To engage the private sector in health, we must align goals and share risks

Photo: Health worker wears personal protective equipment (PPE). Credit: WHO/Egor Dubrovsky

A new policy brief compiles governance lessons from the COVID-19 pandemic

Engaging the private sector in the delivery of health care and goods requires a good understanding of how to align resources with the strategic priorities of a health system. The WHO Regional Office for Europe and the European Observatory on Health Systems and Policies have published a new report for policy makers that analyzes the governance evidence from the COVID-19 pandemic.

“The question is not whether we should do it, but what we can do to do it right,” explained Dimitra Panteli, program director at the Observatory, who presented the policy brief during a launch session hosted by the WHO at the European Public Health (EPH) Conference in Dublin.

Having played a key role in the COVID-19 pandemic, the private sector has demonstrated that it holds resources and expertise that can enhance the delivery of health goods and services and help achieve Universal Health Coverage. It also has a wider role in maintaining essential health services and ensuring the resilience of the health system.

“We cannot be under the illusion that we should not work with the private sector, especially as health services struggle to cope with the delays caused by the pandemic,” said Natasha Azzopardi Muscat, Director of Health Policy and Systems of the Country in WHO / Europe.

Take a governance lens

This collaboration can however present challenges, for example around governance practices. Political successes and failures during the pandemic provide lessons for countries on how to engage the private sector in their health systems effectively.

Focusing on governance in this exercise helps to safeguard publicly funded health systems from the potential used and achieve three crucial goals: respond to political objectives and the needs of the health system to serve the population; success in the provision of services; and ensuring value for money in resource allocation.

The policy summary uses a governance framework called TAPIC to indicate the sites of potential governance problems: transparency, accountability, participation, integrity and policy capacity. It also employs insights from six governance behaviors that can drive private sector engagement successfully. These were identified by the WHO Advisory Group (Headquarters) on Private Sector Governance for Universal Health Coverage.

The importance of transparency and accountability

Transparency and accountability are crucial to ensure that private sector contracts are robustly governed. The authors emphasize that transparent information is closely related to public trust, and is necessary to safeguard the integrity of governments that dispense large amounts of public funds.

Governments must also follow clear processes when considering potential private sector partners and in justifying the choices made in awarding contracts. This is particularly critical in the public procurement sector. “Where public funding is used to contract the private sector, we need to ensure that there is transparency, probity, and no corruption,” emphasized Dr. Muscat.

Equitable risk sharing is also important for accountability and protection, and should be explicitly addressed in private sector commitments. Covering health, financial and supply risks makes contractual arrangements much more efficient.

Experts have called for the establishment of emergency procurement guidelines for “crisis contracts” to protect countries in future health emergencies. These may include pre-vetting potential suppliers using robust selection criteria, and making all tender calls and contract awards publicly available so they can be transparently scrutinized.

Photo: Florian Tille, Naomi Nathan, Gabriele Pastorino and Dimitra Panteli (Observatory and WHO/Europe teams)
at the launch of the policy brief in Dublin, November 2023

The potential for successful private sector engagement

Learning from the experience of private sector engagement during the pandemic can help countries avoid pitfalls and meet health system goals.

Using evidence gathered from the Observatory’s Health Systems Response Monitor (HSRM), the policy brief explores a selection of case studies that describe real-life private sector engagement in the provision of services, procurement of personal protective equipment, and advance purchase agreements for COVID. -19 vaccines during the pandemic.

Italy’s strong tradition of working with the private sector, particularly in the Lombardy region, shows the importance of having clear and aligned goals, said Carlo Signorelli, a professor at Universit√† Vita-Salute San Raffaele in Italy.

Lithuania and Estonia provide examples of actions to ensure transparency and accountability in procurement practices. Other case studies from Germany and the United Kingdom highlight the significant governance challenges that can arise to prevent the risk of corruption or mismanagement of resources.

Speaking at the EPH Conference, Sara Burke, Associate Professor at Trinity College Dublin, said that in Ireland, the COVID emergency has shown that it is possible to establish public-private partnerships in record time: “The government acted quickly and negotiated in days and weeks. an agreement with private hospitals”.

However, as Ireland has not had a surge in COVID-19 patients like other countries, the private sector has been disappointed that its hospitals have not been used for such cases – even though it was a positive public health outcome.

According to Dr. Burke, the latest research also showed that the Irish state had a very poor understanding of how the private sector worked. For example, he “failed to understand that medical consultants work independently of the system.” This emphasized the vital need to build the capacity of public institutions for private sector engagement.

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