Poor patients, private providers, and purchasing for health
Many experts believe that the scale of private healthcare provision in Low- and Middle-Income countries is large enough that engagement of these practitioners will be necessary for any significant advancement towards UHC by 2030. Engagement of private practitioners with government-supported financing is integral to achieving UHC in nearly every OECD country in the world. It is reasonable to imagine LMICs following some version of these models. One advantage of government-led purchasing from private practitioners is that it would respond to well-documented patient preferences for private outpatient services.
Among other goals, over the past six years the African Health Markets for Equity (AHME) project has sought to provide a framework where government or social health insurance (SHI) purchasing from private practitioners can be leveraged to assure good quality and care for the poor.
The challenges faced by AHME in Kenya and Ghana illustrate the difficulties moving from policy to practice and the functional immutability of key aspects of private-patient purchasing behaviour. Our evaluation of AHME provides insights into the critical actors in the patient-provider-purchaser triangle.
In supporting expanded coverage to poor populations, and provision of services that are responsive to the coverage, policies alone can fall short if attention is not given to the gritty details of implementation. The nexus where patients and providers meet, and where providers and purchasers meet, could nullify the best of UHC policies if filled with inconsistencies and confusion that go unacknowledged and unaddressed.
AHME provides insights into these issues and the implications for donors, development agencies, and researchers that result.
Dominic Montagu's research is focused on measurement and on quality. Most of his work is on maternal health, family planning, and abortion services in low- and middle-income countries.
This session will be live-streamed and recorded - link will be available soon.