A pilot public private partnership scheme in Enugu Emergency obstetric care plus. PATHS1 Nigeria

Authors: Health Partners International
Document Type: Policy and technical briefs
Publication Date: 2008

This technical brief describes a small-scale pilot called the Emergency Obstetric Care Plus (EOC+) scheme developed and operated by the Enugu Metropolitan District Health Board (the DHB) in 2006/07. The pilot focused on testing a model for contracting with the private sector to provide public sector services. Although the work described here covers a small portion of EOC work in Enugu, lessons emerging from the pilot should guide further rollout and thus increased coverage. This is important as there has been very limited work on public private partnerships (PPPs) in Nigeria and few attempts to integrate the public and private health sectors.

Summary of some key success factors of the Enugu pilot EOC+ scheme:

  1. “Ownership” of the scheme by the DHB and its willingness to empower its PPP Sub Committee to lead on the development, implementation and evaluation of the scheme
  2. The involvement of a senior, respected, private sector doctor as chair of the PPP Sub Committee who was willing and able to take responsibility for getting things done
  3. The “hands off” stance of the State Ministry of Health and the State Health Board that encouraged local “ownership” – the fact that they allowed the DHB to get on with the pilot without political or bureaucratic interference
  4. Relatively small scale change and a flexible approach to developing the pilot based on experience – in particular switching the role of “gatekeeper” for the pilot from primary care facilities to the provider hospitals
  5. An open, transparent process for selecting partners to participate in the pilot
  6. Shared motivation and values between the DHB and the three faith based hospitals participating in the pilot, particularly a shared desire to benefit poorer women
  7. Mutual trust between the DHB and the provider hospitals
  8. The willingness of the hospitals to adapt their systems in relation to payment and shift the major burden of financial risk from the patient to the scheme
  9. Time allowed to get messages about the availability of the scheme to its target population and the involvement of community mobilisation

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Tags: Nigeria, Health policy, Newborn health, Multi-stakeholder engagement, Maternal health, Obstetric danger signs, Child health, Hospital services, Access to health services, Public-private partnerships, Hospital management, PATHS,