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August 4, 2017

Working With the Private Sector in the Fight against Malaria


Throughout Sub-Saharan Africa, the private health sector is a key factor in the fight against malaria. In Benin, over 65% patients seek treatment for malaria at private health facilities. MCDI's USAID-President's Malaria Initiative-funded Accelerating the Reduction of Malaria Morbidity and Mortality Program (ARM3) has spent the past five years working closely with the private sector to combat Benin's high malaria transmission rates. Through the accreditation of private health facilities, the improvement of private sector reporting into the national health information system, the distribution of Long-Lasting Insecticide-Treated Bed Nets (LLINs) through private employers, and bridging the gap between the public and private sectors in the supply of malaria commodities, ARM3 has been able to help integrate Benin's private sector into the country's fight against malaria.

Registration and Accreditation

With the assistance of MCDI under ARM3, Benin's Ministry of Health has been able to register over 220 private health facilities as accredited to diagnose and treat patients for malaria. Prior to the assistance of ARM3, most private providers were not registered by the Ministry. The National Directorate of Public Health's Technical Committee was formed with the help of ARM3 consisted of 11 doctors, nurses and midwives, covering all health departments in the country.

Prior to beginning the registration process, ARM3 visited 99 health facilities to gauge their knowledge of national guidelines for the treatment of malaria. The Committee found that private facilities had very little baseline knowledge of the case management protocol, and did not meet National Malaria Control Program (NMCP) standards for diagnosis and treatment. The committee recommended that outreach sessions focusing on laws governing health facilities be conducted and supervisory training in national health programs and key health activities be enhanced.

ARM3, in order to accredit health workers and register facilities, trained private health providers in integrated community case management, malaria diagnostics and the treatment of severe malaria in children. The combination of training and accreditation allowed for health providers to be fully compliant with the standards and procedures set by the Ministry and ensuring the quality care of patients who seek out their services. The project also worked with the private sector to increase private sector reporting into Benin's national health information system, increasing participation from 20% in 2011 to 74% in 2014, directly aiding the country's mission to be able to more adequately monitor and evaluate health outcomes.

Malaria commodity management

One of the greatest challenges facing Benin's fight against malaria are unofficial private health providers who are not registered or accredited by the Ministry of Health distributing expensive or ineffective antimalarial drugs or using ineffective rapid diagnostic tests. In March 2017, ARM3 provided support to the NMCP in conducting a workshop on the integration and accessibility of private sector health facilities to subsidized malaria commodities, including both members of the private health sector and the NMCP. This workshop led to the mutual agreement between the NMCP and private providers on the price and conditions of sale for these subsidized commodities.

In May 2017, the NMCP published, in collaboration with ARM3, a report on the status of the private health sector in relation to their diagnosis and treatment of malaria, and suggestions for how to further strengthen the relationship between the public and private health sectors. The report recommended that the NMCP authorize the access of recognized and authorized private health facilities to subsidized malaria commodities, ensuring that private providers do not experience stock-outs, and that the NMCP consider implementing a mixed public-private supply chain for these commodities. The report also encouraged associations of private sector providers to encourage their facilities to seek registration, while also creating a procedure for authorization and start-up for new private providers.

LLIN distribution

Working with the Coalition of Enterprises in Benin against AIDS, Tuberculosis and Malaria (CEBAC-STP), ARM3 launched an innovative partnership with the private sector to distribute LLINs to private business sector employees. ARM3 advocated for the inclusion of CEBAC-STP in the activities of the NMCP, bridging the divide between the public and private sectors in LLIN distribution.

Through this program, ARM3 and CEBAC-STP were able to distribute 100,000 nets to private sector employers at subsidized prices, which were then given to employees. This process involved training CEBAC-STP employees on social marketing, implementation and tracking and implementation of the distribution.

As a result of this multi-year partnership with CEBAC-STP, the organization has been able to become a leader in the malaria fight in Benin, supporting member companies in developing their corporate social responsibility plans and participating in international workshops on public-private partnerships. Several other organizations have also followed CEBAC-STP's lead and purchased LLINs to distribute to their employees outside of the ARM3 facilitated distribution.

The future of public-private partnership in Benin

ARM3 is working closely with private health facilities to promote this integration of malaria commodities while also providing training and supervision to private providers in case management, health information systems management and other methods of malaria diagnostics and treatment.

At the beginning of ARM3, there was hesitation and resistance in collaboration between the public and private health sectors in Benin, impeding the country's progress in combatting malaria. Thanks to the USAID-PMI prioritization of bridging this gap, Benin is actively moving towards a health system that is adequa





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