The Role of the Private for-Profit Sector in

The Role of the Private for-Profit Sector in Reproductive Health in Ethiopia Mengistu Asnake, MD, MPH and Yilma Melkamu, MD, MPH 131 st Annual Meeting and Exposition of the American Public Health Association San Francisco, CA 131 st APHA Annual Meeting 2003 November 19, and Exposition

Program Rationale Huge need for RH/FP information and services • High TFR • Low CPR • Huge unmet need Services limited to public and private non -profit sectors. 131 st APHA Annual Meeting and Exposition

Flourishing of private for-profit sector (1235) Lower Clinics 462 Medium Clinics 189 Higher Clinics 88 Special Clinics 61 131 st APHA Annual Meeting and Exposition

Program Justification People opt for private health care whenever they can. Private for-profit clinics hardly engage in preventive health care. Encouragement of private for-profit involvement. There was a window of opportunity to mobilize the private for-profit sector. 131 st APHA Annual Meeting and Exposition

Program Objectives Reduce fertility and improve maternal and child health by involving the private for-profit sector. 131 st APHA Annual Meeting and Exposition

Specific Objectives ¨ Offer services through private for-profit clinics, community-based reproductive health agents (CBRHAs), marketplace and workplace agents (MPAs and WPAs) ¨ Increase FP/RH knowledge ¨ Improve method mix ¨ Improve service quality 131 st APHA Annual Meeting and Exposition

Program Description FP PAC ANC Delivery PNC IE/BCC Child Health 131 st APHA Annual Meeting and Exposition

Program Description Partnership between different actors: Community Public NGOs HFs Region Zone Woreda EECMY AGOS Private Financial support from the David & Lucile Packard Foundation 131 st APHA Annual Meeting and Exposition

What is expected from health facilities? Provide quality services Ensure quality record keeping and regular reporting Charge affordable prices Post service fees Participate in training sessions 131 st APHA Annual Meeting and Exposition

Technical Support Provide support to the health facilities and community level workers, including: ¨ Contraceptives ¨ Recording and reporting formats ¨ IEC/BCC materials ¨ Training (Basic and Refresher) ¨ Equipment and supplies ¨ Technical assistance 131 st APHA Annual Meeting and Exposition

Achievements General: Public-private partnership strengthened Growing demand to be enrolled into the program Improved access Ø 95 clinics Ø 348 CBRHAs, 97 MPAs, 40 WPAs 131 st APHA Annual Meeting and Exposition

FP services (new clients 2001 -2003) Method Clinics CBRHAs MP WP VSC(F) 46 - - - 46 IUCD 255 - - - 255 Norplant 523 - - - 523 Injectables 15548 - - - 15548 Pills 3739 32894 4082 414 41129 Condoms 5164 19995 2011 803 27973 Total 25275 52889 6093 1217 85474 131 st APHA Annual Meeting and Exposition Total

Service Providers Trained Subject VSC(F) Norplant IUCD No. 34 64 29 PAC EC QOC 38 101 66 Clinic Management and Supervision FP/RH update STIs 40 Total 589 163 54 131 st APHA Annual Meeting and Exposition

Challenges and Lessons Learned Lack of continuous contraceptive supply. Difficulties building trust between public and private sector. Interest in program activities varies by clinic. Providers lack basic knowledge and experience in FP/RH. Providers often focus on other related services, such as antenatal care, postnatal care, and delivery. 131 st APHA Annual Meeting and Exposition

Future Directions Mobilize the private sector around social objectives. Strengthen private, public and NGO partnership. Explore feasible strategies to enhance the role of the private for-profit sector. Explore and implement strategies for sustaining the program. Work closely with private for-profit practitioners. Replicate lessons learned in other projects areas. 131 st APHA Annual Meeting and Exposition

For more information, please contact: Pathfinder International Headquarters Nine Galen Street, Suite 217 Watertown, MA 02472 USA Phone: (617) 924 -7200 Fax: (617) 924 -3833 Web: http: //www. pathfind. org or Pathfinder International Ethiopia Bole Road, Near Lalibela Hotel 251 -1 -61 -33 -30 251 -1 -61 -42 -09 Masnake@pathfind. org