During the initial phases of the COVID-19 pandemic, countries that had previously worked closely with the private sector did a lot better than the ones who hadn’t, said David Clarke, acting unit head of the health systems governance team at the World Health Organization.
“It was very difficult for the ones who hadn't to bring themselves up to speed on how to engage in the middle of an emergency situation,” he said. “It was clear that there was this governance gap when it came to countries’ capacity to work constructively with the private sector.”
Enter the Country Connector on Private Sector and Health. In December 2021, WHO launched a new platform that was designed to be an extension of the WHO’s strategy on private health service delivery sector through governance in mixed health systems, aimed at supporting efforts to build stronger health systems amid and beyond COVID-19.
The idea, Clarke explained, was to provide countries with “something super practical to allow them to make their own decisions about how to work with the private sector in light of their health needs and priorities.” It comprises working groups, a tool repository, training and capacity building support, research, and a support desk. He urged ministries of health and political decision-makers to make use of it.
In an interview with Devex, Clarke explained why working with the private sector post-pandemic is crucial, how the country connector will support such efforts, and how it could be a “game changer” for maternal health.
This conversation has been edited for length and clarity.
Talk us through WHO's new country connector and how this might help with private sector integration?
The country connector is intended to link countries together and help WHO to better link different partners who can support countries when it comes to working with the private sector to achieve public health goals. The idea is very much about connection and peer-to-peer learning while trying to support countries with their specific needs rather than having a top-down approach.
There are a number of different areas within the connector that are intended to support countries. For example, there is a support desk where people can come and ask for support and get more information about the resources that might be relevant to their particular needs. We have a really great platform that summarizes all the research that is happening globally month-by-month that relates to the private sector and a great repository of tools to help countries’ needs when it comes learning how to work with the private sector. Additionally, there is a really nice portal where we're carrying out real-time research on different process topics. We really try to get information directly from the countries, rather than rely on academics from the global north. We’re trying more and more to work with researchers in the global south because often their voices aren’t heard and it's really important for us that they are central to the agenda on empowering countries and decolonizing global health.
How will the connector support countries and governments in terms of their ability to address the various health gaps that they might have in their systems?
It's up to the countries to come to us with their needs. This work is so context-specific we don’t want to deliver one-size-fits-none solutions that have no real-world application. We want to support countries to find their own solutions for their health systems’ challenges. It’s a completely different paradigm. We've already got a pretty good idea of what some of the key issues are, and that's why we set working groups up. For example, on maternal and child health, some of the problems are well known when it comes to the private sector — they’re not a secret, they’re long-standing issues that we are trying to come up with workable solutions for.
This year, we're going to be doing a lot more work to help countries better understand their own capacities — in terms of people, know-how, and resources. They need to be able to work with the private sector. Some ministries of health, for example, don’t have a specific point person who is dedicated to private sector work. We want to come up with a way for countries to assess themselves what resources they need, plan on how to build their capacity, and identify areas where they might need support either from WHO or from other development partners.
With the pandemic hopefully ending and countries now thinking about how to restructure their health services, there are not a lot of resources available. You'll see increasingly that countries are turning to the private sector for support. Having know-how to do that in a way that is consistent with important health policies like universal health coverage and supporting the needs of women and children is very important. Otherwise, these policies will fail.
“If you invest in the government's capacity to work with the private sector, that's a much better investment in long-term health system improvement and better health outcomes.”
— David Clarke, acting unit head of the health systems governance team, World Health OrganizationYou mentioned there's a working group on maternal health. Why is this particular group so important?
When it came to thinking about women’s access to essential health services, like maternal services, it was very clear that during the pandemic there was really a big drop in care. Some of these issues included quality of care, access to care, patient/provider communication, and listening to what women want — so this is obviously a very important area to try and improve. It's been an issue for a long time; there’s been a global shortage of these services, and it got worse during the pandemic. We haven’t done enough to focus on whole health system responses involving the public and private sectors.
The private sector has increasingly been seen as an opportunity to improve access to and quality of care. In some countries, the private sector is the main provider. Women go to either formal or informal private providers before they go to the public sector. During the COVID-19 pandemic, when public facilities were overrun with COVID-19 patients, women didn't have many choices when it came to accessing public services. So, it's become really clear how important this work is to benefit women’s health and respond to their demands for better health services overall.
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.
What are the specific expectations for this group?
The big focus is on improving quality of care, and we’ve got a lot of interest at the country level for support in this area. To give you an example, this May, colleagues from the maternal and child health department and colleagues from my department are going to run a workshop with Ugandan Ministry of Health to look at how we can work with the private sector in Uganda to improve maternal and child health services, very much focused on the quality of those services. This whole stream of work is really intended to support countries to get better health outcomes for women and children.
How can donors support the work you’re doing with the connector?
We did a study about two years ago that looked at how private sector work had evolved over time. We found that, historically, there was a gap in support when it came to countries’ governance capacities and this hasn't necessarily been well supported by donors. One of the messages that we want to get out to donors and development partners when they start to think about how they might be supporting countries with building governance capacities as part of their health systems, is to place an emphasis on working more with the private sector supporting governments. Governments need resources to build their governance capacity and know-how on working with the private sector. This is an investment in the long-term success and sustainability of these reforms.
Over time, the historical record has shown that where this doesn't happen, and where governance capacity building isn’t prioritized, these projects don’t continue, and any health gains that were made aren’t sustained. You might have short-term projects where some money is put into work between the government and the private sector, but as soon as the funds are gone, the project stops and so do the health gains. But if you invest in the government's capacity to work with the private sector, that's a much better investment in long-term health system improvement and better health outcomes.
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.
Join the conversation on finding private sector solutions to improve health service delivery for reproductive, maternal, newborn, child, and adolescent health.
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