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Conference Looks to Boost Healthcare in Africa through Franchising - 2004-06-30

Health care professionals from around the world are meeting in Kenya this week to work out a plan for expanding private sector participation into care for AIDS and tuberculosis patients in Africa.

The conference is looking into what organizers call a franchise model of AIDS and tuberculosis care in several sub-Saharan African countries.

A professor at the California-based Institute for Global Health, Dominic Montagu, likens a franchised private health-care system to a fast-food or retail operation.

"We look at individual private providers who work for their own private interest, they earn money. But they work under a brand and following the regulations of a national franchise organization," said Professor Montagu. "They can't sell any drugs that they don't get from the franchisers, so there's quality control and input. They can't charge more than the regulated prices, which are posted, so there's assurances of quality and that people will not be mistreated, and there's a control system."

Mr. Montagu says more than half of AIDS and TB patients in Africa seek outpatient treatment in the private sector or not at all.

But what they often find, he says, is a maze of private doctors, clinics, hospitals, and other private health care facilities that are poorly regulated and often provide sub-standard quality service, especially to low-income patients.

Mr. Montagu says involvement in the franchise would be voluntary. He says private health care providers would be attracted to the franchise because of its reputation for quality.

The proposal circulated at the conference calls for setting up the franchise system first in Kenya, Uganda, and Tanzania, and then in Nigeria, Cameroon, Malawi, and Zambia.

The franchise, which would be set up by an international, private organization, would be responsible for recruiting franchisees, enforcing clinical standards, providing training, purchasing and distributing drugs and products, and marketing.

A health care consultant with the World Bank, Khama Rogo, says this approach would also make more efficient use of private sector resources.

For instance, he says, an average of 30 percent of beds in private facilities across Africa are vacant, while in some public hospitals, there may be up to three patients sharing one bed.

In Kenya, he says, there are fewer than 1,000 doctors and 16,000 nurses in the public system, while there are 4,000 doctors and 34,000 nurses in the private system.

He calls the private health care system a huge, huge resource that is not being tapped.

"So, why the private sector? We know, that in each country represented here, the private sector is a reservoir of skilled staff," commented Mr. Rogo.

Kenya's deputy director of medical services, Ambrose Misore, admits it is difficult for sub-Saharan African governments to provide good health care, because most face hard economic times, while HIV/AIDS, TB, and malaria are increasing.

"African governments must look beyond the public health care sector. In the past, there's been mistrust between the public and the private health care sector," said Mr. Misore. "These two health care sectors have, in many cases, been in competition rather than working together in a complementary way to increase access to health care services. In fact, private health care sector has largely been ignored when it comes to public health care interventions."

Mr. Misore says his government is eager to form partnerships with private sector health care providers.