By Wycliffe Waweru, Deputy Director, Monitoring, PSI
The need for more healthcare provider stewardship in mixed health systems
In many low- and middle-income countries (LMICs), the private sector plays a vital role in providing health care. “‘Mixed health systems” – in which both public sector providers and private providers deliver health services – are most effective and efficient when the public sector provides stewardship and oversight of privately provided care. Stewardship needs extend from government regulatory oversight of medicines sold in country, to licensing of private facilities, to recent efforts to engage private providers in public health financing programs— such as national health insurance programs.
The breadth and depth of stewardship and oversight opportunities and responsibilities is vast and complex. Additionally, the private sector itself is huge and heterogeneous in many LMICs, posing challenges for this effective government stewardship. This leaves private providers operating in isolation without routine access to public health commodities, clinical protocol updates and continuing education opportunities, or mentoring and support from other providers—factors that ultimately pose risks for patient quality of care.
Models like social franchising and quality accreditation schemes for private provides seek to address these challenges. These models, while effective, are also resource intensive and currently only reach hundreds of providers per country, nowhere near the thousands of providers per country in need of stewardship and support.
The opportunity to leverage digital technologies to meet the demand for stewardship globally
Ministries of Health and global bodies, such as the World Health Organization (WHO), are well aware of the challenges of effective stewardship of the private sector. The recent WHO strategy for government engagement of the private health sector lays out an intentional approach to mixed health systems as a key strategy to leverage all healthcare resources available in support of the Sustainable Development Goals (SDGs) and universal health coverage (UHC). This comes at an opportune time when COVID-19 has strained public health systems and reinforced the need to utilize the capacities of the private sector to meet a country’s total healthcare needs.
With significant growth in mobile phone connectivity and ownership in LMICs, including among private health providers, digital technology offers an opportunity to deliver the scale needed to effectively steward a vast, fragmented private sector. As part of the USAID-funded MOMENTUM Private Healthcare Delivery (MPHD) project – a five-year initiative aimed at increasing the capacity of private providers to deliver evidence-based, quality health care – PSI is launching an intervention to bridge the gap between public sector stewards and private sector providers through use of technology.
Focused on improving private sector delivery of maternal, newborn, and child health and voluntary family planning services, the intervention will bring together public sector and private sector stakeholders, including professional associations to which many individual private providers belong, to identify, build, and scale a system of remote stewardship using a simple digital platform. The work begins in 2021 with an assessment of current efforts in public sector stewardship of mixed health systems across Ghana, Kenya, Nigeria, and Uganda. The assessment will include reflections on global efforts and best practices to enhance stewardship and effectiveness of mixed health systems through digital approaches.
Based on the assessment, one country will be selected to pilot a model of public and private stakeholder collaboration for development of a stewardship roadmap, which can be implemented at scale using digital technologies. Key stakeholders may include Ministry of Health, Ministry of ICT, medical bodies/ regulatory bodies, professional associations of providers, technology providers and mobile network providers. Remote engagement of providers will likely include content such as:
- Regulatory adherence reminders and awareness building for new regulatory requirements;
- Remote capacity building and training for private providers;
- Basic supportive supervision and mentoring;
- Behavior change communication on key topics, such as infection prevention precautions for COIVD-19 transmission mitigation;
- Rapid insight gathering and routine data collection, as needed.
Much work is needed to connect the diverse and sometimes disjointed private health sector with health system stewards. However, digital technology provides the promise of scale needed to address the magnitude of the challenge and opportunity. The body of knowledge and lessons learned on the private sector from other USAID-funded efforts like SIFPO2 and SHOPS Plus provides a solid foundation for this initiative, and COVID-19 conditions the timely catalyst. We look forward to updating you on this journey, and if you are interested in learning more or providing input, please reach out to the intervention lead, Wycliffe Waweru (email@example.com).