Making health care financially accessible to all is fundamental to improving health outcomes. Evidence shows that households in developing countries pay for more than half of all health care out of pocket. Such arrangements limit access to quality services and put patients at financial risk. Every year, more than 100 million people in low- and middle-income countries fall into poverty due to the cost of health care. Reducing out-of-pocket payments (or spreading them over longer periods of time) is critical to increasing access to quality health care and reducing financial hardship resulting from the cost of care.
By engaging the private sector to strengthen components of health financing, including mobilizing resources, pooling health risks, and purchasing services, SHOPS Plus contributes to greater financial risk protection, increasing use of priority health services, and sustaining health outcomes. The project supports health financing initiatives by:
- Expanding health financing programs that include private providers
- Enabling private health actors to participate in health financing initiatives
- Designing and implementing payment mechanisms for private providers that align incentives to improved health outcomes
- Brokering partnerships between public and private purchasers of health services and private providers
Examples of our work
SHOPS Plus works to increase access to family planning, HIV services and other essential health services by strengthening private sector engagement in health financing.
In 2020, SHOPS Plus disseminated a thought-leadership brief that explored the capacity and role of the domestic private sector to mobilize funds for private health – an area of increasing interest as donor funding declines and countries become more self-reliant.
We brokered an innovative public-private partnership – a first of its kind – in Senegal, convening the agency for universal health coverage (Agence de la Couverture Maladie Universelle, aCMU) and the association of private providers (Alliance du Secteur Privé de la Santé du Sénégal, ASPS) to test an approach to increase participation of private providers in mutuelles (health insurance schemes Senegal is scaling up to reach universal health coverage).
In Kenya, we are building the capacity of private sector intermediary (an innovative organizational and legal structure) and health providers it represents to participate in Kenya’s National Health Insurance Fund (NHIF) and private health insurance schemes to digitize clinical and business processes and execute contracts more efficiently.
SHOPS Plus is supporting five NGOs serving PLHIV and other vulnerable groups in the Dominican Republic (DR) to mitigate challenges in contracting with SENASA, the DR’s National Health Insurance Agency. The NGOs aim to become more sustainable by improving operational efficiency and expanding revenue through contracts with SENASA.