Health Policy Project

The Health Policy Project has ended, but work continues under a new USAID five-year project, Health Policy Plus (HP+).


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Building Public-Private Partnerships to Improve Health Services in Afghanistan

Health Policy Project

KABUL, AfghanistanFor years, the relationship between Afghanistan’s public and private health sectors was a tense one. Even though the country’s private health sector is three times as large as the public sector in terms of spending, the government did not seek opportunities to work in partnership with private health entities. Moreover, the public sector’s oversight and regulation of the private health sector was weak, resulting in an uneven quality of services delivered. Longstanding distrust and the lack of a systematic mechanism for private sector engagement made it difficult to collaborate on the nation’s critical health issues.

Now, a new initiative is paving the way for stronger linkages between the public and private health sectors. In 2012, with support from the USAID-funded Health Policy Project (HPP), the Directorate of Private Sector Coordination (DPSC) of the Afghan Ministry of Public Health (MoPH) established the Public-Private Dialogue Forum, which engages key private sector entities and MoPH staff to discuss private health sector concerns and reviews policies and regulations that affect the private health sector and potential public-private partnerships. The forum, which meets quarterly, offers a valuable opportunity for leaders in the private health sector to meet face-to-face with Minister of Public Health Dr. Suraya Dalil, who chairs the gatherings.

The forum represents a critically important development in Afghanistan’s efforts to improve healthcare for its citizens, given the role the private sector plays in service delivery. Of the US$1.5 billion spent on healthcare from 2011 to 2012, 73 percent came from the private sector in the form of out-of-pocket payments by households, while government contributions for health services accounted for only 6 percent of total expenditures. To maximize health resources and increase equity in access to healthcare, the MoPH has come to recognize the necessity of a partnership with private health services.

The forum builds on earlier efforts by the HPP and its predecessor, the COMPRI-A Project, to create an enabling environment for the private health sector and promote partnerships between the public and private health sectors in Afghanistan. COMPRI-A launched the DPSC within the MoPH in 2007 to initiate a working relationship between the sectors. Since then, the DPSC has made considerable progress in developing a policy and legal framework for regulating the private health sector.

“There are many ways that greater dialogue is helpful,” said Dr. Ahmad Jan Naeem, deputy minister of policy and planning. “For several years… [the public and private health sectors] had different views and ideas, but now we [consider] each other as part of a system.”

Since its inception, the forum has been successful in improving coordination and trust between the sectors and has helped remove an important challenge to private sector operations. For example, in the past, pharmaceutical distributors had to go to as many as three different departments within the MoPH to arrange to pay import taxes on pharmaceuticals, then go to the bank to pay the tax itself, then provide proof of payment to another MoPH department. This process was time-consuming, often taking several days to complete. At the September 2013 meeting of the Public-Private Dialogue Forum, the MoPH announced it would move the entire process to the General Directorate at Pharmaceutical Affairs, which means pharmaceutical distributors now only have to make one trip to pay their import taxes. Said Dr. Omarzaman Sayedi, team leader for HPP Afghanistan, “The PP Dialogue Forum provided a platform to bring this issue to the attention of MoPH senior management and determine how to simplify these procedures.”

The forum has already served as a venue for the private sector to provide input on needed revisions to the Private Health Centers Regulation Act (PHRC), which will allow for greater private sector investment in health. Forum members have also helped accelerate approval of a joint monitoring approach for private hospitals (now approved as the “Minimum Required Standards for Private Hospitals”), and secured Cabinet approval to use government-owned land to establish a Medicines Manufacturing Industrial Park.

“I am really interested to work closely with the private health sector to strengthen the health system and do something for the patients and people of Afghanistan,” said Dr. Dalil, praising the forum’s role in strengthening public and private sector relations. “I recognize the private health sector as a member and working partner of the Ministry of Public Health.”

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The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (previously Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and White Ribbon Alliance for Safe Motherhood (WRA). The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

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