Step 2: Determine the Level of Action

The level, or intensity, of follow-on actions can be categorized as high, moderate, or low. The largest determining factor may be the availability of funding, but other factors such as existence of other projects, timing, and government interest may also play a role.

High: SHOPS Namibia is an example of a multi-year program managed by a local office.

Where there is strong commitment on behalf of the development partner, and openness on the part of the government to engage the private sector, a high-level private sector program is possible. In order to establish a local project office, donor commitment would need to be approximately $1 million. This level of funding can support an in-country office  with a staff of three to five people, led by a Chief of Party. Additional support to implement private sector activities is typically provided by international or regional technical experts, as necessary. For example:

In Namibia, SHOPS conducted a private health sector assessment in 2010 to determine the potential role of the private sector in decreasing costs and improving efficiencies in the delivery of HIV and AIDS services, and to recommend options for mobilizing all potential sources of financing. With funding from USAID/Namibia, SHOPS established an office in 2011 to leverage the private sector to sustain the  national response to HIV. In its third year, the innovative program focuses on fostering greater public-private cooperation, lowering the cost of HIV services in the private sector, improving NGO sustainability, and serving remote populations through public-private financed mobile services.

Moderate: SHOPS Tanzania represents short-term technical assistance for priority areas.

Commonly, USAID or another development partner may opt to implement selective recommendations stemming from the assessment, often with a focus on a specific health area (e.g., family planning, HIV and AIDS). At a funding level of between $200,000 and $1 million, it is possible to secure a local consultant with requisite expertise to carry out the desired activities, supplemented by short-term technical assistance from international or regional experts. Funding also supports in-country implementation, including training, workshops, and additional data collection as necessary.

For example, at the request of Tanzania’s Public-Private Partnership Technical Working Group (PPP-TWG), the SHOPS project and IFC’s Health in Africa initiative jointly conducted an assessment of Tanzania’s private health sector in 2012. The assessment focused on leveraging the private health sector to improve health outcomes in the country, especially in the policy environment, financing, and service delivery. Building on recommendations from the assessment, SHOPS has since supported the establishment of a national, sector-wide Public-Private Health Forum and encouraged the Tanzanian government to pursue more formal arrangements with private sector organizations, including the Christian Social Services Commission and the Private Nurse Midwives Association of Tanzania, to expand the delivery of key health services into underserved areas of the country.

Low: SHOPS Caribbean is an example of a “light touch” or virtual assistance.

In instances where donor funding is extremely limited, or where sufficient local capacity exists, virtual or light touch technical assistance may be sufficient to mobilize action through local champions and stakeholders. This approach works best when it’s possible to leverage existing resources, and/or where there is a foundation of public-private coordination upon which to build. For example, in the Caribbean, a region slated for graduation, donor funding is limited.  In this context, SHOPS is pursuing approaches to engage the private health sector, building on broad stakeholder engagement and sharing best practices across countries in the region. SHOPS conducted joint health systems and private sector assessments in seven Caribbean countries in 2011. Following the assessments, SHOPS mapped private health providers in four countries, established a virtual community of practice connecting private health providers from across the region, and is formalizing coordination between public and private sector stakeholders through technical working groups and enhanced reporting of service statistics.

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