The COVID-19 pandemic has created tough new challenges for many low- and middle-income countries that already had strained health systems, while simultaneously triggering a socioeconomic crisis that is disproportionately impacting women.
Lockdowns, supply chain bottlenecks, diverted resources, shrinking incomes, and fear, combined with limited health information, have made it harder for all populations to access essential health services during the pandemic. Those barriers and the consequences of health service interruptions are often amplified for new and expectant mothers and the children in their care.
As the development community seeks new ways to address a funding gap for reproductive, maternal, newborn, child, and adolescent health, or RMNCAH, that stood at $33 billion before the pandemic and efforts to achieve the Sustainable Development Goal target of universal health coverage intensify, private sector contributions are considered more critical than ever.
With this in mind, Devex, supported by MSD for Mothers, hosted a panel of experts on Sept. 22 to discuss a way forward. “Bridging the RMNCAH gap: Delivering UHC for mothers in the era of COVID-19” focused on the vital role the private sector already plays in maternal health and the importance of creating truly integrated health systems that draw fully on its strength and expertise.
Speakers included David Clarke, team leader for UHC and health systems law at the World Health Organization; Monique Vledder, practice manager at the Global Financing Facility; Dr. Jyoti Bobe, a practicing obstetrician and gynecologist; Githinji Gitahi, group CEO at Amref Health Africa and co-chair of the UHC2030 steering committee; and Mary-Ann Etiebet, lead and executive director at MSD for Mothers.
Here are the takeaways:
1. COVID-19 is more than a health crisis
Local private sector providers play an important role in maternal health, especially during the COVID-19 pandemic. Catch up on the main takeaways from a virtual roundtable conversation exploring how to better measure and understand the role of local private sector providers in delivering quality care.
The pandemic has triggered a socioeconomic crisis that impacts women’s lives on numerous levels. Many are enduring job and income losses, shouldering increased child care responsibilities as schools close, and becoming more vulnerable to gender-based violence, mental health problems, and unplanned pregnancy, said panelists from Amref Health Africa and GFF.
Women’s access to essential health services, such as outpatient care and vaccinations, has also declined for themselves and their children, as evidenced by a new progress report on the Every Woman Every Child global strategy, Vledder said.
In India, for example, lockdowns, hospital closures, and fears of infection have caused a drop in women’s ability and willingness to attend doctors’ appointments or seek care in an emergency, Bobe noted. This can mean infections or pregnancy complications such as high blood pressure go undetected.
Private sector engagement has been key to a number of initiatives aimed at overcoming challenges to RMNCAH care like these.
For example, following the Kenyan government’s introduction of an overnight curfew to help control the pandemic, the country’s Ministry of Health teamed up with partners such as ride-hailing company Bolt to launch Wheels for Life in April. The service offers pregnant women free transportation to health care facilities for delivery or other emergency care between 9 p.m. and 5 a.m., helping to combat maternal death, Gitahi said.
2. Dangerous capacity gaps will widen in maternal health systems if private sector contributors are not supported through the crisis
In many LMICs, health systems are mixed, with each woman often relying on a “fruit salad” of public and private providers for their maternal care, Gitahi noted. And in some communities, local private providers — ranging from midwives to community pharmacists and proprietary medicine vendors — are the only health care providers available, Etiebet added. In fact, around 40% of women in LMICs receive maternal care and family planning services from private providers on average.
But Clarke expressed concern that private providers — some of which have stopped operating during the pandemic because of difficulties generating revenue or being reimbursed by governments — might go bankrupt.
“If we do have large numbers of private providers getting into financial difficulties because of this situation, what does that mean for our efforts towards providing services to mothers and children?” he asked. “If we’re going to achieve universal health coverage … it’s critical that countries work constructively with the private sector.”
Catalyzing greater private sector contributions with measurable outcomes is critical to achieving the ambitious RMNCAH agenda laid out in the Sustainable Development Goals. What are we doing to create real change?
Fixing broken funding mechanisms is essential. For example, private sector players such as for-profit hospitals need help absorbing the cost of vital inputs like personal protective equipment, or else costs may be passed on to mothers, potentially pushing them into poverty, Gitahi argued. Integrating private providers into national health insurance systems is a longer-term priority to ensure the continuity of service delivery and business operations, panelists agreed.
Systematically engaging the private sector in countries’ COVID-19 responses may ultimately help revitalize local economies, allow social entrepreneurs to innovate, and enable each dollar invested to “work smarter,” Etiebet stressed. “COVID doesn’t just take lives; it takes livelihoods,” she said.
3. National governments should take the lead on integrating public and private providers into a unified health system
Maternal health care requirements and challenges differ widely from country to country, and any solution must have the needs of women at its heart, Vledder said. It is therefore essential that national governments, albeit supported by donor partners, take a lead on developing integrated health systems that work for them, she argued.
Networks like GFF’s also remain important so that countries can learn from each other, including on how to scale up public-private partnerships that had a proven impact during the pandemic, Etiebet added.
Clarke flagged a need to build political will in some countries that remain reluctant to work with the private sector. He expressed hope that the pandemic could act as a catalyst here, saying countries that had private sector engagement and contracting mechanisms in place before the crisis demonstrated they could deliver a joined-up response much more quickly.
WHO is close to releasing a new strategy for member countries on how to work constructively with the private sector, he added.
In a well-integrated system, public sector providers can also draw on private sector expertise and technical capacity to make their own services more effective and efficient. To this end, GFF, together with MSD for Mothers, the Bill & Melinda Gates Foundation, and The UPS Foundation, in 2018 launched a public-private partnership that leverages private sector expertise in supply chain management and logistics to improve access to medicines and health commodities for women, children, and adolescents in LMICs.
“If we’re going to achieve universal health coverage … it’s critical that countries work constructively with the private sector.”— David Clarke, team leader for UHC and health systems law, World Health Organization
4. Data is key
A shortage of data around private sector involvement in health care systems globally remains a challenge that must be overcome to improve women’s access to quality maternal health care in mixed health systems and spur further willingness by private capital to invest in the sector, according to Etiebet.
A lot of the challenges and obstacles around public-private partnership are not necessarily based on information from recent experiences, which is why data matters; it can become a level-setting and enabling tool, Etiebet added.
For example, a better understanding of which groups of women have the greatest demand for private sector health care services could help governments decide which types of companies to engage with and how. This would help ensure that women receive the quality care they most need.
Clarke mentioned the need to have integrated data and information systems that include private providers to enable better understanding of the care being given and its impact but also so that private providers can be part of capacity-building efforts.
Improving transparency and accountability is also vital for attracting private capital, with investors hungry for data that helps them predict their return on investment from both a financial and social perspective.
“This sense of urgency that we are all experiencing in COVID, it should have existed before,” Etiebet concluded. “To get to that 2030 goals for maternal mortality, we really have to accelerate our progress. And it’s only by working really closely across sectors, including nonhealth actors, that we’re going to get there.”
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.