VMMC Additional Financing Options

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1 VMMC Additional Financing Options Involvement of Private Sector and Health Insurance Schemes in Namibia Dawn Dineo Pereko Chief of Party SHOPS/Namibia This presentation is made possible by the generous support of the American people through PEPFAR with USAID under the Cooperative Agreement Strengthening High Impact Interventions for an AIDS-free Generation, number AID-OAA-A The information provided does not necessarily reflect the views of USAID, PEPFAR, or the U.S. Government.

PEPFAR with USAID under the Cooperative Agreement Strengthening High Impact Interventions for an AIDS-free Generation,

2 Agenda Introduction to Namibia Namibia Private Agenda Sector - Overview Rationale for Partnering with Private Sector Medical Insurance: Additional Funding Option Aligning Incentives for Private Sector Involvement Formalizing Partnerships - PPP

Medical Insurance: Additional Funding Option Aligning

3 Introduction to Namibia Population: 2.3 million Adult HIV Prevalence: 14% Upper middle-income status Big and vibrant private sector Well established health insurance industry Private facilities with high level of standard

status Big and vibrant private sector Well established

4 Who is the Private Sector? Formal providers (solo practitioners in PHC clinics & Medical clinics) (Group practice in Medical Centers) Diagnostics (laboratories) Pharmaceuticals (Distributors, retail pharmacies, local manufacturing) Private Hospitals (Small scale in rural areas, modern in urban centers) Industry (Provides health services to employees and communities) Industry finances health services for employees and communities Medical insurance schemes financing services in private sector Focus on for-profit actors only

(laboratories) Pharmaceuticals (Distributors, retail pharmacies, local manufacturing) Private Hospitals (Small scale in rural

5 Health Facility Distribution by Ownership Facility type Public (#) Private (#) Hospitals Primary care clinics Health centers 42 8 Private provider consulting room N/A 557 Total Source: MOHSS 2008b

care clinics 256 75 Health centers 42 8 Private

6 Health Insurance Industry Fact and 10 insurance schemes Figures 6 closed (open only to employee or sector groups) 4 open (can be purchased by anyone) Contribute ~12% of the THE (2008/9 NHA) Covers 47% of employed population Total insured= 388,000 Males =~190,000 70% of males >15 years

purchased by anyone) Contribute ~12% of the THE (2008/9 NHA) Covers 47%

7 Why Partner with the Private Sector? High MC targets will needs all hands on deck cannot be achieved by government alone Already conducting and paying for MC Has facilities and human resources Can complement public sector efforts Catch population that cannot be reached through public facilities Reduce waiting time Provide privacy especially in older men Leverages domestic resources

conducting and paying for MC Has facilities and human resources Can complement public sector

8 Health Worker Distribution by Sector Category # Registered 2006/07 Public Sector Private Sector # % # % Doctors Registered Nurses Enrolled Nurses Social Workers Sources: MOHSS 2008b, MOHSS website 2010

Registered Nurses 2989 1626 54 1363 46 Enrolled Nurses 2761 1884 68

9 Where to Partner with Private Sector Number of facilities in different towns Windhoek Oshakati Engela Rundu Katima Walvis Outapi Bay Private Facilities Public Facilities 5 53 Swakop

17 24 29 30 7 10 10 5 6 Windhoek Oshakati Engela Rundu

10 Partnering with Private Sector: Meeting Unmet Need Private and Public Clinics in Namibia/Unmet Need for VMMCs Years Old , ,509 60,000 50, , ,896 15,821 13, ,004 9, ,666 Windhoek Oshakati Engela Rundu Katima Walvis Bay Outapi Swakopmund Private Public VMMC UMN 15-29yrs 53 40,000 30,000 20,000 10,000 -

234 26,987 53 23,896 15,821 13,840 7 10 5 10,004 9,939 30 6 7,666 Windhoek Oshakati Engela

11 Partnering to Meet National Goals Previously paying for MC for medical reasons only 2011 accepted a reimbursement rate for VMMC 2012 introduced VMMC as a service offering for beneficiaries Provide statistics on MC to count towards national targets

for VMMC 2012 introduced VMMC as a service offering for

12 Why Finance VMMC? Immediate savings Moving from GA to LA has immediate savings Cost benefit long term There is a net saving through averted new HIV infections Estimated at $400/circumcised male in 2011 Supports national program It is a once off event therefore room for abuse is limited

benefit long term There is a net saving through averted new HIV

13 Cost of ARV savings due to averted infections N$ Circumcised population ART Costs avoided

300000 600 250000 N$ 200000 400 150000 200

14 Intervention: Aligning Private Incentives with Public Health Goals Advocate for VMMC tariff (MC prevention tariff) Activity Based Costing for tariff l Value proposi,on statement for insurance l Cos,ng analysis for savings due to MC l Partnership with health insurance industry l Based on WHO package l Based on services l Actuarial cos,ng to determine reimbursement Uptake of MC to support national goals TA to providers l Value proposi,on - diversifica,on of business offerings l Adapt training package l Support quality (CQI and M&E) l Support demand crea,on

l Based on WHO package l Based on services l Actuarial cos,ng to determine reimbursement Uptake of MC to support national goals TA to

15 Thank You!

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Bringing Primary Health Care to Remote Populations through Public-Private Partnerships: the SHOPS Mister Sister Experience Thierry Uwamahoro Technical Coordinator, SHOPS/Namibia January 24, 2013 SHOPS