PARTNERSHIP PUBLIC - PRIVATE: EXPERIENCE OF BURKINA FASO Dr Arlette SANOU
PLAN DE PRESENTATION I Generality on the Burkina Faso II System of health in the Burkina Faso III Development of the partnership in the implementation of PNDS IV Partnership Public - Private: appraisal V definite Step of complementarity between the establishments of hospital private care (ESPH) and the public establishments of health VI Perspectives VII Conclusion
I. Generality on the Burkina Faso • Population: 13 730 250 inhabitants (women 51,7 % against 48,8 % of men) • Life expectancy in birth: 53, 8 years • 13 administrative regions • 45 provinces, 330 departments, • 49 urban districts, 302 rural districts and villages
II. THE SYSTEM OF HEALTH IN BURKINA FASO • Administrative structuring -The Ministry of Health consists of three levels in its administrative structuring: central, regional and region 1. Organization / functioning of public structures of care 2.Three levels assure primary, secondary care and service sectors:
II. THE SYSTEM OF HEALTH IN BURKINA FASO 3. Traditional Medicine and Pharmacopeias • The decree n°2004-567 of hitting December 14th, 2004 adoption of the document fits of policy in traditional medicine and Pharmacopeias inserted this practice into the national system of care of health;
III. DEVELOPMENT OF THE PARTNERSHIP IN THE BET IN ŒUVRE OF PNDS • The adoption of SSP as strategy of development of health by States at the level of the African WHO constituted a turn mattering in the diversification of the actors intervening in the development of health. • This diversification increased with the deep reforms operated at the top of the State with a repercussion at the level of the different constituting departments of the State. • So, at the level of the Burkina Faso they noted next to the partners multi and bilateral the entrance
IV. PUBLIC PARTNERSHIP DEPRIVES: APPRAISAL Favorable conditions • On political plan: Deep Reforms of the years 1990-1991opérées by the State • Refocusing of the role of the State: the abandonment, by the State, of its classical role as main actor of the economic development of the country to the advantage of the private area • Liberalization of the market • A National Health Policy, adopted by the Government in September, 2000, puts the emphasis on the promotion of the private area. • Organization of competition • law n°15 / 94 / ADP of portan May 05th, 1994
IV. PUBLIC PARTNERSHIP DEPRIVES: APPRAISAL Favorable conditions • They legislative Plan and règlementaire • law n°034-98 / year carrying hospital law; • law n°035 / 2002 / year of November 26th, on 2002 public establishment of health carrying creation of the category of; • decree n°2001-381 / near / PM / MS carrying adoption of PNDS; • decree n ° 2005-398 / medicine, by speaking about a woman • ¡á ß ¡ « ßn Õ / PM / MS of July 18th, carrying 2005 conditions of financial year deprived of occupations of health; • Decree n°2006-448 / medicine, by speaking d '
IV. PUBLIC PARTNERSHIP DEPRIVES: APPRAISAL 2 disadvantageous Conditions: they can keep • national policy of contractualisation is not adopted yet • the not respect for the packet of activities which are devolved in ESPH; • insufficiency in the application of texts in force; • The insufficiency of control on behalf of the State favoring the explosion of ESP; • The insufficiency of support in financial term on behalf of Authorities in the area deprived of health; • The fact that the action of structures deprived of care is still c
IV. PUBLIC PARTNERSHIP DEPRIVES: APPRAISAL 3 Challenges • The strengthening of the partnership with organizations under regional and international; • The transfer of competences in regions with a measure of autonomy as part of the implementation of decentralization as part of a partnership of substitution; • The strengthening of the real partnership with the community; • The strengthening of a partnership of complementarity as part of the strengthening of the incorporation of the different elements of the system of health and strengthening of
V. DEFINITE STEP OF COMPLEMENTARITY BETWEEN THE ESTABLISHMENTS OF HOSPITAL PRIVATE CARE (ESPH) AND THE PUBLIC ESTABLISHMENTS OF HEALTH. • By virtue of: - Law n°10-09 a YEAR of April 21st, 1998 carrying modalities of intervention of the State and the sharing out of competences between the State and the actors of development • - Code of the Public health points out that: « the action of the system of health will practice according to guidelines of which the harmonious development of the public area and the private area. » • Complementarity – or the research of complementarity, between EPS of health public and private, is going to consist in: • Tie partenaria
