Senegal: Building government capacity to work with the private sector
Despite a genuine interest among many governments to work with the private health sector, they often lack the institutional capacity and the appropriate processes to do so.3 Strengthening the capacity of governments to effectively steward the private health sector is a key component of public-private engagement. This includes the capacity to build and manage effective monitoring and oversight systems, and the capacity to design and implement policies, regulations, and reforms that take into account the interests and needs of the private health sector. In addition, public sector managers need improved skills conducive to dealing with private health providers, such as contract negotiation.9 SHOPS Plus’s public-private engagement approach in Senegal is one example of building and institutionalizing a government’s stewardship capacity.
Context
The government of Senegal has long sought to strengthen PPPs, beginning with a law in 2004 that identified such partnerships as a way to reach development goals with limited government funds. The law established a platform for public-private dialogue. Yet these efforts did not formally include health partnerships. To address this, in 2014 MSAS established the PPP Unit to coordinate and steward the process of designing and operationalizing PPPs in health, and a public-private dialogue forum to ensure the private health sector had a voice in strategic health decisions. Institutional change can take time, and despite these reforms, there was growing awareness that the private health sector was not adequately involved in the implementation of health programs. One reason was a lack of knowledge about the scope of the private sector (see the section, “Senegal: Generating information on the private health sector”). Another reason was the limited capacity of the PPP Unit. Specifically, the unit lacked sufficient skills, tools, and processes to accurately identify, evaluate, and implement PPPs.
Approach
Informed by the Senegal Private Health Sector Assessment,13 SHOPS Plus used a comprehensive approach with a series of interrelated activities to advance MSAS capacity to identify, manage, and implement PPPs. This started with an assessment of the state of health PPPs in Senegal, followed by support for the development of a national strategy on health PPPs and integration of these health partnerships into the National Health Development Plan 2019–2028. Subsequently, SHOPS Plus worked closely with the ministry to develop a practical guide for the public sector on how to design and implement health PPPs. It included tools for MSAS to evaluate health PPPs and easily rate and compare options. The project emphasized public-private dialogue as a key element of developing PPPs. To that end, SHOPS Plus conducted training sessions for 46 MSAS staff and members of the Private Health Sector Alliance on how to identify opportunities and implement health PPPs. A SHOPS Plus consultant embedded within MSAS for nine months provided ongoing technical assistance and coaching, and helped ministry staff apply the guide to evaluate potential partnerships. This hands-on support was crucial to building the ministry’s capacity to identify health needs, potential partners, and mutually beneficial health partnerships.
More recently, SHOPS Plus managed a participatory process that involved MSAS’s maternal and child health and private sector stakeholders. The goal was to evaluate potential PPP projects using simple yet effective tools. Stakeholders determined whether a PPP opportunity met a pressing health gap, aligned with MSAS priorities, and was feasible and cost effective. Workshop participants included members of several ministry divisions, the Private Sector Alliance, and non-health governmental units such as the Directorates of Planning, Research and Statistics, Finance, Economy, and Infrastructure. MSAS chose a promising partnership to digitize medical health records for mothers and children. SHOPS Plus led discussions among stakeholders to determine benefits and challenges of the opportunity for the private sector, MSAS, and beneficiaries. The project is currently supporting the Maternal and Child Health division to finalize the functional and technical specifications expected of the private sector partner.
SHOPS Plus’s support to MSAS transformed an ad hoc process to identify, evaluate and implement PPPs into one that is structured, efficient, evidence-based, and trusted by public and private health sector representatives. The training and tools provided by SHOPS Plus strengthened the ability of MSAS to proactively engage with the private sector and identify opportunities for partnerships that address priority health challenges.
| Lessons learned |
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| Building the capacity of the public sector to engage with the private sector requires more than just training stakeholders. Pairing trainings with user-friendly tools, processes, and systems can reduce barriers within the public sector and motivate public stewards to use their new skills. |
| Embedding long-term advisors within key public sector agencies can help promote public sector staff to take up new tools, troubleshoot questions, and better understand opportunities, leading to more successfully operationalized partnerships. |
| Long-term, sustained successful engagement requires going beyond ad hoc, opportunity-driven partnership efforts. It needs a systematic, evidence-based approach that can help stakeholders comprehensively evaluate opportunities with the greatest potential for success. |