During the COVID-19 pandemic, health systems worldwide hit a breaking point, especially across low- and middle-income countries. As a result, the global health community is recognizing the need to think differently to address persistent challenges, rebuild with resilience in mind to prevent future threats, and meet the goals we had set for ourselves for the benefit of humanity — the Sustainable Development Goals.
At the end of 2020, the World Health Organization released its latest universal health coverage strategy report, “Engaging the Private Health Service Delivery Sector Through Governance in Mixed Health Systems. Within the report, it makes a strong declaration in acknowledging the role of the private sector as part of mixed health systems for services delivery in many countries in order to enable the achievement of UHC.
Roughly 40% of women seek care from private providers and in some settings, this can be as high as 70%. Furthermore, the pandemic has exposed that public capacity in many settings is insufficient. Thus, there is an opportunity to leverage the private sector to help augment the capacity to provide care.
Now is the time to create deeper alliances across sectors at scale — we must bring together as many relevant actors as possible or lose this opportunity to make real, sustainable change.
—Since 2019, the Maternity Matters series, a collaboration between Devex and MSD for Mothers — MSD’s global initiative to help create a world where no woman has to die while giving life — has looked at the role the private sector can play in mixed health systems to advance reproductive, maternal, newborn, child, and adolescent health. This integration reflects a principle acknowledgment and purpose of SDG 17, partnerships for the global goals. To achieve the huge ambitions of achieving UHC and reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, it is clear that we must work together.
As defined by the Organization for Economic Co-operation and Development, this is an activity that aims to engage the private sector for development results, which involve the active participation of the private sector.
The definition is deliberately broad in order to capture all modalities for engaging the private sector in development cooperation, from informal collaborations to more formalized partnerships.
Read more about the definition and how Maternity Matters: Funding the Future is exploring the topic.
Many chronic issues within health systems make the world’s vision of achieving UHC a challenge. These issues are most acute in low- and middle-income countries, including:
• Shortage of health workers: WHO projects an 18 million health worker shortage across low- and middle-income countries to make progress toward achieving UHC by 2030.
• A large financing gap: The Global Financing Facility estimates that there’s an annual $33 billion deficit in RMNCAH funding.
• Limited access to essential supplies: Nearly 220 million women in low- and middle-income countries who want to prevent pregnancies do not have access to modern contraception. Similarly, a recent study showed that 119 of 180 countries have insufficient blood to meet their needs.
To address these challenges, we require an efficient, quality-focused health system in which public and private sectors work together with the common goal of improving outcomes. High-quality health systems could prevent half of all maternal deaths each year. Poor-quality care is a bigger barrier to reducing mortality than insufficient access to services.
Now is the time to create deeper alliances across sectors at scale — we must bring together as many relevant actors as possible or lose this opportunity to make real, sustainable change. Below are some examples of how MSD for Mothers has worked with collaborators to leverage private sector capacity in relation to these challenges.
In India, 50% of health care services are provided by the private sector. However, quality is poor within some of these settings due to minimal regulation, monitoring and evaluation, and government oversight.
Manyata is an initiative that builds private providers’ capacity to meet evidence-based, WHO-aligned, national quality standards and recognizes providers who meet standards with a quality certification in India. Building a quality accreditation system fosters consensus on standards and facilitates the growth of a national system. When enough private providers offer quality care, governments can include more private providers as an option for strategic purchasing of health services.
To close the $33 billion RMNCAH financing gap, we can leverage private capital to invest in sustainable private sector solutions within integrated health systems.
In many countries with poor health outcomes, small- and medium-sized enterprises and entrepreneurs are an untapped resource for innovation that can accelerate gains in health using financially sustainable, locally relevant business models. In addition, innovative financing mechanisms — such as performance-based financing, development impact bonds, and equity investments — provide an opportunity to unlock additional funding across sectors and allocate resources more effectively to improve health.
The Maternal Outcomes Matter Initiative, or MOMs Initiative — an innovative collaboration between U.S. International Development Finance Corporation, MSD for Mothers, Credit Suisse, and the U.S. Agency for International Development — has mobilized $50 million to support maternal and child health in low- and middle-income countries. The capital improves and expands infrastructure, services, and access to care to ensure healthy pregnancies.
The MOMs Initiative currently supports five organizations, including Lifebank — a Nigeria-based private company that expands access to lifesaving medical products, namely blood, and blood products for mothers across Africa. The initiative also supports Unjani Clinics — a network of primary care clinics owned and operated by Black women in South Africa that provide accessible, affordable, and quality health care to communities in poorly served, low-income areas.
Engagements with the private sector should go beyond funding. Business capabilities that range from supply chain to product development should be effectively utilized to expand access to quality services.
The leading cause of maternal death is postpartum hemorrhage, or PPH. Oxytocin, the current standard of PPH prevention, requires a stable cold chain, a challenge for many facilities in low- and middle-income countries. In 2013, MSD for Mothers, Ferring Pharmaceuticals, and WHO formed a public-private collaboration — Project Carbetocin Haemorrhage Prevention, or Project CHAMPION — which led to the largest clinical trial conducted in PPH prevention examining heat-stable carbetocin as an alternative for PPH prevention.
We must be bold and act at scale, routinely and systemically. The COVID-19 pandemic has forced us to accept that we must develop and adopt new ways of working and technologies to make efficiency gains. It has also surfaced the gaps in our health systems and is challenging our response — will we really build back better? The achievement of SDG 3 will be a test of how much we’ve learned and our willingness to respond effectively. Let’s rise together.
The Funding the Future series is supported by funding from MSD, through its MSD for Mothers program and is the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.