Recommendations to public sector stakeholders on more effective public-private sector engagement

Through SIFPO2 support, the PSI country affiliates significantly increased their understanding of their local health financing contexts and refined specific ways to increase their engagement with public sector counterparts. However, the experiences of the country platforms suggest that private sector-led engagement is not sufficient by itself to develop well-functioning mixed health systems. Instead, actions and assistance on the public sector side must complement private sector-led engagement and partnership design initiatives.

Here the R4D-PSI team recommends actions that local public sectors could feasibly undertake to help bridge this gap across two thematic areas: developing a conducive enabling environment and implementing deliberative processes32 and reforms to enable more successful partnerships.

5.1 Create an enabling environment for public-private sector engagement

Develop a capacity building and system strengthening agenda for public-private sector engagement Routine and effective engagement of the private sector requires the development of key competencies and systems, such as costing and pricing of services and commodities, mapping private providers and evaluating their value propositions, negotiating contract terms and proactively managing contracts, and carrying out periodic baseline and end line monitoring and evaluation activities. The public sector can improve national and sub-national capacity with external support. Global guidance is available on private sector engagement within mixed health systems.33, 34 Donor partners can also assist the public sector in strengthening stewardship and purchasing functions for public-private engagement.

Engage in strategic communication with private providers As a first step, public sector planners and purchasers can engage private providers within strategic communication initiatives to listen, understand, explain, and act on their key issues, such as adequate and timely reimbursement, or costly and complicated accreditation and empanelment processes. Evidence already indicates that regular interactions, airing of feedback, and joint planning can help public and private actors to become more positively oriented toward each other. 35 As health system stewards, public sector actors must launch such communication mechanisms.

Build and support health market facilitation processes To better harness the provision of private sector FP/RH services, governments can proactively promote coordination, transparency, and collaboration in the health system. In many LMIC contexts, suitable entities are often already present, which can grow to facilitate public-private sector engagement and aggregate and support private providers as intermediaries. Provider associations, health care federations and others may fill these roles more sustainably. Public sector patronage and targeted technical and funding assistance by development partners can help these actors grow. 36

5.2 Conduct deliberative processes to enable better leveraging of private sector providers

Define what support the private sector may provide to fill gaps in public sector delivery Private actors seeking to support service delivery on behalf of public planners and purchasers will be more successful in doing so if the public sector proactively defines how the private sector may support, 20 supplement, or complement its service delivery activities and contribute to health sector goals. “Defining the gaps” can be done routinely as part of health planning and performance review processes. Such information can serve as basis for routine stakeholder consultations, tendering and procurement of services, and processes to co-design solutions. Ultimately, such information could help private actors fine-tune their value proposition vis-à-vis public sector needs, and spark interest and ownership with public officials for promising partnerships.

Position, develop, and leverage provider aggregators to support easier public-private engagement Governments can help the evolution and growth of intermediaries in the health system by: channeling information, supervision, and financing through such aggregators; signaling willingness to enter into multiparty, umbrella contracting modalities; and reimbursing aggregators for networking providers and undertaking specific stewardship and financing functions on behalf of the government. This will help to organize fragmented, unsupervised, unregulated, and under-resourced private sector providers. There may already be actors in the private sector—such as franchising NGOs, provider associations, private for-profit/not-for-profit networks—who are well-positioned to grow into more full-service intermediaries meeting the needs of the public sector.37 Public sector planners and purchasers, and their technical and funding partners, can collaborate on enabling intermediary organizations to play this bridging role and integrate private providers in stewardship and purchasing mechanisms to enable greater engagement.

Reform public financial management practices with consideration of the realities of working with private sector providers. It is likely to take some time in many LMICs for prepaid-pooled financing mechanisms for UHC to optimally integrate FP/RH services. 38 These mechanisms are not often present in LMICs, and where they exist, they do not often cover FP services, or offer limited FP method choice. They may also inadequately monitor and track the delivery and quality of services. 39 Hence, reforming routine budgetary financing to target outputs, track resources, and reduce fragmentation is an important agenda for more strategic use of FP/RH funding. 40 As countries now embark on developing, resourcing, and aligning FP CIPs and GFF investment cases, budgetary resources for FP may become more predictable and better tracked. This provides an opportunity to better integrate private FP/RH providers within these financing regimes. Private providers need flexibility in resource planning, adequate funding, and clear performance standards. Program and activity budgets with clear output targets are more suitable for monitoring objectives and purchasing from diverse providers, as these give providers more flexibility and autonomy for internally planning and budgeting for service delivery.

Expand public oversight to better integrate FP/RH private providers into routine systems Governments can routinely and reliably extend public sector planning, regulation, and reporting mechanisms to providers in the private sector. In the case of HMIS platforms, this may be less complicated in some settings where the public sector has reliable electronic mechanisms that simply exclude private providers. But it may be a much heavier lift in contexts where routine stewardship functions such as HMIS and monitoring are paper-based, infrequent, and unreliable. Provider aggregators may again have a role to play in preparing providers and enabling the flow of such stewardship relationships between the public sector and private providers. They can aggregate and present private sector service delivery data as a basis for planning and review. They can also create awareness, trust, and readiness among public officials to cooperate with private sector providers, 21 including those that are for-profit. This will concurrently help to build local officials’ capacity as stewards of the health market…..more