V. DEFINITE STEP OF COMPLEMENTARITY BETWEEN THE ESTABLISHMENTS OF HOSPITAL PRIVATE CARE (ESPH) AND THE PUBLIC ESTABLISHMENTS OF HEALTH. • The actors of this step are prioritairement: • The public hospital establishments of health: (3 AND CHR (9) TEACHING HOSPITAL • Certain public not hospital establishments of health (example: CNTS) • The area deprived of care: in reference to the interdepartmental order n°2006-111 / MS / MCPEA / MFB carrying definition, classification and nomenclature of the private health establishments • This step draws away stakes which can be envisaged at three (3) levels: ante public planning s
V. DEFINITE STEP OF COMPLEMENTARITY BETWEEN THE ESTABLISHMENTS OF HOSPITAL PRIVATE CARE (ESPH) AND THE PUBLIC ESTABLISHMENTS OF HEALTH. • Justification of complementarity: the pressure of the State the instigation of the State. • Certain conditions must be fulfilled for the implementation of the step of complementarity in EPS of health. In effect for hospital EPS, it will be necessary, on strict juridical plan, to request the opinions of the advisory organs. • Borders • As brakes • the key factors of successes
V. DEFINITE STEP OF COMPLEMENTARITY BETWEEN THE ESTABLISHMENTS OF HOSPITAL PRIVATE CARE (ESPH) AND THE PUBLIC ESTABLISHMENTS OF HEALTH. • At the end of cogitation four domains were kept: • the domain of care • the taking care of different diseases (PVVIH, Noma, Deafness, Malnutrition, dialysis etc); • precautionary care; • réadaptatifs care; • the management of blood; • the coordination of medical activities: development of the telemedicine; • The management of references and against references; • Regulation of the benefits of service (internal and external).
V. DEFINITE STEP OF COMPLEMENTARITY BETWEEN THE ESTABLISHMENTS OF HOSPITAL PRIVATE CARE (ESPH) AND THE PUBLIC ESTABLISHMENTS OF HEALTH. • The domain of the equipment, the logistics and facilities; • the buanderie; • the means of health transport; • co-use in the field of the management of the biomedical waste • sterilization; • the morgue; • restoration; • the co-use of equipment; • the management of ambulances between structures; • production and distribution of medical fluids; • the exchange of purchase; • the co-use of facilities (surgical unit …)
. V. DEFINITE STEP OF COMPLEMENTARITY BETWEEN THE ESTABLISHMENTS OF HOSPITAL PRIVATE CARE (ESPH) AND THE PUBLIC ESTABLISHMENTS OF HEALTH. • the domain of human resources; • the use of the specialized personnel; • adult continuing education in both directions; • research; • the distribution of competences; • basic training (identification of the fields of training period in private life / public, UFR, ENSP-notebook of load). • the domain of service. • Delicate actual situation, to lead a cogitation deepened on a program of conscription, training and distribution of competences
VI. PERSPECTIVES (1/3) • The elaboration of National Health Policy in 2000 and the Plan of National Health Development (PNDS) in 2001, across a participative process which implicated all actors, created conditions which favor and stimulate the participation augmented by all the partners in the implementation. • Structures set up for the monitoring of its implementation regroup the partners multi and bilateral, ONG and Associations, structures deprived. It is d there
VI. PERSPECTIVES (2/3) • Use of step of contractualisation as a true tool of strengthening of performances and complementarity. • Strengthening of contractual relations between the public hospitals and private hospital structures. • Private public development of complementarity in discreet domains more high, care, equipment / logistics and facilities; human resources; service. • Chase of the support of the State to the traditional and private area across the mi
VI. PERSPECTIVES (3/3) • The efficient implementation of this step passes by: -The strengthening by the State of its role of regulation controls, the creation of incentive measurements for the actors, -The strengthening of the capacities of regulation and coordination of the Ministry of Health: improvement of the frame règlementaire, adoption of policy of contractualisation; appeal in common frames; -The strengthening of the capacities of the actors, - The organization and the support to the actors of the private.
CONCLUSION • The involvement of the private in the development of developing countries was progressively obvious and the responsibility of the private in development is acknowledged at all levels. • In countries as Burkina, the Government, and in the particular case of the Ministry of Health, the involvement of the private in development is made on two fronts: Make the promotion of a rising private area which takes more and more largeness and that control seems to avoid from him and in as