Local private sector providers play an important role in maternal health, especially during the COVID-19 pandemic. Photo by: Emmanuel Attramah / PMI Impact Malaria

The COVID-19 pandemic has put an enormous strain on already weak health systems, and in many countries, the lack of adequate resources — including health staff — is making it increasingly hard to uphold basic services such as maternal health.

The United Nations Population Fund has estimated that the pandemic and consequent lockdowns could lead to more than 47 million women losing access to contraception, resulting in 7 million unintended pregnancies in the coming months. A Lancet study also warned of potential increases in maternal mortality as a result of decreased coverage of essential maternal and child health interventions. In the least severe scenario, reductions in coverage would result in 253,500 additional child deaths and 12,200 additional maternal deaths.

The pandemic has highlighted severe gaps within health systems as well as the crucial role of local private sector providers within wider health systems — whether community pharmacies, private clinics, or midwives.

As part of the event “On the Frontlines,” Devex and MSD for Mothers co-hosted a virtual roundtable to discuss the role of local private sector solutions to deliver care in low- and middle- income countries both during COVID-19 and in a post-pandemic landscape.

Leveraging the launch of the MSD for Mothers and Devex collaboration Maternity Matters: Funding the Future, the virtual roundtable also highlighted the importance of better data and measurement of private sector engagement to help improve support to local private health providers.

Here are some of the main takeaways from the conversation:

Private sector engagement

As defined by the Organisation for Economic Co-operation and Development, this is an activity that aims to engage the private sector for development results, involving 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.

1. Local private sector providers are crucial in supporting women’s access to care

“There is a significant role for the private sector to support women's access to health care and family planning, particularly during the current pandemic when public health systems are over-stretched,” said Dr. Mary-Ann Etiebet, executive director of MSD for Mothers.

“Depending on the country and region, between 40% and 60% of women access critical family planning and maternity care services from local private sector providers, local community pharmacists, or local private midwives,” she said.

“Local private providers can play a critical role to help augment government responses and their capacity to deliver services,” Etiebet said, adding that because of their proximity to communities, they can also help amplify government efforts to communicate with women on safe access to health care services. “This is why it’s important to have this conversation now — to understand the role of private providers, what they’re doing, and how well they’re doing it,” she said.

According to Dr. Monique Vledder, practice manager at the Global Financing Facility, the role of the private sector is particularly essential during COVID-19. “The private sector plays a tremendous role in the local production of personal protective equipment and supplies, as well as the delivery of front line services for the full continuum of maternity care and family planning — especially when women don't want to access public facilities,” she said.

Aderonke Saba, a community pharmacist from Nigeria, joined the discussion to explain how she’s serving her community.

“Beyond providing the most needed medicines to the community, we also offer primary health care services, one of which family planning is part of,” she said, adding how important it was to create awareness, provide crucial information, and tackle misinformation around contraceptives in the community.

2. Private sector providers should be integrated into national health infrastructure

“There’s a need to involve both the formal private sector such as private health clinics, as well as other actors who might not be plugged into the national health system in a very formal way,” said Bianca Drebber, portfolio and relationship manager at the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Maternal health and COVID-19: The race to avert a long-term crisis

The importance placed on maternal health before the pandemic and whether there will be a second wave of COVID-19 are among the factors that will determine how quickly and effectively countries can rebuild their services, experts tell Devex.

“There’s a lot that the public sector can learn from the private sector,” Drebber said, adding that when it comes to reporting, it’s key to integrate the private sector into national health information systems. “Ensuring private providers are integrated into public treatment protocols is also crucial if we are to ensure patients receive the right treatment,” she said.

If private sector providers are integrated into the national health infrastructure, all health data can be included in quality improvement efforts and ultimately help improve the quality of care.

Vledder added that mixed health systems combining both public and private actors are “at the base of how we work with governments.”

According to Vledder, there’s a need to support a dialogue between the public and private sector — understanding each other's culture and language — and GFF can help facilitate that. “The important thing is not whether individuals access care in the public or private sector, but ensuring they are receiving quality care wherever they go,” she said.

3. Build trust in the private sector to promote collaboration

Understanding how to better engage local private sector providers starts with understanding the definition. “We use the term private sector but it’s not one, monolithic thing,” said Susan Rae Ross, senior private sector engagement adviser at the U.S. Agency for International Development.

According to Ross, the term private sector can include anything from a private midwife to community pharmacies to large companies such as MSD. But the one thing they have in common is that they’re very focused on commercial, she said. “That makes a lot of people in the health space uncomfortable, even host country governments,” Ross said.

Stewardship from ministries of health is also very important, Ross said, but that doesn’t mean that the public sector has to be involved with every single aspect of health care provision. To make this work, there needs to be more trust engendered between the public and private sectors around sharing data and best practices in order to “destigmatize” the private sector in global health, Ross continued.

4. Collect and share information on private sector engagement activities

Contributions of local private sector providers are being increasingly recognized, yet there is a lack of standardized data on private sector funding and how the sector is being leveraged for RMNCAH.

“We hope to figure out a way to collect this information in a way that’s a value add, and actionable by stakeholders such as yourselves,” MSD for Mothers’ Etiebet told fellow roundtable participants.

Doing so, she said, would bring clarity to the totality of the diversity of collaboration with local providers, the diversity of their contributions on the frontlines, and an understanding of what works and what doesn’t work in terms of health impact.

“This information is very valuable to help inform the type of work organizations such as MSD for Mothers do — we do not want to re-create the wheel and duplicate work that’s already been done when we can share and learn from each other,” she said.

Watch the full roundtable conversation to learn more. We also invite you and your networks to share data and ideas around private sector solutions 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.

Join the conversation on funding the future of RMNCAH.

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