Private sector involvement in the health sector is the subject of a lot of discussion in the development community. And it is absolutely necessary to have this debate. Can we explore the benefits of the private sector while ensuring development gains?
The monitoring and evaluation of development assistance programs may have been “neglected” in the first years of the sustainable development agenda, the European commissioner on international cooperation and development has said, indicating that it will be a greater focus area in the future.
In our European development policy we focus on strengthening all areas of health systems. In other words: we are looking at the big picture. It is not enough to look only at providing health care, but we need to also ensure that there are enough qualified health workers, that the financing of the sector is ensured and that people can actually afford the medicines they need. We have to find solutions to all of these, if we want to achieve universal and affordable health coverage. This is true for public interventions, as well as for initiatives with the involvement of the private sector.
It should be noted that private sector actors — including social enterprises and private companies alike — are already part of many health systems as financiers or service providers. In some countries, private actors even clearly dominate. In low- and middle-income countries, government spending on health is so low that patients and their families have to bootstrap their health care out of their own pockets, which of course exacerbates already existing inequalities. To help address these challenges, we are exploring various innovative financing systems, from community-based insurance schemes to private health insurance.
It is not difficult to see that increased engagement with the private sector offers incredible opportunities and at the same time carries risks. We sometimes tend to overestimate the benefits of engagement and underestimate the risks. That is why it is all the more important to look out for win-win situations — solutions, in which business opportunities contribute to our overarching objective of universal health coverage.
Luckily, we do not have to start from scratch. We have a lot of lessons that we can draw on, for example our work with The Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance — two public-private initiatives, with whose help we have managed to save and improve millions of lives. They taught us about both the opportunities and the risks when partnering up with the private sector to make global health systems more resilient and more sustainable. And one thing is clear: We will need to strengthen all levels to regulate the health market for the common good — from the regional to the national to the global level.
Focusing at the country level
All health systems in the European Union are based on shared values, yet there is great variation in how these systems operate. The same is true for our partnerships with countries outside the EU. With the strong ownership of each respective country, we pay great attention to the local context. We must never forget that when we talk about health, we talk about people, and people's needs differ from country to country, and from context to context.
This is why we support our partners such as the World Health Organization at the regional and at the country level to engage eye-to eye as co-facilitator and coordinator with partner governments. We do this, for example, through the so-called EU-Luxembourg-WHO Universal Health Coverage Partnership Programme. And we are not the only ones: 28 countries have joined us in this endeavor — to date with some 61 million euros of support — and another 25 countries have expressed their strong interest to join the partnership. We have taken action to make our policy dialogue comprehensive and inclusive, and even going beyond the health sector to a broader discussion of financing social services. But we need the engagement of the private sector to really reach as many beneficiaries as possible.
Acting at global level
At the same time, we are working to achieve change on the global level. To convince our international partners to politically commit to universal health coverage and facilitate accountability and knowledge sharing, we are supporting UHC2030, the global movement to build stronger health systems for UHC. We would also like to see the private sector join the table, as a sign of their commitment to take action to strengthen health systems for UHC. Through the ongoing EU-Luxembourg-WHO UHC partnership that I mentioned above, we help to build country capacities so that they can develop comprehensive national health policies, strategies and plans — as well as to monitor and evaluate their implementation.
How to do it — paving the way forward
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We always analyze very closely when private involvement in the health sector is beneficial and how potential risks have to be addressed. When doing so, we consider the following three issues:
1. Will private involvement benefit the health system and promote UHC beyond the life cycle of a specific joint initiative by the public hand and the private sector?
2. Can the involvement of the private sector help to address very specific challenges — such as antimicrobial resistance, access to affordable medicines and vaccines or mental health — in a sustainable way, and thus complement the existing health system?
3. What type of oversight and governance should our partner countries' ministries of health or associated agencies provide in order to maximize benefit and minimize harm? And in the long run, how can they do so with their own resources and independently of development assistance.
Bearing all of this in mind, we should welcome and encourage the private sector to propose and participate in innovative solutions towards UHC.
This is also what we stress in our new European Consensus on Development — our joint strategy of the European Union and its member states for the future of development — which we formally adopted this month at European Development Days in Brussels. The EU will continue to support programs at national, regional and global level that contribute towards building strong and resilient health systems. We are committed to providing affordable access to quality health care. And we are committed to fighting poverty and helping people — especially those who do not have the means to protect themselves.
Over 10 weeks Devex and our partners will take an in-depth look at the innovative financing mechanisms driving forward the 2030 sustainable development agenda. We’ll explore how the funding gap can be filled, ask how cross-sector collaboration can lead to improved global health care, and look at what it takes to build successful partnerships for change. Join us as we examine the innovative financing powering the Global Goals by tagging #Going4Goals and @devex.