Private Health Sector Engagement in the Journey towards Universal Health Coverage: Landscape Analysis

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 Joel Shyam Klinton, Y.W. Hung and Cynthia Eldridge

Most countries have mixed health systems, in which health-related products and services are provided by the public and private sectors from a wide range health service providers. In particular, the fragmented mixed health systems in many low- and middle-income countries (LMICs) lack coordination, which poses additional challenges in meeting national health priorities. Private health sector’s involvement in health services provision may not be ignored as utilization is common for many key health services across low-income populations, especially as countries aim to progress towards universal health coverage. Previous studies and reports have underlined the importance of engaging the private health sector and developed various strategies and approaches for effective public stewardship of mixed health systems. However, the progress on private health sector engagement across LMICs in different regions remains unclear.

This report assessed the level of private health sector engagement in 18 LMICs with highest overall utilization of private health providers in six WHO regions. Through reviewing official documents, grey literature, and peer-reviewed literature, we conducted a landscape analysis of private health sector engagement in the 18 countries using the domains in the World Bank/International Finance Corporation’s private health sector engagement assessment framework. The most recent available documentation and literature were reviewed to provide updated information on the progress and challenges of private health sector engagement in the countries.

Our findings indicated a general recognition of private health sector’s role in achieving population health goals, but specific policies on private sector engagement remained uncommon. Regarding information exchange, a majority of the countries established systems for collecting information from the private health sector, although challenges on implementation were commonly described. In the domain of regulation, all countries have administrative and bureaucratic regulation systems to control the entry of new private health providers to ensure minimal standards and training are met in both medical and pharmaceutical services provision, and some also linked specific requirements with financial mechanisms for cooperation. About a third of the countries also have regulation on pricing of medical services and/or medications. Despite the existence of regulation, enforcement appears to be a challenge in most countries. The financing domain described mechanisms of strategic purchasing of private health services in leveraging service provision to meet population demands. Contracting was the most common mechanism in financing private health services. Nearly two-thirds of countries reviewed have established one or more national programs in tuberculosis (TB), malaria, and immunization, which commonly engaged the private health sector through public good distribution, ensuring referral and notification mechanisms, as well as providing training for private health providers. Countries may build on these national program successes to 2 address implementation gaps in system-wide approach. More uniform implementation of private sector engagement across the six domains may enhance progress towards universal health coverage.

To support the goal of universal health coverage, clearer norms and guidance are needed across the six domains in the World Bank/International Finance Corporation’s private health sector engagement assessment framework to ensure a more system-wide approach for the effective governance of the private sector within mixed health systems.