Abstract
BackgroundPublic health services can be inaccessible for adolescents. The private sector provides many services, but often in parallel to the public sector. This study aimed to understand current private sector engagement in adolescent health service delivery and develop recommendations to strengthen partnerships.MethodsThe study focussed on Mongolia, Myanmar and the Philippines. An initial participatory workshop in each country was followed by semi-structured key-informant interviews (32 in total) with public and private sector actors and adolescents to explore: perceptions of the public and private sectors, strengths and challenges, existing models of partnership, and insights for successful public-private partnership (PPP). Interview transcripts were analysed thematically, with findings and recommendations verified through a second workshop in Mongolia and the Philippines.FindingsThe private sector already plays a significant role in adolescent health care, and stakeholders reported a genuine willingness for partnership. Strengthened PPP was identified as necessary to improve service accessibility and quality for adolescents, unburden the public sector and introduce new technologies, with advantages for the private sector including improved access to training and resources, and an enhanced public image. Recommendations for strengthened PPP included the need to establish the foundations for partnership, clearly define roles and co-ordinate stakeholders, ensure capacity and sustainability, and monitor and evaluate efforts.InterpretationThis is the first comprehensive study of public-private partnership for adolescent health in the Asia Pacific region. It identifies stakeholders are willing for stronger partnerships and the benefits this partnership will bring. We define eight key recommendations to enable this partnership across sectors.
Highlights
This study focussed on three resourceconstrained countries (Mongolia, Myanmar and the Philippines) in the Asia Pacific, [19] selected by the UNICEF East Asia and Pacific regional office based on their interest in advancing public private partnership within their adolescent health programming; this ensured stakeholders were likely to engage in this research and that research findings would likely translate to action
In the Philippines the private sector was recognised as providing a large private clinical sector and some engagement with health services through corporate social responsibility, but there was a broader recognition of the additional services that private providers may provide for adolescent health in supporting clinical training and access to health information and commodities for adolescents, relating to contraception
Engaging with providers across the public and private sectors, as well as from government, key agencies and adolescents themselves in Mongolia, Myanmar and the Philippines we found a genuine willingness for stronger partnership and identified recommendations to achieve this
Summary
Health services are a key platform for optimising adolescent health, [1] yet adolescents experience significant barriers accessing public health services- perhaps more than at any other life stage- including barriers relating to service availability and quality. [2] This appears so for the Asia Pacific region, [3,4,5,6,7] home to almost 1 billion adolescents and adolescents and young people aged 10-24 years that experience a large and unshifting burden of preventable ill health. [8,9] Countries in this region have amongst the lowest index of Healthcare Access and Quality globally, [10] and whilst data specific to adolescents are sparse, demand satisfied with modern contraception amongst 15-24 year old females (a proxy indicator of health service access and quality) is amongst the lowest globally in Pakistan (32%), Nepal (37%), the Philippines (44%) and Papua New Guinea (45%). [9] This may, in part, reflect low levels of public funding on health: Cambodia, Indonesia, Lao PDR, Myanmar and the Philippines spend less than 1% of Gross Domestic Product on health (global average is approximately 6%). [11]Given the constraints of public health systems, there is increasing interest in engaging the private health sector to ensure universal health coverage. [12] In the South East Asian region, private health expenditure is the highest of any region globally (48% of total health expenditure, global average 41%), with private health expenditure high in the Philippines and Myanmar (>65%). [13] There is some evidence from this region that adolescents already seek services and advice around sexual and reproductive health (SRH) from the private sector (which includes private clinics, pharmacies and non-government organisations) [14] as these may provide less judgmental care with greater privacy, more convenient locations and opening hours, and with less stigma than public-sector services. [7,15,16]As such, the critical question is not if the private sector should be engaged in adolescent health, but rather, how? Most health systems in the Asia Pacific region appear to position the public and private sectors in parallel, and sometimes in competition, but rarely in partnership. Our review of the available literature found no published studies of private sector engagement or partnership specific to adolescent health in the Asia Pacific (see research in context and Appendix 1). [18] This study aims to define how the private sector can be better engaged in partnership with the public sector to strengthen health service delivery for adolescents. This study aimed to understand current private sector engagement in adolescent health service delivery and develop recommendations to strengthen partnerships. Interpretation: This is the first comprehensive study of public-private partnership for adolescent health in the Asia Pacific region. It identifies stakeholders are willing for stronger partnerships and the benefits this partnership will bring.
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