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Opinion: 3 drivers to accelerate private sector engagement in health service delivery /

Since the outbreak of Covid-19, overwhelmed public health systems across the world are a new reality. The sudden need to effectively address the surge in healthcare demand has forced governments to look beyond the traditional public health service delivery system towards support from private actors.

In support of these efforts, USAID has launched the Covid-19 Private Sector Engagement and Partnership Fund. To achieve maximum impact, however, it is crucial that private health sector activities are aligned with and integrated in local response efforts and systems. This does not only ensure sustainability beyond the crisis, but also bolsters self-sufficiency and prosperity, aligned with the principles of USAID’s Journey to Self-Reliance.

Having worked with governments across the world for over a century, Crown Agents has experienced first-hand how effective a successful integration of development cooperation into existing systems can be. We currently work with the Government of South Sudan to strengthen local solutions to increase the country’s capacity to provide essential quality health services. To achieve this, we support the country to build local capabilities, such as a robust supply chain system, by working closely with local private sector suppliers. Only last year, for example, we have procured and distributed over 19 million packs of emergency drugs and medical consumables, and over 285,000 PPE emergency kit items. In Nigeria, we led on medicine procurement from local suppliers as part of a £30m DFID funded Health Commodities Project. Coupled with establishing strong quality assurance processes, our activities resulted in the sustainable access to essential health supplies for over 20 million Nigerians.

Based on our experience, we identified the following three drivers to increase effective private sector engagement in health service delivery:

DRIVER 1: Build local systems and capabilities that are destined to last
Development activities supporting local solutions do not only boost a country’s internal capacity, but also decrease its reliance on aid long term. In the short term, the country is more likely to receive international assistance as there is a growing consensus amongst the international development community that aid should be integrated into existing systems to deliver sustainable results.

The benefits of this driver of change are demonstrated through our Health Pooled Fund (HPF3) programme in South Sudan (now in its 3rd phase): The HPF3 consortium is led by Crown Agents and supported by the UK’s FCDO, the EU, USAID, Canada, GAVI and SIDA. The Fund works with the government to increase basic quality health services, prevention and treatment of common conditions and timely availability of essential drugs and medical equipment. HPF3 operates in one of the most challenging contexts, and with some of the worst health indicators in the world. There are often concurrent emergencies to address, such as extreme food insecurity, locust plagues, disease outbreaks and displaced populations.

One of the major challenges that South Sudan has had to address was ensuring that commodities and medical equipment reach facilities and communities who need them most. To achieve this, in partnership with the Ministry of Health and our donors, we designed a robust end-to-end operational process that included careful consideration of the limitations of a country weakened by years of war, lack of infrastructure and poverty. Through multiple and measured incremental changes over the years, we have supported the country to build local systems and capabilities that are built to last. Having established a pool of pre-qualified suppliers, we are now focusing on maximising collaboration by onboarding partners and suppliers towards a more integrated model, based on shared objectives towards high quality standards and timelines, shared best practice, technological improvement, standardisation and rationalisation. Our strategy involves working closely with local suppliers and undertaking annual audits to ensure they are meeting the technical procurement requirements.

In 2020 only, we have procured and distributed over 19 million packs of emergency drugs and medical consumables, and over 285,000 PPE emergency kit items. We are currently working through a second round of PPE supply and plan to distribute over 13,500 items of medical equipment to raise the standards of health facilities across eight states.

DRIVER 2: Strengthen robust supply chain processes and quality assurance
Partnering with local suppliers and establishing strong quality assurance processes enables us to guarantee that items supplied are safe, effective and fit for purpose. By fostering resilient and sustainable supply chains in-country, we promote wellbeing and help countries on their journey to self-reliance.

In Nigeria, for example, one of our key objectives for a £30m DFID funded Health Commodities Project was for most of the medicines to be procured from local suppliers and to deliver products that had over 75% minimum shelf life.

To ensure the suppliers adhered to the highest standards, we hosted a number of workshops to equip them with essential knowledge and an understanding of the competitive tendering processes that followed DFID (now FCDO) and EU regulations. As the country was facing enormous challenges with fake drugs and corruption, all products were registered with the government regulatory agency, NAFDAC. Furthermore, quality checks were applied at different touch points of the supply chain by a qualified resident inspector.

As a result of these trainings, the number of local manufacturers and suppliers of medicines and medical consumables increased from zero to 50% over five years.

DRIVER 3: Enable a competitive and transparent bidding system
Transparency, a vital weapon against corruption, improves competition in the bidding process and the quality of procurement. It also ensures the same level playing field for organisations when they bid.

We have seen this first-hand in Ukraine, for example, where we have been working with the Ministry of Health since 2015 to carry out a bold programme to reform the health sector.

With local manufacturers and distributors historically being marginalised from bidding for government contracts, a competitive and transparent bidding process was established. Crown Agents subsequently hosted pre-procurement workshops for local businesses to provide clarification and understanding of tendering procedures and requirements, offering equal access to opportunities. As a result, the ongoing procurement programme has led to over USD 65million savings for the government, without compromising on the quality of the drugs. Many new businesses have decided to participate in the bidding process which has driven exceptional price performance to deliver millions of vital drugs to patients in need of access to quality medicines. By effectively eliminating corruption, we saw a 50% decline in prices. As a result, everyone in Ukraine who needs a coronary stent can now obtain one funded by the public purse, whereas previously 50% of patients had to pay around $10,000 themselves.

Conclusion

Covid-19 has confronted the world’s health systems with unprecedented challenges. However, the pandemic has also presented us with unique opportunities to “build back better” by exposing system weaknesses and forcing us to rethink how we presently operate. It is now up to us to ensure our health systems are fit for the future and cater for the needs for today’s and tomorrow’s populations.
In the current economic climate, it is particularly important that public and private actors align their efforts to achieve maximum impact which provides a long-term outlook and ensures value for money. We hope our examples provide a powerful snapshot on how this can be done, including in the most difficult environments.
Now is the time to rebuild towards a society that can mitigate and adapt to the threats that confront us – from climate change to pandemics. We stand ready to support the global effort.