25 July 2019

We cannot achieve universal health coverage without the private sector

By Jeffrey Sturchio and Harald Nusser

Expanding global access to healthcare remains a top priority for advocates, activists and policymakers, and rightly so. In addition to self-evident humanitarian reasons, the economic costs of untreated medical conditions include billions of dollars of lost labour and productivity, while the World Health Organisation reports that around 100 million people are forced into poverty every year by catastrophic medical expenses.

With the objective of providing healthcare for all finally within reach, the United Nations General Assembly is preparing to issue new commitments for achieving universal health coverage, due for a vote this fall. Virtually every country has already agreed to achieve universal health coverage (shortened to UHC) by 2030. Yet how countries should go about achieving UHC — defined as all people having convenient access to quality health services and commodities without the risk of suffering financial harm as a result of illness — is a matter of intense debate. Unfortunately, the discussion has largely ignored one crucial subject: the role the private sector can play in delivering healthcare for all.

It’s critical to remember that countries aren’t creating new health systems from scratch. They’re building on systems already in place, and that means strengthening health systems in which the private sector is currently playing an essential role in the delivery of care.

In most lower-income countries, 30-80% of health services are delivered through the private sector. A winning strategy for governments is to identify what’s working well in the delivery of healthcare in their countries, and then to build on those successes. In many cases this will mean developing or strengthening partnerships between both the public health system and the private sector.

This hybrid, public-private approach has already delivered tremendous healthcare impacts in a range of complex, dynamic markets, and social contexts. Examples include the Utkrisht Impact Bond, the world’s first “health development impact bond,” an ingenious solution creating financial instruments that reward improved healthcare outcomes. In this pioneering collaboration, UBS Optimus Foundation, USAID, Palladium, PSI and MSD for Mothers, partnered with the government of India’’s Rajasthan province along with HLFPPT, a local NGO partner, to incentivise improved care for hundreds of thousands of women. The program will reach up to 600,000 pregnant women, and could save 10,000 lives over five years.

Such public-private approaches also include partnerships with faith-based organisations that have long been a critical source of healthcare in low-income countries. In Cameroon, Novartis Social Business has partnered with the country’s Baptist Convention Health Services, a minority faith-based organisation, to improve healthcare access and outcomes with affordable drugs as well as training for medical personnel on the screening and treatment of chronic diseases. After monitoring the initial project, the government is adopting the program in four regions, while the partnership hopes eventually to engage other faith-based groups.

Such networks of public and private stakeholders clearly demonstrate the potential for private enterprise to help countries achieve UHC. In fact, on average, countries with mixed public-private systems have done a better job of providing universal access to a package of essential health services and they have maintained a higher measure of financial protection than countries that have relied entirely on the public sector to deliver care. And the most successful systems have found ways to integrate the private sector with public resources more fully. Even countries as different as the UK and Thailand — held up as having model public health systems — rely heavily on the private sector to deliver care.

As Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation has said, when it comes to achieving UHC, “[T]he private sector has a crucial role. Research and development for new medicines and diagnostic tools is just one area where private sector investments are needed. While health financing is the role of the public sector in most countries, private sector actors can facilitate efficient supply chains, health service delivery, and infrastructure investments.”

However, discussion about strategies to achieve UHC tends to focus on public sector solutions, often treating the private sector as a source of conflict to be managed — or in some cases, even as an adversary — rather than an ally to be embraced.  Of course, governments will still need to play a role as stewards of the health system overall, with appropriate regulations and rules of the road. But this needn’t be a barrier to greater engagement with the private sector to help achieve UHC.

To be sure, innovative  thinking is needed to ensure we channel substantial new resources toward providing quality healthcare for everyone. Consider it from the economic perspective: the global healthcare market is valued at $10 trillion — dwarfing the amount of money invested in healthcare through public channels. These market forces will only become more significant as developing country markets mature and grow. We would only need to invest a tiny fraction of that money in improving systems and addressing healthcare delivery challenges to have a big impact in the most challenging environments.

Whether countries achieve UHC by 2030 will ultimately come down to political willpower and accountability. Developing the partnerships necessary to achieve UHC requires sustained engagement from political leaders who are willing to be creative, put new ways of working in practice, and listen to and respond to the needs of citizens. In the quest to achieve UHC, we must recognise that there are no universally applicable solutions. Each country has a unique path to reaching this goal and must strive to design strategies based on a multifaceted, multi-sectoral process that includes all relevant actors.

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Jeffrey L. Sturchio is CEO at Rabin Martin, a global health strategy consulting firm and co-editor (with I. Kickbusch and L. Galambos) of The Road to Universal Health Coverage: Innovation, Equity and the New Health Economy (Johns Hopkins University Press, 2019).

Harald Nusser is Head of Novartis Social Business and a contributor to The Road to Universal Health Coverage.