The role of the private sector in delivering essential packages of health services: lessons from country experiences

Abstract

Many countries are adopting essential packages of health services (EPHS) to implement universal health coverage (UHC), which are mostly financed and delivered by the public sector, while the potential role of the private health sector (PHS) remains untapped. Currently, many low-income and lower middle-income countries (LLMICs) have devised EPHS; however, guidance on translating these packages into quality, accessible and affordable services is limited. This paper explores the role of PHS in achieving UHC, identifies key concerns and presents the experience of the Diseases Control Priorities 3 Country Translation project in Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar. There are key challenges to engagement of the PHS, which include the complexity and heterogeneity of private providers, their operation in isolation of the health system, limitations of population coverage and equity when left to PHS’s own choices, and higher overall cost of care for privately delivered services. Irrespective of the strategies employed to involve the PHS in delivering EPHS, it is necessary to identify private providers in terms of their characteristics and contribution, and their response to regulatory tools and incentives. Strategies for regulating private providers include better statutory control to prevent unlicensed practice, self-regulation by professional bodies to maintain standards of practice and accreditation of large private hospitals and chains. Potentially, purchasing delivery of essential services by engaging private providers can be an effective ‘regulatory approach’ to modify provider behaviour. Despite existing experience, more research is needed to better explore and operationalise the role of PHS in implementing EPHS in LLMICs.

Essential packages of health services in low-income and lower-middle-income countries: what have we learnt?

“…Siddiqi et al . The role of the private sector in delivering essential packages of health services: lessons from country experiences 10…”

“…EPHS are mostly being delivered by the public sector. However, Siddiqi et al 10 argue in paper 6 that the role of the private health sector, which too often remains untapped, is essential for package design and implementation. Many LLMICs have mixed health systems, with an extensive and heterogeneous private health sector and varying degrees of governance effectiveness.…”

Country readiness and prerequisites for successful design and transition to implementation of essential packages of health services: experience from six countries

“…As highlighted before, not all countries had meaningful engagement of the finance and planning sectors, and only one country engaged community and civil society representatives during the package design process (table 3). The private health sector, which currently delivers a major proportion of the high-priority health services,14 19 did not seem to be involved in four out of the six countries. A more elaborate review of the role of the private sector in package design and implementation is covered by Siddiqi et al 14.…”

“…[7][8][9][10] The experience of six LLMICs has recently been reviewed by a knowledge network of professionals engaged in DCP3-related country work to extract lessons learnt and update evidence and good practice. The review covered seven key areas in the process of designing an EPHS: requirements for successful EPHS design (current paper), decision-making processes, 11 estimating costs, 12 financing, 13 building implementable packages, role of the private sector 14 and monitoring and evaluation. 15 The seven papers in this collection cover the key findings of the review.…”

“…The other papers in this collection describe the different processes followed by the six countries to design their packages. [11][12][13][14][15] In this paper, we focus on steps that directly relate to the requirements that determine successful package design and increase the prospects of a successful rollout.…”