The new framework, according to the United Kingdom’s Department for International Development (DFID) funded agency, is to optimise private sector contribution to health for improved Maternal and Newborn Child Health (MNCH) outcomes through effective Public Private Partnership (PPP) coordination.
Specifically, the model shifts stakeholders’ focus to improved networking, efficient referral system, universal health coverage through state health insurance scheme, even as it will offer technical assistance to monitoring, inspection and quality assurance activities of government agencies among others.
Monitoring and Evaluation/ Knowledge Management Specialist, Olutobi Adeogo said that the current phase of PATHS2 intervention programme in the state aims to establish the PPP framework for improve maternal and child health.
The private sector, which has both for-profit and not-for-profit driven facilities, are responsible about 70 per cent of healthcare services in the state and central to the partnership framework.
Explaining the framework, Adeogo said that it aims to provide technical assistance to the state ministry of health to build meaningful partnerships between public and private facilities.
This, according to him, will facilitate networking among private providers through a process facilitated by the SMoH (as part of health system integration) in exchange for reduction in the cost of MNCH services in the pilot communities.
“With PATHS2/ PHN support, the SMoH will improve the business management skills of participating private providers, to identify and leverage on each other’s strengths and support them to access funding for developing their health businesses,” he said.
Among the opportunities on offer are promotion of group practices among members of the Association of General and Private Medical Practitioners of Nigeria (AGPMPN) for the establishment of the PHCs with diagnostic capacities; contracting out MCH services to qualified private clinics; availability of credit opportunities for consolidated or group practices and availability of institutions willing to build business management capacity in the health sector among others.
In the area of referral, PATHS2 will work with the SMoH to strengthen referrals between the public and private (formal and informal) providers of care.
It would be recalled that in May 2013, the SMoH instituted a Maternal Death Review programme in all secondary health facilities. A total of 260 maternal deaths (78 per cent unbooked cases) were recorded as of December 2014. The three causes of maternal deaths were post-partum haemorrhage (27 per cent), sepsis (26 per cent) and eclampsia (21 per cent).
Delayed referral, according to the survey, contributed to some of the maternal deaths especially from the informal sector. This could have been prevented if the clients had been referred to the next level of care.
Adeogo added that it was in the light of this that PATHS2 would provide technical assistance to the SMoH to work with relevant stakeholders to facilitate cross-referrals between the public sector and the private (formal and informal) under agreed terms.
This will involve identifying facilities with the necessary equipment and human resources to provide necessary and human resources to provide necessary services through mapping, issues of quality, standards and cost would be considered to ensure that the key elements that enhance access are not jeopardized.
In this regard, “stakeholders’ engagement between the sectors would be facilitated and partnership agreements brokered in such a way that the private facilities get the necessary referred patient volumes that would ensure that they stay within agreed cost thresholds,” PATHS2 stated.
Further, a framework for incentivising Traditional Birth Attendants (TBAs) and other informal providers for referrals would be put in place in order to facilitate increased access to timely quality care.
PATHS2 also noted that one of the key challenges to achieving Universal Health Coverage (UCH) is the financial barrier to accessing healthcare at all levels of care. In alignment with the national agenda of ensuring UCH, through reduction in out-of-pocket payment, the state government recently passed the Lagos State Health Management Agency bill into law, to institute the State Health Insurance Scheme for all residents of Lagos State.
PATHS2 will provide technical assistance to the SMoH to articulate learnings from the initial process and support the state to improve the efficiency and effectiveness of the current active schemes and at the same time, support the SMoH to deploy CBHIS to the four pilot PPP LGAs.
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