How can private partnerships help countries meet the UHC goal?

HANOI, Vietnam — On a hot summer day in May, health officials in Vietnam did something that many would call unusual — they stood on stage and acknowledged that Vietnam was not on track to achieving universal health care by 2030. And that could become the first step in ensuring that adequate measures are put in place.

To move toward that goal, the officials solicited help from academia and the private sector.

“Unless we can openly all agree what the problem is and discuss it, it is difficult to work towards a common goal,” said Deborah Gildea, head of Novartis Social Business, Asia who was present at the event.

As countries like Vietnam advance toward the goal of universal health care, the willingness of governments to acknowledge gaps and limitations in the health care system will be key in forging successful partnerships, experts say.

Playing on strengths 

Explaining how organizations, such as Novartis, decide on partnering with governments, Gildea said that the work starts at the macro level: “We ask: ‘What are the public health challenges in this market? Where is the government choosing to focus? Where does the ministry want to focus?’”

“And then we think from a Novartis perspective — where are our natural strengths? How can we create a sustainable contribution in strengthening the public health care system in the market,” she said.

Gildea said that partnerships in primary health care can be directly with the government or with other private players. In India, where NSB has been active for the last 11 years, the challenges are unique in that large sections of rural areas still lack access to health care.

“In markets like rural India where the infrastructure is still quite nascent, we partner with private providers to create a continuum of care. So it’s very much a country by country solution,” she said.

Strengthening the system, and making sure it’s sustainable is key, making it important to have a sustained presence on the ground.

But to do so, Gildea said that they count on support from international bodies such as the World Health Organization.

But it isn't clear if WHO thinks the private sector is needed. In its “Accelerator Discussion Paper” on innovation and access — a document that is meant to be used as a roadmap for achieving UHC — WHO highlighted the need for the private sector for funding, but not in program delivery.

Gildea said it was a it a “missed opportunity.” “The paper seems to consider that funding for research and innovation comes primarily from governments and philanthropic sources, and ignores the vast contribution of the private sector and private capital,” she said

Noting that companies such as Novartis are investing substantially in both R&D and in access programs to ensure people in poor countries can afford such treatment, she said, “We see it as an investment in our shared future.”

However, some civil society members have criticized the role given to the private sector at the policy-making table.

Ahead of the U.N. High-Level Meeting on Universal Health Coverage scheduled for Monday, a coalition of organizations including People’s Health Movement called the emphasis given to the private sector a “conflict of interest.”

“While dialogue with for-profit private sector is needed for better regulation of its practices, they certainly should not be present at the policy table or be involved in assessing health and other social policies. Such a provision can be misused to further private rather than public interests,” it said in a statement.

Filling the gaps

Gildea said private companies can support governments in bridging both resources and training gaps. “Usually the challenges are bigger than the governments have the budget and capacity to address in one go.”

“In a place like Vietnam, the government has understood that it’s not as simple as putting in a health care center into a commune and staffing it with people, and the problem is solved,” she added.

“The local community needs to believe that they will get the care they need in the primary health care center, and all the tests they need will be there, and the staff need to stay so we have to make sure that they are trained. That is the challenge,” she said.

Experts say that trust in the system is lacking, which makes people skip primary health care centers.

“That’s where there are gaps right now. Our research has indicated that a lot of people are bypassing commune health care systems to go to the district health care centers — because the perception is the quality isn’t there. I think that relates to both perception, and the actual quality, and the capacity to diagnose and treat in an ongoing way,” said Andrew Ellner, director of the Harvard Medical School program in global primary care and social change.

“That’s where we all see opportunities here to dramatically change and strengthen the way service is delivered. We know that it’s not a sustainable solution for the people to be by-passing the first level because it ends up driving up costs and is wasteful,” he said.

A new kind of capacity building

As a solution, Ellner advocates for what he calls “a new kind of capacity building.” 

“There is an opportunity to be innovative in a way that will accelerate progress towards UHC. We have to think — “capacity to do what?” In this instance, it is building capacity at the frontlines not just to treat specific diseases, but also manage and lead at the frontlines of care delivery such that the stations are able to deliver a service that works well, is responsive to feedback,” Ellner said.

The capacity around the use of information systems, and the ability to collect and use data in a more advanced way is also lacking, he says — and is another way in which private organizations can support governments.

Harald Nusser, head of Novartis Social Business, thinks investment in rigorous monitoring mechanisms would help governments understand the gaps in the reach of its health care systems.

“Governments are more interested in a surveillance network in order to prove to WHO that they’re malaria free or polio free. Monitoring and evaluation in a proper scientific sense is complicated and costly. It requires not only willingness to do it, but also the endurance to actually perform it and live with the results,” Nusser said.

But the question of how governments can be convinced to set up these monitoring systems is the bigger challenge. According to Ellner, countries have to believe in their utility.

“You can’t make people change. They have to want to want to change. Governments are no different.”

Editor’s Note: Devex's travel and logistics for this reporting were supported by Novartis Social Business. Devex maintains full editorial independence and control of the content.

For a closer look at the innovative solutions designed to push for progress on universal health coverage around the globe, visit the Healthy Access series.