Global Health: Cross-Bureau Budget Analysis
The Bureau for Global Health’s (GH’s) cross-bureau budget (CBB) allocates funds to activities that...
Integra conducted this assessment under LEAP III to identify opportunities for greater engagement of the private health sector to contribute to a stronger health system in Zambia. While prior studies were focused on obtaining information on certain products, this study focused on Sexual and Reproductive Health (SRH) service delivery, including HIV, while addressing any gaps relating to these products or services. The assessment found that the private sector plays a relatively small role in the provision of SRH and HIV products, and services overall. This is largely due to the provision of such products and services for free through the public sector. Apart from PrEP, all of the products and services evaluated can be accessed through the private sector, though not in all facilities or regions. The reasons for this include: many clinics lack the expertise and equipment to perform such services safely, demand is low, and the services are cost-prohibitive for most consumers to access through the private sector. The primary supply side barriers included: limited public-private engagement, skewed markets due to social marketing and free distribution, regulatory and legal issues, policy lags, marketing restrictions, and training and competency issues. The primary demand side barriers included: awareness, ability to pay, and social and cultural norms. The team found high potential for distribution of injectables and self-testing kits through private channels, while female condoms and daily oral contraceptives had the lowest potential. The assessment generated a series of recommendations for USAID/Zambia based on the findings, including investing in demand generation, leveraging pharmacies, and encouraging better market segmentation by private clinics.