Mister Sister mobile clinic program wins World Bank PPP Short Story Competition

The Mister Sister program, which uses mobile clinics to provide primary healthcare services to both remote and underserved people in Namibia, has won the PPP Short Stories Competition. According to the panel of public-private partnership experts, this program is “a unique PPP arrangement that leverages both governmental and private sector resources to cover the cost of service delivery and has played a vital role in upgrading health infrastructure and the quality of services delivered to rural populations in Namibia.”

Mister Sister is a PPP run by PharmAccess Namibia that brings quality primary healthcare within reach of low- and middle income people in Namibia. It started as a pilot program in 2010, with support from the Namibian Ministry of Health and Social Services, local private sector companies, Namibia Medical Care, Heineken Africa Foundation, Health Insurance Fund (with funding from the Dutch government), USAID and the Ohlthaver & List Group.

Namibia’s large landmass, difficult terrain, and sparse population make accessing basic healthcare services a challenge for many Namibians. With five trucks that have been converted to mobile clinics, Mister Sister visits remote and underserved areas to provide primary healthcare services to over 15,000 registered patients.

Mixed-funding model
Mister Sister uses a unique mixed-funding model to leverage both public and private sector resources in covering the cost of delivering these services. The Ministry of Health supplies the necessary drugs and vaccines used by the mobile clinics. Commercial farms and other local private businesses cover the costs of bringing healthcare to their employees. Donor funding and corporate social responsibility contributions help fill the gaps in funding. Namibia Medical Care, for example, a local private medical aid fund, cross-subsidizes funds to provide services for underserved communities in Windhoek.

Ingrid de Beer, general manager of PharmAccess Namibia, said “This model allows us to provide quality services across the board. Whether in the shanty towns or at private companies, all our patients receive the same quality care. They’re treated by the same nurses and they get the same medicines.” The mobile clinics are part of the quality improvement program SafeCare, which stimulates constant monitoring and improvement on the quality of their services.

Since private companies pay for Mister Sister to visit their premises, employees are healthier and no longer need to take off time from work to visit a faraway clinic. Complementary to the government outreach programs, which tend to be disease-specific, the mobile clinics provide integrated services. This includes HIV/AIDS testing and treatment, TB sputum collection, family planning, pap smears, and antenatal as well as postnatal care. In case of chronic conditions or other ailments that require seeing a doctor, Mister Sister has a referral agreement with the Ministry of Health. “Mister Sister lightens the burden on public sector facilities as we filter out people who can be treated by our nurses,” de Beer explained.

Partners in the PPP
Mister Sister was the first public-private partnership in Namibia. It brings together:
– Namibian Ministry of Health and Social Services (MoHSS), which provides all medication free of charge;
– Private sector companies, ranging from farms and lodges to manufacturing and retail companies as well as financial service companies, which contract Mister Sister to visit their premises and provide services for employees and their dependents;
– Namibia Medical Care (NMC’s), the country’s largest medical aid insurer, which paid for two clinics and also has a match funding agreement with PharmAccess. As part of NMC’s corporate social responsibility program, it transfers NAD 5 (EUR 0.50) per month for every main member registered in its program. This funds most of the services Mister Sister provides for the informal settlements around Windhoek;
– Heineken Africa Foundation, which paid for two clinics as well as two years of funding for health education and demand creation;
– Health Insurance Fund, through the financial support of the Dutch Ministry of Foreign Affairs, provided operational funding with which PharmAccess was able to demonstrate proof of principle of the PPP;
– USAID, initially through Boston University and later through SHOPS
– Ohlthaver & List Group of Companies, as local partner in the health education program

Dutch Postcode Lottery funded the very first mobile clinic through the Okambilimbili project in 2004. “One of the things we learned from this project,” de Beer recounts, “was that improving access to care would require more than a funding mechanism like health insurance. Many people couldn’t afford private health services and were too far away from the public facilities. We realized that we needed to find an alternative way of providing healthcare. This is where the idea for a high quality mobile service that can reach underserved population groups originally came from. Since 2010, donor funding from the Dutch government has allowed us to demonstrate that this model works. The next step for us is to find a way to expand the PPP and to scale this approach through the existing government structure.”