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Clinical Services


this problem in mixed health systems like India, Nigeria and Kenya requires replacing out-of-pocket expenditure with public financing in both public and private sectors. We are entering an era where domestic financing, and particularly the public share of that financing, is on the cusp of a considerable scale up. Global service delivery organisations must be ready for this transition to remain relevant. To date, Marie Stopes International’s contraception and other reproductive health programmes are already partially financed by public funds in ten countries, including Vietnam, South Africa, Papua New Guinea, India, Nepal, Ghana, China, Bolivia, Kenya, Australia and the UK. We prioritise our ability to adapt to financing changes in the market so that we can ensure continuity of care to our clients. Aside from gearing up for domestic financing,


how else can a global service delivery organisation participate in UHC reforms? As it turns out, more countries are still in planning and piloting phases for UHC. These countries have expressed a desire for service delivery’s experience and skill set at the table. So in these years of transition, Marie Stopes International is focusing on a few key areas where we see we can make a distinct contribution.


Focusing on a cost-effective service package The first is to support and influence benefits package decision-making, to help ensure the best value for money and greatest health impact for UHC reforms. Few services are as cost-effective to both health and economic development as contraception, and as such must be prioritised for universal access. In some cases, there is a trend towards more curative than preventative care. This means coverage for family planning might be omitted. Marie Stopes International is playing our part in countries like Ghana and Kenya, but also globally, to move contraception and reproductive health back up the UHC agenda on behalf of our clients.


Making UHC work for the low-level private sector Next, Marie Stopes International is not only a private sector provider. We also have franchise relationships with 3,600 social franchisees in 17 countries, largely consisting of privately owned and operated, lower-level outpatient clinics. As we enter the UHC era, we are making sure that these lower-level private facilities, which are a frequent lifeline to their communities, are not forgotten in public financing reforms. In the Philippines, we have assisted nearly 200 midwives through the arduous accreditation process into the national health insurance scheme, operated by PhilHealth. Once accredited, these small maternity homes are able to serve their communities free of change with maternal health and family planning services and receive PhilHealth reimbursements. Most of these midwives report not having adequate knowledge or capital to get through the accreditation process alone, making Marie Stopes International’s franchising quality assurance


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Marie Stopes International CAITLIN MAZZILLI


Caitlin Mazzilli has provided technical leadership on Marie Stopes International’s health financing activities, including contracting, insurance and voucher programmes since 2012. She brings eight years of experience in


managing health financing activities in low- and middle- income countries, as well as developing strategies for better engaging the private health sector. Previously, Caitlin worked as a consultant across Africa for organisations such as Population Services International, UNICEF, and Family Health International.


and support role the bridge to private sector inclusion in UHC. Meanwhile in countries like Ghana we see another


role for private sector support and advocacy related to UHC roll-out. The shift to public financing can mean slow and low payments that can cripple a clinic’s cash flow. Under the African Health Market for Equity project, we are seeking to link private providers’ cash flow and other financial product solutions to ease the teething pains of working with public financed national insurance schemes.


Advocating for financing by doing Finally, in countries that are not yet taking great strides in UHC, Marie Stopes International can still contribute to progress through proof-of-concept interim financing projects that feed the right dialogue. In Uganda, Pakistan and Madagascar, we operate large-scale voucher programmes that demonstrate the power of removing client financial barriers, while simultaneously reimbursing all types of health providers such as faith-based, for-profit, or public, for the quality assured services they offer. We can show that the market takes off and significant results are achieved with this financing strategy, serving as testimony for the potential power of UHC reforms. In all of this, we laud many of our donors who


are helping governments but also helping service delivery organisations like ours to do our part towards UHC objectives. The UK’s Department of International Development (DFID), the United States Agency for International Development (USAID) and the Gates Foundation have all helped us move into the next level of family planning/reproductive health programming complexity by frequently including a health financing and health system integration focus.


In summary, we are in a new era for global service delivery organisations. Working with emerging domestic financing systems can be messy, but we all need to roll our sleeves up and get busy. Marie Stopes International has never seen so much opportunity to fulfil our mission and serve our clients both sustainably and equitably.


Further information www.mariestopes.org.uk


Issue 01 | Global Opportunity Healthcare 2015 67


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