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Integrating Private Providers in Côte d'Ivoire’s National HIV Response

Côte d'Ivoire contends with one of the highest HIV prevalence rates in West Africa. The private sector represents half of all health facilities in the country. However, research conducted by Abt Global for the Strengthening Health Outcomes through the Private Sector (SHOPS) project in 2013 found that low provider knowledge about HIV service delivery, limited availability of products and services, lack of patient knowledge about the private sector’s services, and lack of dialogue between sectors hindered the private sector from fully engaging in the national HIV response.

In response, SHOPS piloted a package of technical support activities in 2014 and 2015 with 15 private clinics in Abidjan that were experiencing legal and regulatory barriers to HIV service provision. SHOPS advocated for regulatory and policy reforms promoting greater private health sector inclusion through national- and district-level public-private platforms. From 2016 through 2019, Abt’s Private Sector Health Project (PSHP) expanded this support to 150 facilities in 20 districts across eight health regions with the highest HIV prevalence.

Preparing the Private Sector to Combat HIV
PSHP used trainings and visits from mentors to improve private providers’ ability to offer high-quality HIV services. Support included:

  • Conducting Government of Côte d’Ivoire (GOCI)-approved trainings for 473 private providers in HIV prevention, data and logistics management, and antiretroviral therapy (ART);
  • Training lab staff on services necessary to identify and manage HIV;
  • Training 150 clinic data managers on quality improvement, data analysis, data verification, and timely data reporting;
  • Creating databases and tools to capture critical patient data, monitor monthly yields of individual sites, and track linkage rates; and
  • Procuring equipment—including computers and phones—to ensure timely and accurate monitoring and reporting.

Ensuring lasting impact through public-private collaboration
PHSP worked to improve the conditions necessary for private providers to offer ART on-site and to comply with GOCI’s clinical protocols. At the national level, PSHP supported a Ministry of Health directive allowing private health clinics to offer government-provided antiretrovirals (ARVs) for free. At the district level, PSHP facilitated linkages between private clinics and district health offices to increase public-private coordination.

Donors, including USAID, do not anticipate providing any further funding to strengthen private sector contributions to the HIV response. To ensure an ongoing role for the private sector in Côte d’Ivoire’s national HIV response, PSHP focused on increasing private provider responsibility for HIV activities through “handover” meetings with local stakeholders. Though PSHP has ended, district health authorities have taken ownership in leading a multi-sectoral HIV response through ongoing collaboration with private providers, in particular for HIV data reporting and activity coordination. Results to date—including linking 100 percent of ARV recipients to PSHP clinics, and a retention rate of 80 percent—suggest the private sector can provide sustainable support to GOCI’s prevention and treatment efforts.

 
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