The COVID-19 pandemic has created numerous challenges for achieving quality maternal health care. However, the response to COVID-19 has also demonstrated government and private sectors’ ability to quickly respond to a crisis at scale when they work together, participants in a Devex World session — co-hosted by MSD for Mothers — learned on Dec. 10, 2020.
Harnessing the power of private sector health providers is key to helping close an estimated $33.3 billion annual funding gap for reproductive, maternal, newborn, child, and adolescent health services globally. The Sustainable Development Goal 17 specifically calls for greater private sector participation, Tayo Erogbogbo, global advocacy director for MSD for Mothers, noted in his introduction.
This gap has a devastating impact on women and their families. For example, the United Nations Population Fund estimates that 232 million women in low- and middle-income countries wish to prevent pregnancies but do not have access to modern contraceptives or family planning services. UNFPA estimates that a $68.5 billion investment would be required between 2020 and 2030 to tackle this problem and provide family planning services across 120 priority countries. This investment could reduce global maternal mortality by one-third.
Private health providers play a vital role in maternal health — 40% to 70% of reproductive health services in LMICs are provided by local private providers — however, there are numerous barriers to integrating them fully into national or local health systems, the panel of experts said. These included Samuel Oyeniyi, deputy director in the safe motherhood division in Nigeria’s Federal Ministry of Health, Dr. Bashir M. Issak, head of the department of family health at Kenya’s Ministry of Health, David Clarke, team leader for universal health coverage and health systems law at the World Health Organization, Mary-Ann Etiebet, lead and executive director at MSD for Mothers, and Dr. Agnes Binagwaho, vice chancellor of the University of Global Health Equity and former minister of health in Rwanda.
Here are some of the main takeaways and proposed solutions that came from the conversation:
1. More education and advocacy is needed to align all parties on the opportunities of private sector capacity
Although panelists acknowledged that governments must become less dependent on external donor support, funding is also critical as programs grow. “To scale up from 10 facilities to 10,000 facilities is a totally different ballgame,” noted Issak. “Getting government to fund this [scale] is a huge task, because budget is already stretched.”
Etiebet argued that breaking down barriers currently preventing private sector participation in RMNCAH requires a three-pronged approach, exploring the policies, processes, and perspectives at play.
More education and advocacy are needed to ensure that governments introduce legal frameworks and policies that are supportive to scaling innovative solutions and tapping private sector expertise, noted Binagwaho. “We need a legal system that protects everyone,” she stressed.
Therefore, as well as being persistent in the face of government bureaucracy, when advocates for maternal health make their case for government funding, they must focus on the tangible results that innovations will bring, he advised.
A new strategy released by WHO looks at how to engage the private health delivery sector in mixed health systems as part of its work on achieving UHC by 2030. Launched last year at a virtual event, the strategy outlines the importance of six governance behaviors critical to successful private sector governance. According to Clarke, they represent a fundamental shift in approach and amount to doing governance in a new way.
1. Build understanding: Collection and analysis of data to align priorities for action.
2. Foster relations: Working together to achieve shared objectives in a new way of doing business.
3. Enable stakeholders: Institutional framework that empowers actors.
4. Align structures: Organizational structures to align with policy objectives.
5. Nurture trust: Mutual trust amongst all actors as reliable participants.
6. Deliver strategy: Agreed sense of direction and articulation of roles and responsibilities.
2. Leverage insurance systems to enable access to care
The capacity of the public sector to deliver care is unlikely to be able to meet the demand and address everyone’s RMNCAH needs, so it is vital that care is made affordable for those using local private providers, Etiebet said. National health insurance systems can be a vital tool here, helping scale up innovative maternal health solutions and ensuring women are empowered to choose both the type of care they need and the right health service provider to deliver it.
This is already happening in some African countries. In Kenya, for example, national health insurance card holders are able to visit any health facility of their choice — public or private — with that facility then reimbursed by the system, Issak explained.
In Rwanda, the national health insurance system already extends to NGO-owned facilities — which account for a quarter of those facilities that are treated by the government as public, Binagwaho added. In a country where 90% of the population has access to NHI and the remaining 10% has either private health insurance or public servant health insurance, 5% of all private insurance profits are invested back into community-based health insurance to improve the quality of care for everyone.
3. Share data and integrate digital technology
Sharing data and information between government and local private health providers is critical for reaching the most vulnerable women and children, panelists agreed.
Private providers are already recognized as significant players in RMNCAH. Oyeniyi noted that 60% to 70% of Nigeria’s population uses the private health sector. In many countries, however, lack of data or failure to share data around where and how much private providers contribute, makes it harder for governments to create evidence-informed policies or for donors to know where to direct investments, Erogbogbo said.
As defined by OECD, 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.
To read more about the definition and how Maternity Matters: Funding the Future is exploring the topic, click here.
There is no excuse for this, Binagwaho argued, pointing to the availability of free software such as health management information system DHIS2, which facilitates the capturing and management of analysis of health service data.
“It’s through data that we get transparency and accountability, understand where women are going, the care they’re receiving, and understand the cost and the outcome,” Etiebet noted. “If there are not the right channels and infrastructure to support that free data flow, we won’t understand what’s happening. And where there’s a vacuum of data and information, sometimes people make up their own minds about things.”
4. Harness innovation unleashed by COVID-19
The rapid response of public and private health providers and their sponsors to the COVID-19 pandemic, with a flourishing of local innovations to meet local challenges — including investments in and new uses for data tracking technology — has demonstrated what is possible in maternal health care and raised the bar for future interventions.
For example, MSD for Mothers had previously partnered in Kenya with the PharmAccess Foundation to develop MomCare, a digital infrastructure that tracks where expectant mothers go, what services they need and their health outcomes, and which links to national insurance systems. Because the platform enables connectivity, when COVID-19 hit it was able to add on services and give real-time information about which facilities were open or closed and link women to ambulance or transportation services during lockdown. In Nigeria, social enterprise LifeBank was also able to tap innovative financing to scale up its services, adding oxygen to its slate of products in response to the pandemic.
It is important that this spirit of innovation is maintained post-COVID-19, Etiebet stressed.
The speakers believe that integrating the private sector can help bridge the funding gap for RMNCAH and achieve UHC. As outlined in its new strategy report on private-sector engagement to achieve UHC, WHO is keen to use its convening power to build political will around improving the management and regulation of mixed health systems, Clarke added. He called on panel participants to contribute to implementation plans at country level for private sector engagement, to help develop indicators, and to support learning and technical guidance in this area.
To find out more about how to implement innovative solutions for maternal health at scale, watch the full event here.
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.