Q&A: How private sector integration in health systems can improve efficiency

A mother and her child receive medical care at a center in Ouagadougou, Burkina Faso. Photo by: © Dominic Chavez / The Global Financing Facility / CC BY-NC-ND

Private sector integration is a key part of creating more efficient and equitable health care systems, according to Monique Vledder, head of the secretariat at the Global Financing Facility, a global partnership housed at the World Bank that is committed to ensuring all women, children, and adolescents can survive and thrive.

“We see the private sector as a really big contributor to the efficiency agenda, meaning that we think resources that are available for women’s and children’s health can be used together to scale up access to affordable, quality care and achieve better, more sustainable health results,” Vledder said.

By facilitating greater public-private collaboration, GFF is helping to build understanding, trust, and the enabling environment needed for the two sectors to work together and achieve greater impact in delivering affordable, quality health care and commodities, she said.

For example, in collaboration with MSD for Mothers, the Bill & Melinda Gates Foundation, and The UPS Foundation, GFF is leveraging private sector expertise in supply chain management and logistics to improve women’s, children’s, and adolescents’ access to medicines and health commodities — including family planning — in low- and middle-income countries. This is ensuring more efficient and effective delivery of health care where it’s needed the most.

In total, 270 million women of reproductive age have an unmet need for contraception.

While other such public-private partnerships exist in the reproductive, maternal, newborn, child, and adolescent health space to bring about more efficient health systems, Vledder said she believes more should be done to track such engagement so that successful initiatives might be better known and potentially scaled for greater impact.

Speaking to Devex, she discussed how GFF works with countries to engage the private sector, what steps it takes to keep track of engagement, and the lessons it has learned in its partnerships thus far.

What is GFF’s level of private sector investment in RMNCAH?

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, 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.

Overall, when we look at what has been achieved over the last few years in women, children, and adolescent health, one thing is clear: We cannot achieve universal health coverage and reach the poorest women, children, and adolescents without leveraging private sector resources and capacities to complement what the public sector is doing.

The private sector plays a really important role in the design of the GFF approach. They’re part of business planning and our governance structure, we have private sector representation, but more importantly we have approached the work of maternal and child health in countries from what I call a “mixed system” perspective.

We’re working across our partner countries to engage the private sector through the GFF country platforms to develop priorities to make sure we can deliver the essential services to women and children either through public services or private services. That service delivery part is very much an anchor that starts off by supporting governments in doing assessments to understand the role and scope of the private sector, and the quality of care that’s being provided, and then integrating those findings in the country investment cases.

What challenges has GFF faced in working with the private sector in the area of RMNCAH?

On a country level, in the initial phase — particularly when we start engaging with a country — one of our core challenges is a lack of data. We know the private sector plays an important role, but oftentimes there’s no data to see which services [are needed], [in] which areas of the country, who are they reaching, what are the prices, what is the quality of care.

We invest a lot when we engage in countries for the first time — ensuring that we do comprehensive assessments for their ministries of health — so that we’d be well positioned to understand and assess the best areas for improvement. We make these assessments publicly available on our website and share with relevant stakeholders through our country platforms.

Secondly, we’re very keen for the private sector to play a role in coordinating and aligning priorities with the public sector. In many countries, this engagement is lacking, so it is really important to support countries to bring the private sector in the discussions around the priorities as part of their investment case. That’s definitely an area where a lot of the progress needs to happen.

The GFF is providing financing and technical assistance to strengthen public-private dialogue and build trust between the two sectors. In some countries, we help the private sector form associations with common objectives to serve as a more effective counterpart to the government.

Finally, in a more regulated engagement of the private sector on country level, the ministry of health plays the role of steward and sets the priorities. It’s important we really ensure that if it’s not there, we support governments in the capacity to negotiate well with the private sector so that the contracting is in line with country priorities and also good value for money.

What lessons has GFF learned from previous projects around collaborating with the private sector that could be applied to future projects, and how do you share any lessons learned among countries and partners?

We work with a lot of countries to build government capacity to manage contracts with private as well as public facilities to deliver a high-quality, comprehensive package of maternal and child health services. The support helps strengthen transparency because the contracts have a clear focus and mechanisms to measure results before paying service providers, which brings a lot of accountability. It helps ensure that funding is directed to those women and children that are most vulnerable, that they receive the services they need with really high quality.

I think this is a good example of how we can effectively work with the private sector, as well as the public sector, to deliver essential services. Some of these examples are available in our latest annual report, and we are also in the process of systematically capturing experiences and lessons learned from these engagements.

On the global level, work with partners to develop innovative financing mechanisms to attract private investors who want to invest into areas where they know their money would have social impact. For example, two years ago we collaborated with the World Bank Treasury to create a sustainable development bond for women’s and children’s health. The bond has mobilized $2 billion in new funding. That was a new, exciting area for us to engage with a different part of the private sector on a really ambitious agenda.

How are you tracking GFF’s engagement with the private sector in the area of RMNCAH?

The data measurement and the monitoring that we do is comprehensive of services in the public and private sector. We have many other areas where we engage with the private sector that are part of our overall theory of change and our results framework as outlined in our annual report. We’re doing a lot of work to ensure that we have regular monitoring data, that we do assessments, and that we track the impact of that work, including what some of these innovations and partnerships bring to the agenda.

[This helps to] make sure that effective, smaller-scale private [initiatives] that we develop in partnership with others can be scaled up with support from the World Bank and other financiers. So for us, the monitoring, the implementation, research, and evaluation agenda is an incredibly important part of our strategy.

Devex and MSD for Mothers co-hosted a virtual roundtable last year 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. Watch 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.

About the author

  • Devex Editor

    Thanks for reading and for your interest in Devex. Sponsored content is produced in collaboration between Devex’s partnerships editorial team and our partners to promote a partner’s work or perspective on a particular issue. It gives actors across the global development sector — including nongovernmental organizations, private sector stakeholders, aid agencies and government institutions — the opportunity to go beyond traditional advertising and tell their stories in an impactful way. If you'd like to learn more about how you can shine a spotlight on a particular issue with Devex, please email advertising@devex.com. We look forward to hearing from you.