Côte d’Ivoire Family Planning Private Health Sector Assessment

The country has achieved lower middle-income status. However, despite these improvements, a significant number of health challenges persist. Fertility rates remain high, at 5 children per woman, and neonatal mortality rates are 38 deaths per 1,000 live births. Maternal mortality rates are also high, at 645 deaths per 100,000 live births. Only 17 percent of women and 15 percent of married women used a modern contraceptive method as of 2016. The demand for modern family planning methods is not being met, with only one-third of the demand satisfied. The government, in partnership with international donors, seeks to improve the country's ability to meet the demand for family planning information, products, and services. Achieving this goal requires the participation of both the public and private sectors. However, there is limited information on the private market for family planning products and services in Côte d'Ivoire. To inform future family planning programming and better understand the dynamics of the family planning market, the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project conducted a family planning-focused private sector assessment. The assessment aimed to identify opportunities and provide recommendations for USAID/Côte d'Ivoire to support increased access to and use of modern family planning methods through the private sector. The assessment focused on the following areas: policy and health sector overview, demand for family planning in the private sector, and supply of family planning products and services in the private sector. The assessment team conducted interviews with more than 30 key stakeholders in the public and private health sectors in Abidjan and Yamoussoukro in May and June 2017. The private health sector in Côte d'Ivoire is an important source of care and a growing contributor to public health initiatives. The sector includes a well-developed pharmaceutical distribution network, for-profit facilities, and nonprofit health organizations. However, data on this sector are outdated, with the most recent publicly available data on the size and distribution of medical facilities dating back to 2011. The majority of health facilities in the private sector were categorized as Level 1, followed by Levels 2 and 3 based on a 2010 survey by the Ministère de la Santé et de l'Hygiène Publique (MSHP). Private facilities tend to be concentrated in urban areas, especially in and around Abidjan, although both for-profit and nonprofit facilities are found throughout the country. Many of these facilities operate outside of the formal health system. As of 2015, nearly three-quarters of private facilities did not have formal authorization from the MSHP. Private providers face difficulties attracting highly skilled providers and must hire public sector specialists under the widespread convention of "dual practice." Up to 70 percent of physicians and 50 percent of other health workers engage in dual practice. Private providers in Côte d'Ivoire tend to struggle with limited opportunities for training, low access to financing for equipment and infrastructure, and a lack of representation in discussions about health policy and law. In addition, they experience difficulties dealing with insurance providers and protecting their ability to charge prices. The assessment identified opportunities and barriers that affect the delivery of family planning methods by the private sector, including government policies, regulations, health financing, access to finance, human resources, training, and access to products.