Innovative models for reproductive, maternal, newborn, child and adolescent health, or RMNCAH, are emerging from the private sector — but more collaboration is needed to integrate private providers into health systems to strengthen localized services.
That’s according to Charles Dalton, a senior health specialist at the International Finance Corporation, or IFC, who says that if partners can work together more effectively, women and children in need will benefit.
Robust public-private collaboration models are particularly crucial considering the fragility of many health systems due to COVID-19, which includes current and predicted shortages in health care workers. There’s an estimated global shortage of 1.1 million workers in the RMNCAH sector alone, with the largest shortage being midwives.
From Dalton’s perspective, the good news is that development partners and governments are increasingly recognizing the need to firm up links with the private sector to boost better and wider health outcomes. “Already, there are private organizations playing key roles across multiple income groups at more local levels,” he said, adding that the key question is how to maximize this potential.
Better localized collaboration can be underpinned by digital health, which has accelerated in response to the pandemic. However, data analytics need to be properly harnessed from across health care systems, combining both private and public health providers, to optimize promising models emerging in the maternal and child health sector, Dalton said.
Devex spoke to Dalton about what can be done to boost collaboration between the public and private sector in maternal and child health, and lessons learned from those who are already working to integrate the two.
This conversation has been edited for length and clarity.
In what ways has the COVID-19 pandemic highlighted the fragility of health systems in low- and middle-income countries, particularly maternal and newborn health services?
All countries have been impacted differently by COVID-19, but overall, the pandemic definitely appears to have impacted and slowed access to health services in low- and middle-income countries the most. As many governments have focused on COVID-19-related issues, countries have often seen access restricted to other services — and I think many health systems globally have seen increased dysfunction because of this priority shift. For maternal and child health services, from what we’ve seen, there were restrictions on getting supportive care and access to care for pediatrics [during the COVID-19 pandemic].
The situation has also reiterated the lack of prior investment, with glaring holes in service provisions both from a public and private sector perspective, confirming the lack of data analytics to better manage disease. It has further compounded and confirmed that we have a lack of health care professionals globally too, with a direct impact on maternal and child health-related services.
My final point is that the public and private sectors should be better coordinated. There’s a need to adopt a broader health care-system thinking, and not just this silo mentality that often exists.
There’s lots of talk about how COVID-19 has highlighted the need to strengthen local health system capacities, but what’s changing on the ground to achieve this?
I think it’s a work in progress. Prior to COVID, there was excellent work being done by a lot of development partners to figure out how to get services down to the community level.
I expect that agenda will continue, but COVID has demonstrated how you can also enhance localization digitally to provide support to health care workers in community areas. That may, in part, help overcome worker shortages.
Governments still need direction, and donors can help provide this support. If you’re going to localize, you need to understand who’s going to provide those services and how.
A lot of focus has been on localization [efforts] from a public sector perspective — not necessarily with local private sector providers. COVID has taught us that the for-profit private sector can also work with governments and should be looked at in terms of how they can contribute to overall health-system strengthening.
What implications would closer collaboration between the public and private sectors have specifically for mother-and-child services?
We see innovative business models in the private sector focused on maternal and child health-related services for multiple income groups — even though there’s sometimes a perception that the private sector just serves the richer communities.
These include initiatives involving social health insurance, digital health, and access to medications. It is key to embed these initiatives in the community correctly so there is quick access when needed. For example, this may include how organizations can contract and work with governments to provide structure and support for these projects.
There are huge benefits for both maternal and child health if we can get all stakeholders working together. If we put the right building blocks in place, look at the strengths and weaknesses of the public and private sector, and make it all more seamless, then we can coordinate better, allowing patients to have better and quicker access [to health services].
From what you’re seeing, are donors “walking the talk” when it comes to investing in and supporting local private sector providers in LMICs?
The dialogue among development partners and governments has shifted towards how they work with the private sector, which is an improvement. In the past, there was a bit of lip service, but what’s now happened is that some development partners are saying, “We’ve always known there’s a not-for-profit private sector that does an amazing job, but we now need to also work with the for-profit private sector — how do we bring them in?”
As defined by the Organisation for Economic Co-operation and Development this is an activity that aims to actively engage the private sector for development results.
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.
We are beginning to see traditional stakeholders more actively talking about the private sector. During COVID-19, we also saw how some governments were trying to look at ways they could contract members of the private sector. We need development partners to continue that dialogue and then demonstrate action.
What interesting examples of collaboration have you seen between the public and private sectors?
Kenya is a fascinating country to look at because it’s been evolving its national health insurance fund. Now, both the public and private sector players registered with the [National Health Insurance Fund] are providing services through the fund.
An interesting entity in Kenya is Jacaranda Health, a maternal and child health-related service targeting the mid- to lower-income population that is looking to work with the government as well. Another example is Penda Health, a network of primary care clinics that look to serve the mid- to low-income population group.
Another example to look at is the Unjani Clinic model in South Africa, comprising nurse-led clinics where people can access services, including mother-and-child ones. That’s a good example of a growing network of nurse-based clinics providing key care in the community and helping to coordinate it as well.
What innovations need to happen in procurement and contracting to better integrate these sectors?
It is important to acknowledge that there are many different ways of procuring services from the private sector other than just traditional public-private partnerships. That means there is a huge opportunity to look at new models for contracting health care services, medical equipment and digital health.
We must be able to embrace these innovative ways of doing things and governments need to be more clearly informed on the situation. Having better data analytics across the health care system to help understand demand patterns, which diseases are driving demand, and risk areas. This information can help to make more informed decisions on how to procure through either the traditional ways, other public-private collaboration, or new ways of contracting.
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., in Kenilworth, New Jersey, U.S.
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