By Hilary Kinka, Healthcare Networks Advisor, PSI
In early October, PSI welcomed World Health Organization’s Senior Health Systems Advisor David Clarke, Impact for Health CEO and Founder Cynthia Eldridge, and Impact for Health Associate Katherine Jennings for a conversation on the governance of mixed health systems, globally.
In many countries, the COVID-19 pandemic has brought new light to the importance of strong government stewardship of mixed health systems to respond swiftly to health crises. COVID-19 has accentuated the challenges, but also the opportunities for private sector engagement. It’s an area in which PSI has historically worked by supporting private providers across vertical health areas including sexual and reproductive health, malaria, tuberculosis, HIV/AIDS and WASH.
A lack of alignment between the public and private health sectors is not uncommon. In many countries across the development spectrum, strategic action is needed from the government to promote collaboration between public and private partners, thereby strengthening mixed health systems. This includes allocating public funding and supplies toward private sector engagement in a collective response to this crisis and future outbreaks. The pandemic has offered a shared goal that promotes precisely this type of collaboration—as well as case studies in success and failure.
Governments who effectively engage their private sectors have been able to leverage them in their response to the pandemic through strategic action. In the best-case scenarios, the private sector has offered assistance to the public sector and successfully maintained essential service provision. For example: In Myanmar, the public and private health sectors held a 5-week design sprint to provide surge capacity for the pandemic response through joint planning and decision-making. In South Africa, the government introduced a new reimbursement system for the private sector to cover the cost of COVID-19 service provision to consumers, enabling quick mobilization.
Meanwhile those nations with weak private sector governance have struggled. In the worst-case scenarios, the pandemic has reduced access for clients to critical care, led to exorbitant prices for care, or forced private sector facilities to close. In India, where healthcare is governed by provinces rather than the federal government, some private facilities are closing down as they were told to stop all non-essential services and cannot cover their costs, while in other provinces private facilities and labs were quickly empaneled and able to contribute to the response.
Even before COVID-19, many Ministries of Health were starting to feel the pressure to better manage the private healthcare system within their national health plan and were turning to the WHO for support. To this end, a Private Sector Advisory Group was assembled to develop and recommend a strategy to the WHO on Governance of the Private Sector for Universal Health Coverage (UHC). This group was intended to reinforce the WHO’s general program of work goal of 1 billion more people benefiting from UHC. Over the past two years, in her previous role as PSI’s Vice President of Global Marketing, Nikki Charman represented PSI and contributed her leadership and expertise to this Advisory Group, alongside colleagues from a variety of other organizations.
Charman welcomed Clarke to speak on these issues and give an overview of the WHO’s new strategy, which has just recently been ratified. Clarke leads work on using law to achieve UHC and effective governance of the private sector. He also co-leads the WHO’s work on anti-corruption in health. Eldridge and Jennings, who have been supporting the WHO’s work, joined in conversation.
The strategy defines a clear and compelling vision of a well-governed health system in which public and private actors collectively deliver on the realization of UHC, and aims to build consensus around six governance behaviors to improve engagement of the private sector in health care service delivery:
- Building understanding by coming to a shared understanding and appreciation of the need for improved health governance through collection and analysis of data that allows alignment of priorities for action.
- Fostering relations by building and sustaining partnerships and coalitions so that actors can work openly, sustainably, and effectively together with trust.
- Enabling stakeholders by ensuring formal tools for implementation including powers, incentives and sanctions. The objective is to create an institutional framework that recognizes the autonomy of actors, creates decision-making space and builds capacity to work together.
- Align structures by ensuring a fit between with policy objectives and organizational structure and culture so that relevant stakeholder groups are structured/reorganized and work to actively align with policy.
- Nurture trust by ensuring actors are accountable for their actions.
- Deliver strategy by agreeing on a sense of direction and articulating roles and responsibilities to formulate strategic policy direction.
These governance behaviors can be used for effective engagement between the government and the private health sector in the five main domains of:
- Policy and dialogue
- Information exchange
- Provision of service
How can PSI and other WHO partners play a part?
To catalyze strategic action, four priorities are put forward by the Advisory Group to the WHO, which underline the importance of building capacity within the WHO, governments, and the private health sector itself to work effectively together to address healthcare needs. Given PSI’s extensive experience with private sector engagement and coordination of fragmented private sectors globally, David highlighted key roles that PSI and other WHO partners might play in the implementation of the strategic priorities: