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Principles for Engaging the Private Sector in Universal Health Coverage

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 Mark Hellowell and Barbara O’Hanlon

In most health systems, it is a combination of public and private providers that delivers health services. If mixed health systems are a reality in low, middle and high-income countries, the ability of governments to steer their mixed health systems and to engage with all providers toward the national health objectives varies. This article analyzes the lessons learnt by countries which have been able to implement effective governance of mixed health systems and presents a set of evidence-based principles to orientate the actions of governments on how to realize key governance behaviors and on how to implement effective policy frameworks and tools.

Four principles, underpinning effective private sector engagement, have been identified. First, a well-functioning mixed health system relies on strong governance. Governments must correct market failures to ensure the appropriate health services are delivered. They have three tools at their disposal (financing tools, regulatory tools, and information tools) that would usually be used in combination to influence different aspects simultaneously.

Second, effective PSE approaches are defined by “problems” and not “solutions”. The article underlines a common failure of private sector engagement activities: they are often composed of pre-designed solutions, while the starting point should be the problems that the country is facing.

Third, successful governance of the private sector requires good data. Sound policies that are able to harness private sector capacity to advance UHC objectives cannot be developed without sound data. Countries have several options to gather those data: (i) Sector Analysis; (ii) Health Market Analysis (iii) Provider Research; and (iv) Consumer Research.

Fourth, the private sector needs to be engaged in a meaningful dialogue. Increasingly, developments partners, governments, and private health sector alike agree that sustainable development requires all key players to work together for change. The article highlights six attributes of successful public-private dialogue.

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