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Measuring the Size of the Private Sector: Metrics and Recommendations

This is a discussion document commissioned by the World Health Organization and recommended by the Advisory Group on the Governance of the Private Sector to support the development of a WHO strategy. By Dr Nirali Chakraborty, Andrea Sprockett and Shekwoduza Baba

As our global community seeks to advance universal health coverage (UHC), we must acknowledge that the private health sector is an important and growing source of care worldwide. To reach UHC, we must effectively engage the heterogeneous private sector. Governments need to be able to regulate care provision, and ensure proper stewardship of resources. To do so, we must understand the size and scope of the private sector and be able to measure its contribution toward universal health coverage on a routine basis.

A limited number of metrics have already been suggested to measure the private sector’s role in UHC. However, the underlying data sources are often infrequent or incomplete, and thus do not meet the need to provide a routine source of information on the private sector. For a metric to be more immediately useful, the ability to calculate it from existing and more frequent data sources would be beneficial.

After having examined the possibilities of administrative data, financial data, nationally representative surveys, and social media data we suggest 12 metrics to measure the private sector’s role in UHC and explore the feasibility of these metrics in a set of four case studies. Through the case studies we demonstrate that while each country may face different challenges in measuring UHC, there is still an important need to define standardized metrics. Starting with a small set of priority metrics, the World Health Organization can support countries to bolster their data through selection of key data and encouragement to report, research that advances the knowledge of promising existing data sources, and guidelines on standard data collection on the health workforce and service delivery points.

The keys to understanding the private sector’s contribution to universal health coverage are to build the best available picture using existing data, while simultaneously investing in multisectoral improvements to standard data availability. We must also address data gaps with high quality and timely research. Through these actions, we will be able to provide new insights to help countries achieve UHC.

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