accelerate efforts to reach women with essential, lifesaving care. Non-health businesses, including transportation operators, mobile service providers, and financial institutions, also play an important role in facilitating health care.

Speakers at the event, moderated by Diane Brady of Bloomberg Businessweek, included Nigerian Minister of Finance Ngozi Okonjo-Iweala; Dr. Flavia Bustreo, Assistant Director-General of the World Health Organization; Sweta Mangal, co-founder and CEO of Ziqitza Health Care Limited, a private ambulance service in India; and Karl Hofmann, CEO of Population Services International (PSI), an NGO that focuses on “social marketing” of family planning and other essential health supplies and services.

Jill Sheffield, president of Women Deliver, provided the context for the discussion and introduced Geralyn Ritter, Merck’s Senior Vice President of Public Policy and Corporate Responsibility, who noted the vital, but often overlooked, role that private healthcare providers and health businesses play in delivering health care in local communities. Roughly half of Africans and up to 80% of South Asians now receive care from the private sector, she said; independent midwives, private clinics, and local pharmacies are trusted by the communities they serve, and are key partners in government efforts to improve maternal health. The Merck for Mothers initiative, a 10-year, $500 million initiative to reduce maternal deaths, is working with private providers and health businesses at the local level to ensure that the care they provide is accessible, affordable, and of high quality.

Dr. Bustreo, who heads WHO’s programs for Family, Women’s and Children’s Health, described WHO’s work, in partnership with governments and the private sector, to identify and promote innovative solutions to the maternal health challenges faced by countries, health providers, and women. She also highlighted the high cost of maternal health services as a critical barrier that limits women’s access to the services they need, and discussed approaches that countries are using to address it.

The Honorable Dr. Okonjo-Iweala, who has served as Nigeria’s Minister of Finance and as its Foreign Minister, and is a former Managing Director of The World Bank, focused on empowering women and girls: “Women are the next emerging market and are a force to reckon with. If we invest in women, we can move the world.”  In Nigeria, she noted, 43% of health care facilities are private, so the government understands the importance of engaging private providers and ensuring that they are appropriately regulated. Scaling up midwifery services is a key to ensuring increased coverage in rural areas, she said, and Nigeria’s conditional cash transfer scheme, which provides women with financial incentives for attending a certain number of antenatal visits, is a key policy for expanding access to care. Dr. Okonjo-Iweala reported that, in the areas where these cash transfers have been offered, there has been a 16% decline in maternal deaths.

Karl Hofmann discussed social franchising, a “cousin of social marketing,” as a channel for ensuring that quality services and technologies reach women and their families. Social franchising efforts work to build recognition for providers who serve poor and vulnerable women: a key element of their “brand” is ensuring that all franchisees meet improved service standards and provide good quality care. PSI has, to date, provided support for franchising 10,000 providers in 24 countries; these providers reach 10 million people with essential health care services each year.

Sweta Mangal shared Ziqitza Health Care’s experience operating more than 860 advanced and basic life support ambulances across India, filling a gap in government services and increasing access to quality, lifesaving care for poor patients. One-third of Ziqitza’s patients are pregnant women needing transport to health facilities that offer skilled delivery care. In addition, she said, more than 5,000 babies have been born in Ziqitza’s ambulances, since government hospitals are often too overcrowded to immediately accommodate all of the pregnant women who arrive by ambulance.

A lively discussion followed these presentations, focusing on how to ensure that private providers and health businesses comply with government regulations and protocols, meet quality standards, and provide services that are affordable and accessible for users from all income levels.

At the meeting’s conclusion, Family Care International’s president Ann Starrs referenced recent remarks by Dr. Margaret Chan, Director General of WHO, that universal health coverage is an idea whose time has come. “There is a consensus in most parts of the world that it is the responsibility of governments to ensure that all people have access to basic preventative and curative health care,” she noted. “But that doesn’t mean that governments have to provide those services themselves.” The private sector offers clear advantages, she said, in terms of pioneering innovative approaches, their connection to the community, efficiency and cost-effectiveness, and sustainability. Enabling the private sector to maximize its potential contributions requires governments to provide a normative and regulatory framework to ensure that quality standards are met; financing mechanisms to make services affordable; training and support of private sector providers; and sharing learning, experiences, and evidence. “Partnership,” she said, “is the key.”